Associations among gastroesophageal reflux disease, mental disorders, sleep and chronic temporomandibular disorder: a case–control study

Abstract

T emporomandibular disorders (TMDs) are a set of craniofacial pain-related disorders associated with impaired function in the jaw, temporomandibular joint and muscles of mastication. 1 A 2015 clinical review found that pain was most frequently reported in both the muscles of mastication and the temporomandibular joint (myalgia with arthralgia in 73% of cases), followed by myalgia alone (23% of cases). 2 Pain associated with TMD is found in 13% of the Canadian population. 3 Like other musculoskeletal disorders including chronic low back pain, fibromyalgia and headache, chronic painful TMD cannot be explained by physical conditions. The cause of TMD has changed substantially from a mechanistic origin to one that is multifactorial and biopsychosocial in nature. 1,4 Chronic TMD has been associated with somatization, anxiety, depression, parafunctional behaviours, jaw injury and other chronic pain syndromes. 1,2 Some authors have previously suggested a potential association between TMD and gastroesophageal reflux disease (GERD). 5 Gastroesophageal reflux disease is diagnosed when reflux of stomach contents precipitates troublesome symptoms. 6 Sufficient evidence supports the relation between GERD and mental disorders including somatization, anxiety and depression. 7-9 Psychological factors and somatic symptoms are closely associated with onset of TMD and persistence. 10 Mental disorders are either potential mediators connecting GERD and TMD or comorbidities caused by shared pathophysiological processes. 5 Undermined sleep mediates the effect of stress on painful TMD. 11 Considering the association between GERD and undermined sleep, 9 it is possible that undermined sleep is a mediator linking GERD with TMD. Current evidence of an association between TMD and GERD from a case-control study provides only descriptive

Clinical manifestations of gastrointestinal diseases in the oral cavity

“…Dental erosion, a significant oral finding in patient with GERD, affects the palatal surfaces of the maxillary anterior teeth and the occlusal and lingual surfaces of the mandibular incisors ( Greenwood and Meechan, 2003 , Chi et al, 2010 , Firouzei et al, 2011 , Marsicano et al, 2013 , Alnasser et al, 2019 ). Additional oral manifestations may include xerostomia, burning sensation, halitosis, palatal erythema, and temporomandibular disorders ( Chi et al, 2010 , Yoshikawa et al, 2012 , Marsicano et al, 2013 , Li et al, 2019 ). Furthermore, patients affected with GERD may feel uncomfortable while in the fully supine position in the dental chair, which must be considered during dental visits ( Greenwood and Meechan, 2003 ).…”

Eating disorders through the periodontal lens

“…Nearly 60% of people with eating disorders reported some form of facial pain currently or in the recent past 42 . Interestingly, an association has been reported between gastrointestinal reflux disease and chronic, painful temporomandibular disorders mediated by anxiety and somatization 43 . The presence of chronic facial pain may interfere with the overall treatment of individuals with eating disorders and should be systematically measured and managed.…”

"The link between Gastroesophageal Reflux Disease and Temporomandibular Disorder: A Systematic Review"

“…GERD symptoms might also be associated with several extraesophageal syndromes, including reflux cough, laryngitis, asthma, and dental erosion syndrome. Symptomatic GERD may be associated with chronic pain in the temporomandibular joint (TMJ), temporomandibular disorder (TMD), anxiety, somatisation and undermined sleep [1,2]. TMD is a group of pain-related disorders in the craniofacial region [1].…”

“…Symptomatic GERD may be associated with chronic pain in the temporomandibular joint (TMJ), temporomandibular disorder (TMD), anxiety, somatisation and undermined sleep [1,2]. TMD is a group of pain-related disorders in the craniofacial region [1]. The cause of TMD has not been elucidated and changed from mechanistic to multifactorial and biopsychosocial in origin [1].…”