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Temporomandibular disorders in women—symptoms and signs in population-based studies

Doctoral thesis
Authors Karin Bäck
Date of public defense 2019-12-06
ISBN 978-91-7833-607-4
Publisher Göteborgs universitet
Publication year 2019
Published at Institute of Odontology
Language en
Keywords Temporomandibular disorders, Women, Degenerative joint disorder, Epidemiology, Oral Health-Related Quality of Life, Osteoporosis, Psychological distress, Radiography, Panoramic, Screening, Temporomandibular joint
Subject categories Dentistry, Epidemiology


The overall aim of this thesis was to investigate symptoms and signs of temporomandibular disorders (TMD) and orofacial pain in the Swedish female population in relation to some other health factors. The thesis includes four cross-sectional studies. The specific aim of Study I was to analyze the relationship between chronic, severe orofacial pain in women aged 38 and 50 years and signs of depression, anxiety, sense of coherence (SOC) and oral health-related quality of life (OHRQoL). The aim of Study II was to analyze whether screening questions can be valid in estimating TMD prevalence in epidemiological research. The aim of the longitudinal Study III was to analyze the prevalence and incidence of radiographic signs of degenerative joint disorder (DJD) in the temporomandibular joint (TMJ). The aim of Study IV was to analyze whether osteoporosis has any relationship with radiographic or clinical signs of TMD in the elderly. The results showed that 15 % of the women responded positively to questions about TMD-related pain in questionnaires (II). The validity of screening questions about TMD pain was considered acceptable (II). Of the almost 8 % who reported chronic, severe orofacial pain, it was noted that a larger proportion had signs of depression, anxiety, low SOC and poor OHRQoL. The likelihood of having severe orofacial pain increased if the SOC was low, if there were signs of depression, and if the OHRQoL was affected (I). Any clinical diagnosis of TMD was noted in 45 % of the women 38, 50 and 80 years of age, and a pain diagnosis in 21 %. The 80-year-old women rated their pain as less intense. A function diagnosis was found in around 31 % (II + IV). DJD in the TMJ, assessed on panoramic radiographs, was noted in 18 % at the age of 38 years, gradually increasing to 38 % at the age of 62 years and stable in older age groups at around 45 %. Usually, only one side was affected. The highest incidence of new DJD was seen between 55 and 65 years of age (III). Signs of osteoporosis had no association with DJD or a clinical TMD diagnosis (IV). It can be concluded that screening questions are useful in indicating signs of TMD pain in middle-aged women. Orofacial pain that is frequent and intense has a relationship with psychosocial factors. TMD-related pain was reported by 15-20 % in women aged 38, 50 or 80 years, with the elderly reporting a lower intensity. The prevalence of DJD in the TMJ increases with age and the condition usually occurs around the age of 60. Osteoporosis seems to be unrelated to TMD.

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