Clinical characteristics of patients with temporomandibular disorder pain according to the pain origin and trauma history

Abstract

Temporomandibular disorder(TMD) is a multifactorial disease with chronic pain that was related with physical and psychological symptoms. Pain is the most common TMD symptom and showed different psychosocial and clinical patterns depending on the origin in the previous studies. Trauma on the orofacial or neck region potentially lead to increase severity and frequency of tempormandibular joint pain and to aggravate psychological factors. The aims of this study were to compare the differences in the clinical pain and psychological condition between the patients with and without history of trauma on the orofacial or neck region, and among the myogenous, arthrogenous, and mixed pain origin of TMD pain patients. A total of 1052 patients (mean age 34.4±15.7 years, 791 women and 261 men) with TMD who visited the Orofacial Pain Clinic of Seoul National University Dental Hospital were evaluated. Patients were divided into trauma and non-trauma groups according to the history of trauma in the orofacial or neck region, and the patients with TMD pain were categorized into three groups (Myogenous, Arthrogenous, and Mixed) according to the pain origin based on the RDC/TMD axis I diagnostic guidelines. Each patient was evaluated the clinical characteristics according to the RDC / TMD axis I and axis II questionnaires. The psychological characteristics were evaluated by the Symptom Checklist-90-R (SCL-90-R). The obtained results were as follows: 1. There were no significant differences in age and gender among the TMD pain groups and between trauma and non-trauma groups. 2. Myogenous pain group showed significantly higher SOM, GSI, PSDI, and PST scores than arthrogenous pain group. Mixed pain group showed significantly higher SOM, I-S, DEP, ANX, HOS, PHOB, PAR, PSY, GSI, PSDI, and PST scores than arthogenous pain group. 3. Trauma group has significantly higher SOM, ANX, PSY, GSI, PSDI, and PST scores than non-trauma group. 4. Mixed pain group showed significantly higher intensity of pain than two other groups and the percentage of high disability group in GCPS was higher in the order to mixed pain group, myogenous pain group, arthrogenous pain group. 5. Trauma group showed significantly higher intensity of pain and higher percentage of high disability group. There were no significant differences in duration of pain among the each group. 6. Arthogenous pain group showed lowest prevalence of headache, subjective insomnia, and tinnitus among the TMD pain groups. Myogenous pain group had highest prevalence of sleep bruxism. 7. Trauma group showed significant high prevalence of headache than non-trauma group. There were no significant differences in the prevalence of subjective insomnia, sleep bruxism, and tinnitus between non-trauma and trauma groups. 8. Patients who had both myogenous origin and history of trauma showed highest scores in the most SCL-90-R dimensions among the groups.

Trauma history and pain origin could affect the clinical symptoms and psychological characteristics of patients with TMD pain and should be considered for the establishment of treatment.