Chronic Fatigue Syndrome, Fibromyalgia Syndrome & Temporo Mandibular Joint Syndrome
The relationship between temporomandibular disorders and stress-associated syndromes.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Oct;86(4):416-20.
PMID: 9798224; UI: 99014958
Controversies in the aetiology of temporomandibular disorders. Part 1. Temporomandibular disorders: all in the mind?
Prim Dent Care. 1997 Jan;4(1):25-30. Review.
PMID: 10332343; UI: 99264747
Comorbidity of depression with chronic facial pain and temporomandibular disorders.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Nov;82(5):496-500.
PMID: 8936511; UI: 97090603
The relationship between temporomandibular disorders and stress-associated syndromes.
Korszun A, Papadopoulos E, Demitrack M, Engleberg C, Crofford L
Department of Psychiatry and School of Dentistry, University of Michigan, Ann Arbor 48109-0840, USA.
OBJECTIVES: The purpose of this study was to determine the comorbidity of temporomandibular disorders and other stress-associated conditions in patients with chronic fatigue syndrome and fibromyalgia. STUDY DESIGN: Of 92 patients who fulfilled the criteria for chronic fatigue syndrome or fibromyalgia (or both), 39 (42%) reported a prior diagnosis of temporomandibular disorder. Further questionnaires were sent to the members of this group, and 30 patients responded. RESULTS: Of the original 92 patients, of whom 42% reported temporomandibular disorders, 46% had histories of irritable bowel syndrome, 42% of premenstrual syndrome, and 19% of interstitial cystitis. Of the patients with temporomandibular disorders, the great majority reported an onset of generalized symptoms before the onset of facial pain. Despite this, 75% had been treated exclusively for temporomandibular disorders, usually with bite splints. CONCLUSIONS: Patients appearing for treatment with chronic facial pain show a high comorbidity with other stress-associated syndromes. The clinical overlap between these conditions may reflect a shared underlying pathophysiologic basis involving dysregulation of the hypothalamic-pituitary-adrenal stress hormone axis in predisposed individuals. A multidisciplinary clinical approach to temporomandibular disorders would improve diagnosis and treatment outcomes for this group of patients.
Controversies in the aetiology of temporomandibular disorders. Part 1. Temporomandibular disorders: all in the mind?
Pankhurst CL
King's College Dental Institute, London.
The aetiology of temporomandibular disorders (TMDs) is now considered to be multifactorial but the relative importance of individual aetiological factors is still controversial. Psychosocial factors play an important role in the aetiology of TMDs, in adaptation to pain and eventual recovery. TMD patients exhibit a variety of psychological and behavioural characteristics including increased somatization, stress, anxiety and depression. Subcategorisation of TMD patients into joint-related and muscle-related groups reveals psychological differences. Myogenic patients have increased severity of pain and suffer enhanced psychological distress. Within this group of patients are a minority of refractory cases who show marked overlap with those suffering from chronic pain syndrome; such patients benefit from psychiatric assessment and treatment. However, no common TMD personality profile has emerged from the psychometric test research. Recent knowledge of the molecular pathways induced by stress and the evaluation of stress-response substances may, in the future, provide diagnostically valuable biochemical markers of disease susceptibility. The role of psychological factors in the development of TMDs in the general population is critically examined.
Comorbidity of depression with chronic facial pain and temporomandibular disorders.
Korszun A, Hinderstein B, Wong M
School of Dentistry/Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, USA.
OBJECTIVE: The objective of this study was to examine the comorbidity of depressive disorders in patients with chronic facial pain presenting to a multidisciplinary facial pain clinic. STUDY DESIGN: Data were collected from 72 consecutive patients with chronic facial pain who had received a maltidisciplinary evaluation including a psychiatric examination for the presence of depressive disorders. RESULTS: Twenty-eight percent of patients met criteria of the latest Diagnostic and Statistical Manual of Mental Disorders for major depression, and 25% met the criteria for minor depression. A further 22% reported subsyndromal depressive symptoms. Temporomandibular disorders were demonstrable in 71% of these patients, but the remaining 29% had no objective physical findings. There was no statistical difference in comorbidity of depressive disorders in patients with temporomandibular disorders compared with patients without temporomandibular disorders. CONCLUSION: Screening for symptoms of depression should be an integral part of the evaluation of all patients with chronic facial pain, even when masticatory muscle or temporomandibular joint disorders are identified.
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