Risk Factors of the Masticatory Function in Patients with Temporomandibular Disorders: A Cross-Sectional Cohort Study

Abstract

Purpose: To investigate the masticatory function of patients with different temporomandibular disorders (TMD) phenotypes, and to explore the risk factors for the masticatory function of TMD patients among multiple biopsychosocial variables using patient-reported outcomes (PROs). Methods:Clinical features and TMD diagnoses of 250 cases were investigated by reviewing medical records. Psychosocial factors were evaluated using four questionnaires representing pain severity and pain interference (Brief Pain Inventory), pain catastrophizing (Pain Catastrophizing Scale, PCS), psychological distress (Symptom Check List-90-Revised, SCL-90R) and kinesiophobia (Tampa Scale for Kinesiophobia for Temporomandibular Disorders, TSK-TMD). Masticatory function, as a dependent variable, was determined using the Jaw Functional Limitation Scale (JFLS). Kruskal-Wallis test and Spearman's rank correlation were used for analyses. Results:A total of 145 cases were included and classified into four subgroups including group 1: TMD with internal derangement without pain (n=14), group 2: TMD with muscle pain (n=32), group 3: TMD with joint pain (n=60) and group 4: TMD with muscle-joint combined pain (n=39). Pain severity (p=0.001) and interference (p=0.022) were the highest in group 2, but the mean global score of JFLS was the highest in group 3, followed by group 4, group 2, and group 1 (p=0.013). Pain severity, pain interference, the mean global score of PCS and the mean global score of TSK-TMD showed significant and moderate correlation with the mean global score of JFLS. All subdimensions and the global severity index of SCL-90R had significant, but weak correlations with all scores of JFLS. Conclusions:The results suggest that masticatory functional limitation depends on the TMD phenotypes. Among the various PROs, pain perception, pain catastrophizing and kinesiophobia seem to be more influential risk factors on jaw function than psychological distress, such as depression and anxiety.

Disturbed sleep may be a core risk factor for jaw functional limitation in patients with painful temporomandibular disorders

“…None of the included biomedical factors affected the jaw functional limitation. Our previous study included a pain‐free TMD group with ID (n = 14) and compared it with the painful TMD groups, which was consistent with Fetai et al 39 The results of our previous study (Part I) showed that pain‐free TMD group with ID presents less jaw functional limitation than painful TMD (χ 2 = 9.534, p = 0.023) 12 …”

“…Fetai et al 39 The results of our previous study (Part I) showed that pain-free TMD group with ID presents less jaw functional limitation than painful TMD (χ 2 = 9.534, p = 0.023). 12 The mean global scores of the JFLS-20 of patients with ID (presented in the previous study) were 0.8 (SD 0.9), 1.4 (SD =1.4), 0.2 (SD = 0.6) and 0.9 (SD = 0.7) for mastication, mobility, communication and global score, respectively. In the comparison of JFLS-20 scores of individuals who were lifetime negative for TMD in the OPPERA study, 38 jaw functional limitation of the patients with ID seems to be higher than those of controls showing the mean scores of 0.28 (SD 0.02), 0.18 (SD 0.02), 0.14 (0.02) and 0.16 (0.02) for mastication, mobility, communication and the global score, respectively.…”

“…This was a secondary exploratory analysis of our previous study, 12 in which 145 patients were included as the subjects and four biopsychosocial factors (pain perception, pain catastrophising, psychological distress and kinesiophobia) assessed as putative risk factors for jaw functional limitation. In the present study, 14 patients with internal derangements (IDs) without pain were excluded, and sleep quality was added to the biopsychosocial risk factors for functional limitation.…”

“…In the previous study, out of a total of 250 patients who first presented at the Orofacial Pain Clinic of Dankook University Dental Hospital, Cheonan, Korea, from January to February 2019 with TMD complaints, 145 patients were included according to the inclusion and exclusion criteria. 12 To be eligible for inclusion, the subjects were those diagnosed with primary TMD, patients who completed the questionnaires and…”

“…In this context, we explored putative risk factors for masticatory function using a JFLS-20 instrument in 145 TMD patients. 12 The results presented a hierarchy of correlations between the risk factors and jaw functional limitation. Axis II components including pain severity, pain catastrophising, kinesiophobia and psychological distress showed significant correlations with jaw functional limitation.…”