What Are Temporomandibular Disorders?
Temporomandibular disorders (TMDs) mainly refer to the collective group of musculoskeletal diseases (conditions affecting muscles, joints, and connective tissues) that primarily affect the temporomandibular region (jaw joint and the surrounding muscles) or the temporomandibular joint (TMJ) of the face. These disorders are part of the orofacial cavity disorders and are characterized by mild to moderate or even severe clinical symptoms of the affected TMJ in individuals. Primarily, the affected person with TMDs can experience discomfort either usually in the temporomandibular joint itself or mainly in the chewing or masticatory muscles, or sometimes both. TMDs have been traditionally defined by their characteristic of inflicting discomfort in the joint or the muscles of mastication. The presence of at least one symptom would indicate that the patient may be suffering from TMD (temporomandibular disorder).
The dentist or surgeon usually looks out for clinical signs and symptoms, such as the TMJ sounds of clicking, popping, or jaw trismus (limited mouth opening), or jaw tiredness. Commonly, the clinical symptoms that exist in most patients suffering from TMD are orofacial pain because of the afflicted joint, often accompanied by a limited mouth opening. TMDs have been further considered a subset of the broader range of musculoskeletal disorders. TMDs can indeed not only prove a major cause of non-dental pain, but they can also create confusion in the affected patients by leading them to believe that the pain may be arising from the orofacial or dental region rather than from the joint itself. A registered healthcare professional, like a dental or maxillofacial surgeon, can certainly differentiate dental symptoms from TMD symptoms and give a thorough evaluation and assessment of the TMJ status.
What Is the Role of PTSD or Stress in Temporomandibular Disorders?
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According to the information given by the American Psychiatric Association, post-traumatic stress disorder (PTSD) is defined as the development of characteristic symptoms that follow exposure to extreme traumatic stressors involving the direct personal experience of an event experienced by an individual. These instances may involve cases of actual or threatened death, serious injuries, or threats to one’s or their loved one's physical integrity.
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PTSD was discovered to be one of the second most prevalent psychological disorders after anxiety and depression and came first in terms of prevalence rates in patients who suffered from orofacial discomfort or joint distress.
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Current research over the last two decades has studied the impact of psychosocial disorders, anxiety, depression, and post-traumatic stress disorder on developing TMDs. Also, as per the information given according to the orofacial pain prospective evaluation and risk assessment (OPPERA), the high-risk population groups who may be developing TMDs with anxiety, stress, or depression as the underlying etiologic factors are usually the high-risk population groups. These include children, young adolescents, and the geriatric or elderly population. The TMD conditions are higher or at a larger prevalence rate because of the psychosocial factors in these groups as per current dental research.
How Do Psychological Disorders Influence Temporomandibular Disorders?
Individuals who are stressed are more likely to develop or be predisposed to a higher risk of acquiring TMDs. The dental research highlights this direct link between TMD and stress, and thus, the dentist needs to correlate the patient's clinical symptoms with their psychological symptoms or causes through an interdisciplinary team approach (psychologist or a physician-based intervention).
The development of TMD in life is further known to be heavily influenced by psychological risk factors whether it may be depression, anxiety, or stress. Several research studies have concluded that stress is one of the major risk factors that can not only predispose but also worsen existing symptoms of TMDs when the patient may leave it untreated for a long period.
According to a major research study, the Manfredini study, the report suggested that individuals who suffered from orofacial pain were much more likely to have higher levels of anxiety as well. Several dental research studies in the past point to the following comorbid conditions that are associated with TMDs such as :
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Fibromyalgia (muscle pain).
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Headaches or severe migraines individuals with clinical symptoms of anxiety.
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Anxiety group of disorders in individuals with tension-type headaches.
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Post-traumatic stress disorder.
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Mental health disorders.
How Exactly Does Stress or Conditions Like PTSD Lead to Temporomandibular Disorders?
Even though medical research may be elusive about the answers, the general hypothesis behind the predisposition to temporomandibular joint issues is that several biological changes would be initiated in the afflicted individual because of the secretion of stress hormones or cortisol in excess. The central nervous system, after being in a hyperactive state for extended periods, would hence be capable of inducing tissue injury by itself, which can manifest as the clinical symptoms associated with TMDs.
For example, a restricted motion within the joint or difficulty in opening and closing the temporomandibular joint, muscle cramps, referred dental or orofacial pain, fatigue that is localized in the joint or the orofacial region, or pain that radiates up to the eyes or ears are classic symptoms that are indirectly related to the biologic changes initiated as a result of stress in the body cells. Similarly, when the patients affected by TMD have a previous history of back pain, migraines, and headaches, persistent conditions can lead to stress, anxiety, and depression as clinical symptoms.
How Are Temporomandibular Disorders Managed?
It is important for dental professionals to not only recognize the underlying causes of TMDs in patients but also refer them or manage the clinical symptoms with the help of an interdisciplinary approach, such as a physician or a psychologist.
Psychological intervention or modalities, meditation, cognitive behavior therapy (CBT), oral physiotherapy, strict oral hygiene, regular dental follow-ups, physical therapy, psychotherapy, jaw bracing, shoulder raising, breathing exercises, or yoga can certainly alleviate the symptoms of TMD arising from PTSD, stress, anxiety or depression.
Conclusion
Stress, depression, or PTSD are broadly classified as psychological disorders and generally play a role in developing TMD. Therefore, it is important to note that any individual who is a victim of PTSD or stress can undergo symptoms of mental anxiety, and depression that are interrelated. This clearly can also subject individuals to developing the clinical symptoms associated with temporomandibular disorder (TMD). Hence, there is a clear need for interdisciplinary management on behalf of dental surgeons who elicit patients' mental, physical, or medical history and may call further for a physician or psychology-based intervention to treat temporomandibular disorders.
