Premorbid and concurrent predictors of TMD onset and persistence

Abstract

Background Multiple risk factors predict temporomandibular disorders (TMD) onset, but temporal changes in risk factors and their contribution to risk of TMD have not been evaluated. The study aims were to (a) describe changes occurring in premorbid TMD risk factors when re‐measured at TMD onset and 6 months later, and (b) determine if measures of change improve accuracy in predicting TMD incidence compared to premorbid measures alone. Methods In this observational prospective cohort study at four university research clinics, 3,258 community‐based, 18‐ to 44‐year‐olds without TMD were enrolled. During the 3‐year median follow‐up, 260 incident cases of first‐onset TMD were identified, and 196 TMD‐free subjects were selected as matched controls. Six‐months later, 147 of 260 incident cases (56.6%) were re‐examined revealing 72 (49%) with ‘persistent TMD’ and 75 (51%) whose condition had resolved (‘transient TMD’). Virtually all (126) of the 127 re‐examined controls remained without TMD. Questionnaires and clinical measurements evaluated risk factors from clinical, health, psychological and behavioural and neurosensory domains. Results Most risk factors across all four domains increased with TMD onset, remained elevated in the persistent group and declined in the transient group (i.e., significant ANOVA interactions, p < .05). Accuracy in predicting first‐onset TMD, quantified as area under the receiver operating characteristic curve was 0.71 (95% CL 0.68, 0.73) using only premorbid measures of risk factors, which increased to 0.91 (95% CL 0.89, 0.94) after addition of change measures. Conclusions TMD pain onset and persistence appear to be determined by enduring characteristics of the person as well as mutually interactive with temporally evolving variables. Significance TMD is known to be a complex disorder, in which onset and persistence are associated with disease‐related variables in multiple domains, including environmental exposure, clinical, psychological, health status, and pain processing variables. Using a more dynamic approach in order to capture change across time, many aspects of those domains were found to worsen prior to the reporting of pain, with bidirectional influences between domains and pain emergence likely. TMD onset appears to represent the cumulative effect of multiple system dysregulation.

Pain Predictors in a Population of Temporomandibular Disorders Patients

“…TMD pain is known as a complex disease being impacted by many disease-related variables in multiple domains, including biological, psychosocial, and pain processing variables [33]. Therefore, this patient population investigation supports the so-called biopsychosocial model of pain, which must include both an Axis I and Axis II evaluation [34].…”

Catastrophizing Has a Better Prediction for TMD Than Other Psychometric and Experimental Pain Variables

“…The results indicate that nearly all risk factors from all domains increased in patients who developed TMD, while remaining in patients with persistent TMD and declining in those with transient TMD. This suggests that TMD pain onset is determined by enduring characteristics and changes in biopsychosocial functioning across time [ 45 ]. These results corroborate our study, which found high psychological scorings in patients with severe TMD and long-lasting pain.…”

Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis

“…Some of the risk factors for transitioning to chronic TMD can be identified by the use of biopsychosocial assessment. 43 , 44 , 45 For example, high scores in the Characteristic Pain Intensity index and the presence of myofascial pain in the early phases are the strongest predictors for TMD chronification. 46 Prospective studies on the efficacy of early biobehavioural interventions have shown that such strategies contributed a lot to reduce risks for chronification.…”