Anxiety and Temporomandibular Disorders: A Relationship in Chronic Pain Development (pp. 93-124)
Authors: (Tomislav Badel, Sandra Kocijan Lovko, Dijana Zadravec, Department of Removable Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia, and others)
Abstract: The current decade (2010-2020), which has been dedicated to bone and joint diseases by the World Health Organization, is the right time to pay attention to musculoskeletal diseases of the orofacial system. Musculoskeletal diseases play a very important role at both the individual and the societal level, because they are generally extremely common in today's world. The development of a number of musculoskeletal diseases is closely related to decreasing age and increasing longevity, and is more common in females.
Temporomandibular disorders (TMD) are arthrogenic and myogenic disorders in the area of temporomandibular joints (TMJs) and/or masticatory muscles. TMDs show a greater frequency in females, and our open longitudinal study undertaken between 2001 to 2012 confirmed these epidemiological data, i.e., that TMDs are up to four times more frequent. Their main clinical characteristic is musculoskeletal pain and they are one of the most common causes of pain in the stomatognathous system. Magnetic resonance imaging was used as a 'gold standard' tool for diagnosing intra-articular TMD. The prevalence of clinical symptoms in the adult population ranges from 12% TO 42.7% and the need for treatment, from 3% to 9%. The etiopathogenesis of TMD has not been entirely explained and it is characterized by a multifactorial etiology, with a number of mutually interacting physical and psychosocial factors. Moreover, TMD constitutes the most common cause of nondental, musculoskeletal pain in the orofacial region. The biopsychosocial conceptualization of the pain experience is found in the close connection between pain and psychosocial factors.
The relationship between the patients‘ psychological condition and their reaction to experiencing pain is very important, as are the pathophysiological mechanisms of chronic pain whose intensity is often independent of clinical findings. Untreated acute pain can evolve into a chronic form and become a separate illness. Psychosocial factors, as in other musculoskeletal disorders, play a dominant role and therefore the clinical and radiological findings tend to be disproportionate to the symptoms. Anxiety is the most common affective disorder and a great problem for psychiatry and general medicine. A certain degree of anxiety is normal and can serve as a warning signal of an external or internal threat and has lifesaving qualities. The negative effects of anxiety on the improvement of TMD pain complaints have not been completely explained. A psychological assessment was undertaken using Spielberger‘s State-Trait Anxiety Inventory (STAI) according to age and sex-related reference values.
Reversible, non-invasive therapeutic means are the recommended treatment, and dentists most often use the Michigan or stabilization splint. Other frequent options for the treatment of temporomandibular pain require a multidisciplinary approach, which may involve physical therapy and kinesiotherapy, acupuncture, non-steroidal anti-inflammatory drugs, biofeedback and psychotherapy. Anxiety plays a significant role as comorbidity with TMD-related orofacial pain. Regarding the important role of psychological factors in the development of temporomandibular pain, a system of multidisciplinary diagnosis is needed in TMJ diagnostics, such as STAI, a very easy-to-use psychological tool.
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