OBJECTIVE: The association between jaw function and income in patients with temporomandibular disorders (TMDs) remain unclear. The aim of this study was to explore this association and its relationship with anxiety and depression. SUBJECTS AND METHODS: A total of 451 TMD patients, including 361 males and 90 females, participated in this study. The sociodemographic information of patients and their questionnaires including the Generalised Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire 9-item (PHQ-9), and Jaw Functional Limitation Scale-8 (JFLS-8) were collected. Patients were divided into the high-income and low-income groups based on a household per capita income of 6000 RMB per month. Multiple regression and mediation analysis were used to explore the association between variables. The bootstrap method was applied to estimate confidence intervals (CIs). RESULTS: Higher JFLS-8 scores were significantly correlated with higher GAD-7 scores (r = 0.361, p < .001), PHQ-9 scores (r = 0.339, p < .001). Females and patients with low income had statistically higher JFLS-8 scores (p < .01, p < .001). Mediation analysis with 10 000 bootstrap simulations revealed a significant direct association between JFLS-8 scores and income (-2.920, 95% CI [-4.757, -1.044], p = .002). A significant indirect association of JFLS-8 scores with income via GAD-7 scores and PHQ-9 scores was also observed (-0.889, 95% CI [-1.728, -0.164], p = .025), accounting for 23.3% of the total association. CONCLUSIONS: Low income is associated with impaired jaw function via anxiety and depression in patients with TMD. Clinicians may need to pay more attention to the psychological status of low-income TMD patients in clinical practice.

Academy of Future Education Xi'an Jiaotong Liverpool University Suzhou China

Psychology Research Institute Research departments Faculty of Social Studies Masaryk University Brno Czech Republic

State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases Department of Orthodontics West China Hospital of Stomatology Sichuan University Chengdu China

State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases Department of Temporomandibular joint West China Hospital of Stomatology Sichuan University Chengdu China

Zobrazit více v PubMed

Durham J, Newton-John TRO, Zakrzewska JM. Temporomandibular disorders. BMJ. 2015;350:h1154. doi:10.1136/bmj.h1154

Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group†. J Oral Facial Pain Headache. 2014;28(1):6-27. doi:10.11607/jop.1151

Slade GD, Fillingim RB, Sanders AE, et al. Summary of findings from the OPPERA prospective cohort study of incidence of first-onset temporomandibular disorder: implications and future directions. J Pain. 2013;14(12):T116-T124. doi:10.1016/j.jpain.2013.09.010

Zhu R, Zhang L, Zheng YH, et al. Association between stigma and pain in patients with temporomandibular disorders. Int J Clin Pract. 2022;2022:e2803540. doi:10.1155/2022/2803540

Valesan LF, Da-Cas CD, Réus JC, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Invest. 2021;25(2):441-453. doi:10.1007/s00784-020-03710-w

Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. Temporomandibular disorders: a review of etiology, clinical management, and tissue engineering strategies. Int J Oral Maxillofac Implants. 2013;28(6):e393-e414. doi:10.11607/jomi.te20

Manfredini D, Lombardo L, Siciliani G. Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era? J Oral Rehabil. 2017;44(11):908-923. doi:10.1111/joor.12531

Fillingim RB, Ohrbach R, Greenspan JD, et al. Psychological factors associated with development of TMD: the OPPERA prospective cohort study. J Pain. 2013;14(12):T75-T90. doi:10.1016/j.jpain.2013.06.009

Committee on Temporomandibular Disorders (TMDs). From research discoveries to clinical treatment, board on health sciences policy, board on health care services, health and medicine division, National Academies of sciences, engineering, and medicine. In: Bond EC, Mackey S, English R, Liverman CT, Yost O, eds. Temporomandibular Disorders: Priorities for Research and Care. National Academies Press; 2020:25652. doi:10.17226/25652

Riley JL, Gilbert GH, Heft MW. Socioeconomic and demographic disparities in symptoms of orofacial pain. J Public Health Dent. 2003;63(3):166-173. doi:10.1111/j.1752-7325.2003.tb03495.x

NHIS. 2018 Data Release. 2021 Accessed April 6, 2023. https://www.cdc.gov/nchs/nhis/nhis_2018_data_release.htm

de Sousa FS, Costa EM, Alves CMC, et al. Socioeconomic inequalities and temporomandibular joint disorders in adolescents: contributions from a Maranhão cohort. Community Dent Health. 2021;38(3):192-197. doi:10.1922/CDH_deSousa0028506

Yu Q, Liu Y, Chen X, et al. Prevalence and associated factors for temporomandibular disorders in Chinese civilian pilots. Int Arch Occup Environ Health. 2015;88(7):905-911. doi:10.1007/s00420-015-1018-1

Visscher CM, Ligthart L, Schuller AA, et al. Comorbid disorders and sociodemographic variables in temporomandibular pain in the general Dutch population. J Oral Facial Pain Headache. 2015;29(1):51-59. doi:10.11607/ofph.1324

Simangwa LD, Åstrøm AN, Johansson A, Minja IK, Johansson AK. Oral diseases and socio-demographic factors in adolescents living in Maasai population areas of Tanzania: a cross-sectional study. BMC Oral Health. 2018;18(1):200. doi:10.1186/s12903-018-0664-6

Ridley M, Rao G, Schilbach F, Patel V. Poverty, depression, and anxiety: causal evidence and mechanisms. Science. 2020;370(6522):eaay0214. doi:10.1126/science.aay0214

Chen H, Pendleton C, Caplan DJ, Xie XJ. Chairside risk assessment for first-onset temporomandibular disorders: result from the orofacial pain: prospective evaluation and risk assessment data set. J Am Dent Assoc. 2021;152(7):505-513.e2. doi:10.1016/j.adaj.2021.02.010

Xu L, Cai B, Fan S, Lu S, Dai K. Association of Oral Behaviors with anxiety, depression, and jaw function in patients with temporomandibular disorders in China: a cross-sectional study. Med Sci Monit. 2021;27:e929985. doi:10.12659/MSM.929985

Ross C, Juraskova I, Lee H, et al. Psychological distress mediates the relationship between pain and disability in hand or wrist fractures. J Pain. 2015;16(9):836-843. doi:10.1016/j.jpain.2015.05.007

Statistical Bureau of Sichuan. NBS survey Office in Sichuan. Sichuan Statistical Yearbook. China Statistics Press; 2022.

Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016;39:24-31. doi:10.1016/j.genhosppsych.2015.11.005

Costantini L, Pasquarella C, Odone A, et al. Screening for depression in primary care with patient health Questionnaire-9 (PHQ-9): a systematic review. J Affect Disord. 2021;279:473-483. doi:10.1016/j.jad.2020.09.131

Negeri ZF, Levis B, Sun Y, et al. Accuracy of the patient health Questionnaire-9 for screening to detect major depression: updated systematic review and individual participant data meta-analysis. BMJ. 2021;375:n2183. doi:10.1136/bmj.n2183

Keller S, Bocell FD, Mangrum R, et al. Patient-reported outcome measures for individuals with temporomandibular joint disorders: a systematic review and evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol. 2023;135(1):65-78. doi:10.1016/j.oooo.2022.08.002

Textor J, van der Zander B, Gilthorpe MS, Liśkiewicz M, Ellison GT. Robust causal inference using directed acyclic graphs: the R package ‘dagitty’. Int J Epidemiol. 2016;45(6):1887-1894. doi:10.1093/ije/dyw341

Rosseel Y. Lavaan: an R package for structural equation modeling. J Stat Softw. 2012;48:1-36. doi:10.18637/jss.v048.i02

Bao HWS. bruceR: Broadly useful convenient and efficient R functions. 2023 https://CRAN.R-project.org/package=bruceR

Arel-Bundock V. Modelsummary: data and model summaries in R. J Stat Soft. 2022;103(1):1-23. doi:10.18637/jss.v103.i01

Luo LY, Lee J, Li KY, Leung YY, Li DTS. Psychological outcomes on anxiety and depression after interventions for temporomandibular disorders: a systematic review and meta-analysis. Diagnostics (Basel). 2023;13(4):653. doi:10.3390/diagnostics13040653

Wysocki AC, Lawson KM, Rhemtulla M. Statistical control requires causal justification. Adv Methods Pract Psychol Sci. 2022;5(2):25152459221095824. doi:10.1177/25152459221095823

Hongxing L, Astrøm AN, List T, Nilsson IM, Johansson A. Prevalence of temporomandibular disorder pain in Chinese adolescents compared to an age-matched Swedish population. J Oral Rehabil. 2016;43(4):241-248. doi:10.1111/joor.12366

Moeller J, Quiñonez C. The association between income inequality and Oral health in Canada: a cross-sectional study. Int J Health Serv. 2016;46(4):790-809. doi:10.1177/0020731416635078

Yekkalam N, Wänman A. Associations between craniomandibular disorders, sociodemographic factors and self-perceived general and oral health in an adult population. Acta Odontol Scand. 2014;72(8):1054-1065. doi:10.3109/00016357.2014.949843

Northridge ME, Kumar A, Kaur R. Disparities in access to oral health Care. Annu Rev Public Health. 2020;41:513-535. doi:10.1146/annurev-publhealth-040119-094318

Seo H, Jung B, Yeo J, et al. Healthcare utilisation and costs for temporomandibular disorders: a descriptive, cross-sectional study. BMJ Open. 2020;10(10):e036768. doi:10.1136/bmjopen-2020-036768

Blyth FM, Briggs AM, Schneider CH, Hoy DG, March LM. The global burden of musculoskeletal pain-where to from here? Am J Public Health. 2019;109(1):35-40. doi:10.2105/AJPH.2018.304747

Liu HX, Liang QJ, Xiao P, Jiao HX, Gao Y, Ahmetjiang A. The effectiveness of cognitive-behavioural therapy for temporomandibular disorders: a systematic review. J Oral Rehabil. 2012;39(1):55-62. doi:10.1111/j.1365-2842.2011.02239.x

Noma N, Watanabe Y, Shimada A, et al. Effects of cognitive behavioral therapy on orofacial pain conditions. J Oral Sci. 2020;63(1):4-7. doi:10.2334/josnusd.20-0437

Fisher E, Law E, Dudeney J, Palermo TM, Stewart G, Eccleston C. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev. 2018;9(9):CD003968. doi:10.1002/14651858.CD003968.pub5

Penlington C, Bowes C, Taylor G, et al. Psychological therapies for temporomandibular disorders (TMDs). Cochrane Database Syst Rev. 2022;8(8):CD013515. doi:10.1002/14651858.CD013515.pub2

Jochum H, Baumgartner-Gruber A, Brand S, Zeilhofer HF, Keel P, Leiggener CS. Chronic myofacial pain. Reduced pain through psychoeducation and physiotherapy. Schmerz. 2015;29(3):285-292. doi:10.1007/s00482-015-0005-5

Lam J, Svensson P, Alstergren P. Internet-based multimodal pain program with telephone support for adults with chronic temporomandibular disorder pain: randomized controlled pilot trial. J Med Internet Res. 2020;22(10):e22326. doi:10.2196/22326

Ho FYY, Chan CS, Lo WY, Leung JCY. The effect of self-help cognitive behavioral therapy for insomnia on depressive symptoms: an updated meta-analysis of randomized controlled trials. J Affect Disord. 2020;265:287-304. doi:10.1016/j.jad.2020.01.062

Yeung E, Abou-Foul A, Matcham F, Poate T, Fan K. Integration of mental health screening in the management of patients with temporomandibular disorders. Br J Oral Maxillofac Surg. 2017;55(6):594-599. doi:10.1016/j.bjoms.2017.03.014

Tran C, Ghahreman K, Huppa C, Gallagher JE. Management of temporomandibular disorders: a rapid review of systematic reviews and guidelines. Int J Oral Maxillofac Surg. 2022;51(9):1211-1225. doi:10.1016/j.ijom.2021.11.009

Garrigós-Pedrón M, Elizagaray-García I, Domínguez-Gordillo AA, Del-Castillo-Pardo-de-Vera JL, Gil-Martínez A. Temporomandibular disorders: improving outcomes using a multidisciplinary approach. J Multidiscip Healthc. 2019;12:733-747. doi:10.2147/JMDH.S178507

Potts LC, Henderson C. Moderation by socioeconomic status of the relationship between familiarity with mental illness and stigma outcomes. SSM Popul Health. 2020;11:100611. doi:10.1016/j.ssmph.2020.100611

Mertz EA. The Dental-Medical divide. Health Aff. 2016;35(12):2168-2175. doi:10.1377/hlthaff.2016.0886

Atchison KA, Weintraub JA, Rozier RG. Bridging the dental-medical divide: case studies integrating oral health care and primary health care. J Am Dent Assoc. 2018;149(10):850-858. doi:10.1016/j.adaj.2018.05.030

Patel K, Eley KA, Cascarini L, et al. Temporomandibular disorders-review of evidence-based management and a proposed multidisciplinary care pathway. Oral Surg Oral Med Oral Pathol Oral Radiol. 2023;136(1):54-69. doi:10.1016/j.oooo.2023.02.001