Summary of Findings From the OPPERA Prospective Cohort Study of Incidence of First-Onset Temporomandibular Disorder: Implications and Future Directions

Abstract

Papers in this volume investigate when and how putative risk factors influence development of first-onset, painful temporomandibular disorders (TMD). The results represent first findings from the OPPERA prospective cohort study which monitored 2,737 men and women aged 18–44 years recruited at four U.S. study sites. During a median 2.8 year follow-up period, 260 participants developed TMD. The average incidence rate of 4% per annum was influenced by a broad range of phenotypic risk factors including sociodemographic characteristics, health status, clinical orofacial factors, psychological functioning, pain sensitivity and cardiac autonomic responses. A novel method of multivariable analysis used random forest models to simultaneously evaluate contributions of all 202 phenotypic variables. Variables from the health status domain made the greatest contribution to TMD incidence, followed closely by psychological and clinical orofacial domains. However, only a few measures of pain sensitivity and autonomic function contributed to TMD incidence, and their effects were modest. Meanwhile, age and study site were independent predictors of TMD incidence, even after controlling for other phenotypes. Separate analysis of 358 genes that regulate pain found several novel genetic associations with intermediate phenotypes which, themselves, are risk factors for TMD, suggesting new avenues to investigate biological pathways contributing to TMD.

Orofacial myofunctional disorder, a possible complicating factor in the management of painful temporomandibular disorder. Case report

“…As the sessions evolved with improvement in the patient's conditions, strategies were included and trained to balance chewing and swallowing and to promote a more intelligible phonoarticulation, in addition to the mandibular rest with free mandibular functional space preserved (step 3 orofacial myofunctional therapy) ( Table 1). After 13 weekly sessions, other 10 sessions were carried for 6 fortnightly sessions and 4 monthly ones, in which were included in the therapeutic process complementary mindfulness practices that constitute an important group of meditation practices used as a tool to reduce stress and anxiety, also being recognized to contribute in the reduction of painful pictures 2,13 . Since the phonological approach was directed to the stomatognathic system, the exercises, guided by the therapist, focused on the rhythm of breathing and attention to the orofacial structures (anchor of the mindfulness practice: aspect or object to which the targeting -or focus -is exercised).…”

Genetics of chronic post-surgical pain: a crucial step toward personal pain medicine

“…The National Institutes of Health (NIH)-funded Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) project studies the genetics of temporomandibular pain disorder (TMD). 34 Temporomandibular pain disorder is the most prevalent chronic orofacial pain condition affecting about 450 million adults worldwide, mainly females ages 20-50 yr. It manifests in spontaneous and movementinduced pain in the temporomandibular region involving the jaw, temple, and neck muscles, resulting in limitation of jaw movements and occasionally accompanied by temporomandibular joint (TMJ) clicking sounds which indicate that the TMJ disk and muscles are out of coordination.…”

Genetics: An incomplete mosaic

“…The team collected data for up to 5 years from just over 2,700 TMDfree men and women, 260 of whom developed TMD during the study. Maixner's group examined DNA variations known as single nucleotide polymorphisms (SNPs) in 358 genes that regulate pain, and tracked 202 phenotypes in the volunteers 1 . The initial findings underscored the complexity of TMD.…”