Home » Temporomandibular disorder: how the pandemic and stress have affected the problem

Temporomandibular disorder: how the pandemic and stress have affected the problem

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The SARS-CoV2 coronavirus possesses mechanisms that help postpone the immunological response of cells. The pathological process responsible for tissue deterioration is caused by the response of the host. The pandemic has heightened individuals’ susceptibility and concern and stress levels. Thus highlighting how the COVID-19 pandemic and the related stress may have increased the onset of temporomandibular problems. In the latest review, the researchers assessed whether COVID-related anxiety led to an increase in temporomandibular dysfunction (TMD) symptoms in adults compared with children. The eligibility of each study paper was determined using the following criteria: population, exposure, comparator and outcomes (CEECs).

  1. (P) Participants included TMD patients.
  2. (E) TMD patients examined with TMD diagnostic criteria during the pandemic constituted the exposure group.
  3. (C) The comparison group consisted of pre-COVID TMD patients.
  4. (O) The result resulted in the determination of the prevalence of TMD during the pandemic. Comparison of TMD prevalence and severity during the pandemic with the pre-pandemic period was considered as a secondary outcome.

The authors carefully searched PubMed, Lilacs, Scopus and Web of Science search engines for articles published between 2019 and 30 September 2022. This systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews and the Elements Signaling System for Systematic Reviews (PRISMA). A total of 198 studies were found and analyzed for admission criteria. During the last phase of the screening, the abstracts of 54 publications were evaluated to determine if they met the CEEC and inclusion criteria. Only four studies were selected for inclusion in this systematic survey involving 556 patients. The study designs employed in these studies included randomized clinical trials, retrospective studies, and prospective cohort searches.

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One of the studies included 288 patients who underwent temporomandibular joint examination according to TMD diagnostic criteria to determine the presence of symptoms. During COVID-19, day and night bruxism was more prevalent among women. Another study analyzed 182 subjects who took Axis II of the DC/TMD, a questionnaire assessing chronic jaw pain, its impact on social life, and psychosocial stress. Examination of the questionnaire data showed that 40% of individuals experienced symptoms of TMD in the previous month. Nearly 60% of them had experienced facial pain in the previous three months, while 51% noted that their symptoms had worsened in the past month and 51% believed their symptoms had worsened due to the lockdown.

One study also assessed the quality and intensity of life of a group of women with TMD, assessing their pain and severity of complaints before and during the pandemic. There were no statistically significant differences in pain severity. Another study examined the effect of COVID-19 on the severity and psychology of facial pain in TMD patients. Participants included 19 individuals with chronic TMD, along with 26 individuals with acute/subcutaneous TMD. In patients with persistent TMD, scale scores were significantly higher. There was a significant correlation between the alterations in patients with chronic diseases and the change in COVID Stress Scales (CSS) scores.

The study results highlighted the correlation of COVID-19 with a high incidence of TMD by various populations during the pandemic, particularly due to stress, which leads to muscle hyperactivity and worsening of bruxism. Parallel to this review, another study was published that assessed the stress of the pandemic in a Spanish university community, through an anonymous questionnaire. Participants completed a Well-Being Index (WHO-5), a sleep quality questionnaire (BEARS test), a headache diagnostic test (tension headache and migraine diagnosis test), and the DC- questionnaire. TMD extension. The questions were addressed in three scenarios: before the lockdown, during and then the return to normal.

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A total of 436 responses were collected (70% women, 30% men). Respondents declared a reduction in well-being and quality of sleep, reported more tension headaches and migraines during and after the lockdown. Overall, the lockdown and return to normal did not increase TMD symptoms and only minor effects were observed, such as more intense joint pain and a higher incidence of muscle pain in women during the lockdown. Well-being was strongly influenced, as were sleep quality, risk of depression, headache and migraine frequency. In contrast, the temporomandibular muscle joint showed greater resilience and was only slightly affected. This may also be due to the lower representation of TMD susceptible individuals among this university community.

Among other things, the contribution of psychological problems involved in emergency or threatening situations such as those faced with the pandemic, to the onset and duration of TMD has been recognized by an increasing body of research. In addition to anxiety and stress, gender, age, sociodemographic, and psychological factors, including somatization, depression, daytime sleepiness, optimism, may influence pain intensity in patients with TMD or even leap out in those with arranged.

  • By Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.

Scientific publications

Minervini G et al. Brain Sciences 2023; 13(3):481.

Rosales LJI et al. Int J Envir RPH 2023; 20(3):2340.

Camagni GF et al. J Oral Rehabil. 2023 Mar 13.

Ashraf J et al. Clin Oral Investig. 2022; 26(1):729-738.

Tchivileva IE et al. J Headache Pain. 2021; 22(1):42.

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