Introduction:
Stress, anxiety, or depression are some of the reasons behind temporomandibular joint disorders (TMD). They are mostly neglected in the primary stages and are diagnosed only at a later stage. Early interventions make it possible to rectify the condition swiftly. Read the article to learn about risk factors, prevalence rates, and interdisciplinary management of dental and psychological approaches for treating TMD.
What Are the Causes and Symptoms of TMD?
Medical research on the causes of temporomandibular disorders signifies that this disease entity has various causes. These risk factors would commonly result from abnormal interference from different factors such as psychological, physiological, or structural (such as occlusion and TMJ trauma) causes. The causes would also be either postural ranging from parafunctional habits or even from certain genetic conditions. These conditions would certainly compromise the homeostasis state or the normal internal state of the stomatognathic system according to dental researchers. These factors enlisted above can be initiated or deemed responsible (for the distress of the TMJ) which can predispose an individual to a host of issues that arise out of temporomandibular joint disease. When left untreated, the TMD symptoms can commonly aggravate in the following ways:
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Pain or discomfort in the TMJ.
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Pain radiating to the ears.
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Pain in the muscles of mastication or the chewing muscles.
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Pain radiating from the TMJ to the eyes, and face.
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Psychological distress of the joint.
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Physical disability impacting the joint that is often accompanied by noises, crackles, or even clicks on the joint surface.
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Locking of the jaw.
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Limitations in jaw opening (joint trismus).
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Difficulty in closing or lateral movements of the joint.
According to the orofacial pain prospective evaluation and risk assessment (OPPERA), the information highlighted in the etiology of TMD conditions is that there is a large prevalence rate of psychosocial factors that are interlinked definitely to the clinical symptoms of TMD in these high-risk population groups (the young and the elderly) in comparison to the healthy adult individuals or healthy children.
What Is the Prevalence Rate of TMD?
According to global statistics, the prevalence of temporomandibular disorders among the general population was concluded to be at an overall prevalence rate of approximately 31 percent in the geriatric or elderly adult population and nearly 11 percent in TMD issues affecting children or young adolescents. When researchers evaluated these conditions according to joint or muscle subgroups, the authors investigated and found that the most prevalent of the TMD conditions in these two population groups (the elderly and the children) was disc displacement with reduction (DDwR).
This was found to impact approximately 26 percent of geriatric adults and around 7.5 percent of children or young adolescents. Research also shows that a large proportion of these populations affected (the young or the old) may often be suffering from underlying anxiety or psychosocial distress that can aggravate the clinical symptoms of the TMD condition.
This dental statistics or literature hence indicates that whether the TMD conditions are accompanied in the patient by acute or chronic onset, these still remain largely unaddressed or often ignored by many suffering patients due to a lack of awareness about this health issue.
What Is the Link Between TMD and Psychological Disorders?
The etiology of TMD linked to stress is a mechanism though not fully understood in dental literature but is still being focused upon by researchers. This is because of the reason that the affected patients suffering from anxiety can trigger a change in the way pain is felt in the body or the sensations experienced normally through the pain pathway in the central nervous system (CNS). There would also be changes in the neurotransmitters secreted when anxiety is an underlying factor for TMD issues. Patients suffering from parafunctional habits may be having a subconscious anxiety or fear that these may be unaddressed. Anxiety further holds the ability to promote hyperactivity of the masticatory muscles of the face and mouth (the chewing muscles) that are directly associated with TMJ. This can hence initiate the process or phenomenon of ‘joint overload’.
A temporomandibular joint overload or stress condition can be directly linked to the patient's state of anxiety or a stressor such as a pathological, or emotional stressor particularly according to the latest dental research and evidence. Previous research studies over the last few decades have clearly implicated the role of psychosocial disorders and psychosocial impairments directly linked to the development of TMD. Anxiety for instance is a potent individual and psychosocial risk factor that has been presumed to act as both an initiating and aggravating or perpetuating factor for causing temporomandibular joint pain or distress. Anxiety currently stands out as the most common patient comorbidity that is frequently associated with TMJ disorders.
What Are the Dental and Psychological Management Approaches for Managing TMD?
The recommended advice is usually to follow a soft‐food diet in the early stages of TMD and also the underlying cause of stress should be addressed by the psychologist or the physician.
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Care should be taken by the patient to avoid parafunctional activities like bracing, clenching, or a wide form of yawning.
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Home care instructions should be given by the dentist to relax the jaw as well as manage the TMJ pain which is intermittent or continuous in nature with the application of heat, ice, or by taking over‐the‐counter medications.
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For patients who particularly have the parafunctional habit of clenching or grinding their teeth, a mouthguard use would be deemed appropriate as recommended by the dentist or a surgeon.
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Dentists commonly recommend mouthguards as a first‐line treatment of choice to prevent parafunctional habits in TMD patients.
When the TMD pain is persistent beyond three months, it can be categorized as chronic or persistent pain. For managing such pain with anxiety as the underlying cause, then a multidisciplinary treatment approach with psychological therapy, individual or group‐based behavioral therapy, or even cognitive-behavioral therapies should be considered for a fixed period (usually ranging between four to 12 sessions of these therapies according to psychological research studies). From the psychological intervention perspective for anxiety patients suffering from TMD, the common feature that they would be experiencing is pain. Hence, if anxiety is indeed the underlying cause that is diagnosed by the dentist and the psychologist, the psychological interventions applied would be the same for all the patients.
Conclusion:
Stress, anxiety, depression, or any mental or psychosocial disorder may be directly implicated as a major risk factor in the development of temporomandibular disorders. There is a widespread need for dentists or oral surgeons to recognize and treat not only the clinical symptoms of this disease but also a psychological intervention and a multidisciplinary approach may be needed to improve the long-term prognosis of these patients.
