Objective To evaluate stress effect of COVID‐19 pandemic and Zagreb earthquakes on symptoms of temporomandibular disorders (TMD). Materials and Methods One hundred and two previously diagnosed TMD patients were contacted by email to participate in an online survey about impact of those events on current and/or new symptoms, perceived stress, anxiety and symptom intensity in time‐points at the baseline, following pandemic and following earthquake. We compared data between earthquake‐affected and non‐affected respondents. Results Response rate was 79.4%. Effects stress had on deterioration of symptoms were significantly different between earthquake‐affected and non‐affected (p = .024). In earthquake‐affected, numerical pain rating scale (NPRS) scores significantly increased between baseline and after COVID‐19 (p > .001) and between baseline and after earthquakes (p > .05). However, scores insignificantly dropped from COVID‐19 to after earthquakes time‐points. In earthquake‐affected, positive correlation was found between impact of COVID‐19 on stress and NPRS (p < .001) and between earthquakes’ impact on stress and NPRS (p < .001). Earthquake‐affected respondents reported significantly more new behavioral habits when compared to non‐affected (p = .048). Conclusions A series of stressful events do not necessarily have a cumulative effect, but are likely to have a complex interaction (e.g., acute stress might trigger the protective mechanisms), which could have decreased pain scores after the earthquakes.

Temporomandibular disorders (TMD) have been associated with altered salivary oxidative status, but the relation with pain source and pain severity isn’t clarified. With the aim to assess their interaction with TMD, we compared levels of selected salivary oxidative stress (OS) markers (glutathione peroxidase, superoxide dismutase, total antioxidant capacity (TAC), uric acid, 8-hydroxydeoxyguanosine, malondialdehyde) and salivary cortisol (SC) as a stress indicator, between 20 TMD patients and 15 healthy control subjects. In order to record differences relating to pain source and severity, patients were respectively classified according to specific diagnoses (myofascial pain or disc displacement (DD)), and pain intensity (high or low). TAC was significantly higher in TMD patients than in controls (morning p = 0.015; afternoon p = 0.005). Significant differences were also observed when TAC levels between high-intensity pain patients and controls were compared, as well as between DD patients and controls. In logistic regression analysis, higher levels of TAC were related to DD (morning OR: 1.66, 95%CI: 1.05–2.64, p = 0.029; afternoon OR: 2.10, 95%CI: 1.11–3.98, p = 0.021) and to high-intensity pain (morning OR: 1.81, 95%CI: 1.04–3.15, p = 0.037; afternoon OR: 1.79, 95%CI: 1.02–3.14, p = 0.043). We also found that morning SC was positively correlated with antioxidant parameters in TMD patients. Our data suggest compensatory mechanism as response to higher level of stress. This stress could be extrinsic and lead toward TMD, or intrinsic, emerging from established TMD, or could be both. The intensity and the source of pain should be considered important factors in future investigations evaluating salivary OS markers in TMD patients.

The present study evaluated diurnal variations and day-to-day fluctuations of salivary oxidative stress (OS) markers in healthy adult individuals. Whole unstimulated saliva was collected at 2 time intervals over 3 consecutive days. Glutathione peroxidase (GPX), superoxide dismutase (SOD), total antioxidant capacity (TAC), and uric acid (UA) were analyzed using spectrophotometric methods, while 8-hydroxydeoxyguanosine (8-OHdG) and malondialdehyde (MDA) were determined using immunoassays. No significant differences for salivary OS markers between men and women were observed. For all examined OS markers, no significant day-to-day variations were demonstrated. Significant diurnal variations were found in salivary GPX, TAC and MDA levels. For SOD, TAC, GPX, and UA, good-to-moderate intraindividual coefficients of variations (CVs) were observed in more than 75% of the subjects. For MDA and 8-OHdG, intraindividual CVs > 35% were observed in 60% and 40% of the subjects, respectively. Between-subject variance was wide for all examined OS markers (CV% 30.08%–85.70%). Due to high intraindividual variability in the salivary concentrations of MDA and 8-OHdG, those markers cannot be reliably verified based on single measurements and multiple measurements over several days would provide more reliable information. Salivary SOD, TAC, GPX, and UA proved stable across three days of measurement. Trial Registration. ClinicalTrials.gov NCT03029494. Registered on 2017-01-19.

PurposeThe aim of this study was to compare long-term effectiveness of stabilization splint (SS) with that of placebo splint (PS) in chronic TMD patients and to investigate differences in treatment outcomes based on diagnostic subgroups [disc displacement (DD)/myofascial pain (MP)].Materials and MethodsThirty-four female participants, diagnosed with chronic TMD, were classified in groups: one provided with SS and other with PS and were followed for six months. Treatment outcomes included spontaneous pain [visual analogue scale (VAS)], self-perceived quality of life (OHIP-14), pain-free maximal mouth opening (MCO), maximal mouth opening (MMO), level of perceived stress (PSS), characteristic pain intensity [graded chronic pain scale (GCPS)], and functional jaw limitation [jaw functional limitation scale (JFLS)].ResultsBaseline characteristics did not differ significantly between the two groups (p>0.05). After six months of treatment the changes in spontaneous pain and OHIP-14 scores differed significantly between treatment groups (p=0.004, p=0.02 respectively), with greater reduction in SS compared to the PS group. Pain-free maximal mouth opening did not change significantly over time, however MCO values differed significantly between the two treatment groups, with greater overall values in the SS compared to the PS group (p= 0.046), as well as between TMD subgroups, with greater overall values in MP compared to DD patients (p= 0.03). In the SS group, significant difference in JFLS categories was found between baseline and after 6 months of treatment in all except emotional and verbal expression (mastication p=0.00015; vertical jaw mobility p=0.00018). No such changes in JFLS categories were observed in the PS group.ConclusionsDuring 6-month period, SS was more effective than PS in reducing spontaneous pain and improving self-perceived quality of life and functional limitations of the lower jaw. Moreover, significantely higher values of pain-free mouth opening were observed in patients treated with stabilization splint. While placebo might be partly responsible for improving the symptoms of TMD, it seems that itcannot maintain a continual long-term positive therapeutic effect.

No abstract