Temporomandibular joint dysfunction syndrome and police work stress: an integrative review

Urbani, Giselle; Jesus, Lêda Freitas de; Cozendey-Silva, Eliana Napoleão

doi:10.1590/1413-81232018245.16162017

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REVIEW • Ciênc. saúde colet. 24 (5) • May 2019 • https://doi.org/10.1590/1413-81232018245.16162017 copy

Temporomandibular joint dysfunction syndrome and police work stress: an integrative review

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Abstract

This study aimed to investigate whether stress found in activities performed by Brazilian police workers is associated with the risk of developing a temporomandibular joint dysfunction syndrome (TMD), a disorder that is commonly associated with stressful conditions. An integrative literature review on stress, TMD and police work was carried out. We identified several stressors in the work of Brazilian police officers and observed that stress influences the development, aggravation and treatment of TMD symptoms. The quality of life and health of TMD carriers is compromised. The fact that studies have shown the association between stress and activities carried out by Brazilian police officers, as well as between stress and TMD, has led to the assumption of a possible relationship between stress caused by police work and the risk of these workers developing TMD. It is recommended that individuals be thoroughly examined before being treated and that such treatment be multidisciplinary. The literature on TMD in police workers is still incipient, which is why we recommend the development of further studies on the topic.

Occupational stress; Temporomandibular joint dysfunction; Police officers; Worker’s health

Base	Studies retrieved	Studies used
Lilacs	168	06
SciELO	51	14
Medline	149	02
BVS/MS	09	02
Google Acadêmico	06	02
Total	383	26

Author, Year	Title	Type of document – Type of study	Objective	Key data on police officers stress generators
Andrade et al., 2009¹⁵15. Andrade ER, Sousa ER, Minayo MCS. Intervenção visando a auto-estima e qualidade de vida dos policiais civis do Rio de Janeiro. Cien Saude Colet 2009; 14(1):275-285.	Intervention aiming at the self-esteem and quality of life of the civil police officers of Rio de Janeiro	Paper - Research-Action	To show data on the self-esteem and quality of life of civil police officers in Rio de Janeiro, from an intervention process	They perform unhealthy and risky activities in their daily life and almost do not have alternatives to perform the catharsis of the stress generated by such activities
Bezerra et al., 2013²⁰20. Bezerra CM, Minayo MC, Constantino P. Estresse ocupacional em mulheres policiais. Cien Saude Colet 2013; 18(3):657-666.	Occupational stress in female police officers	Paper – Cross-sectional	To present and discuss the occupational stress experienced by military police women	Work organizational and managerial issue; gender discrimination; harassment; occupation of managerial positions; operational activities
Caria et al., 2014²³23. Caria PHF, Faria RJA, Faria CRS, Croci CS, Negrão Filho R. Efficiency of occlusal splints on police officers with TMD. Braz. J. Oral Sci. 2014; 13(4):292-296.	Efficiency of occlusal splints on police officers with TMD	Paper – Cross-sectional	To evaluate the effect of two occlusal splints on different police officers with TMD	Constantly face danger and risk life at any time
Costa et al., 2007¹³13. Costa M, Accioly Júnior H, Oliveira J, Maia E. Estresse: diagnóstico dos policiais militares em uma cidade brasileira. Rev Panam Salud Publica 2007; 21(4):217-222.	Stress: diagnosis of military police officers in a Brazilian city	Paper – Cross-sectional	To diagnose the occurrence and the stress phase in military police offices of Natal, Brazil, besides determining the prevalence of physical and mental symptomatology.	Higher level of stress among women, perhaps due to double working hours, domestic obligations, female tendency to present more sources of stress, since they suffer more from poor interpersonal relationships, and also from physiological and psychological characteristics women.
Dela Coleta e Dela Coleta, 2008¹⁷17. Dela Coleta ASM, Dela Coleta MF. Fatores de estresse ocupacional e coping entre policiais civis. Psico-USF 2008; 13(1):59-68.	Occupational stress and coping factors among civilian police officers	Paper – Cross-sectional	To identify occupational stress factors and verify coping strategies used by civilian police officers	Main stressors: working conditions, employment conditions (salary and stability), relationships with colleagues and superiors, negative image of the class by society and the media, and lack of legal and governmental support to police work.
Gomes e Souza, 2013¹⁸18. Gomes R, Souza ER. A identidade de policiais civis e sucessivos espelhamentos. Cien Saude Colet 2013; 18(3):601-610.	The identity of police officers and successive mirroring	Paper – Cross-sectional	To analyze the perceptions of civilian police officers about their professional identity and the institution in which they operate, as well as their opinion about the image that society has about its performance.	Negative image that the police officers believe that society has on them, which implies and reinforces a devaluation of the profession.
Minayo et al., 2011²²22. Minayo MCS, Assis SG, Oliveira RVC. Impacto das atividades profissionais na saúde física e mental dos policiais civis e militares do Rio de Janeiro (RJ, Brasil). Cien Saude Colet 2011; 16(4):2199-2209.	Impact of professional activities on the physical and mental health of civil and military police officers in Rio de Janeiro (RJ, Brazil)	Paper – Cross-sectional	To know the health conditions of the civil and military police officers of Rio de Janeiro, from several angles: that of pleasure and suffering	Having two jobs, working night and day, spending 12 hours in the street having had only one meal, working under pressure, having to stay alert and sleep little.
Minayo et al., 2007¹⁴14. Minayo MCS, Souza ER, Constantino P. Riscos percebidos e vitimização de policiais civis e militares na (in)segurança pública. Cad Saude Publica 2007; 23(11):2767-2779.	Perceived risks and victimization of civilian and military police offices in public (in) security	Paper – Cross-sectional	To analyze and compare victimization and risks perceived by military and civil police officers from the State of Rio de Janeiro, Brazil, in the exercise of their profession, within and outside the work environment.	Working conditions and involvement in other activities during the time off
Oliveira e Bardagi, 2009¹1. Oliveira PLM, Bardagi MP. Estresse e comprometimento com a carreira em policiais militares. Bol Psicol 2009; 59(131):153-166.	Stress and commitment to career in military police officers	Paper – Cross-sectional	To evaluate the levels of occupational stress and career commitment among military police officers of the First Military Brigade of Santa Maria, RS.	Direct confrontation with crime and emergencies, which eventually expose them to risks, in relation not only to their own life and physical integrity, but also that of third parties
Souza e Minayo, 2005¹⁹19. Souza ER, Minayo MCS. Policial, risco como profissão: morbimortalidade vinculada ao trabalho. Cien Saude Colet 2005; 10(4):917-928	Police officer, risk as a profession: work-related morbimortality	Paper – Bibliographic review	To analyze deaths and health problems to the civil, military and municipal police officers of Rio de Janeiro within and outside their working day, due to their social activity	Victimization growth in the three categories studied; The servants of the three corporations make up a specific category of workers at high risk for deaths and morbidity due to violence and accidents, with internal differences between the three groups.
Spode e Merlo, 2006²¹21. Spode CB, Merlo ARC. Trabalho policial e saúde mental: uma pesquisa junto aos Capitães da Polícia Militar. Psicol. Reflex. Crit. 2006; 19(3):362-370.	Police work and mental health: a survey with the Military Police Captains	Paper – Cross-sectional	To understand the relationship between the work of the Military Brigade Captains - name received by the Military Police in the State of Rio Grande do Sul / Brazil - and their mental health	Work organization; Pressures imposed by disciplinary surveillance and control mechanisms; Non-recognition of the work actually carried out and efforts to carry it out with quality

Author, Year	Title	Type of document – Type of study	Objective	Main data on stress as an etiologic or risk factor for TMD
Biasotto-Gonzalez et al., 2009²⁹29. Biasotto-Gonzalez DA, Mendes PCC, Jesus LA, Martins MD. Qualidade de vida em portadores de disfunção temporomandibular – um estudo transversal. Rev Ins. Ciênc Saúde 2009; 27(2):128-132.	Quality of life in patients with temporomandibular dysfunction - a cross-sectional study	Paper – Cross-sectional	To classify TMD patients and correlate with impact on quality of life	There is a direct influence of the degree of TMD on the quality of life of the symptomatic participants
Bortolleto, et al., 2013²⁴24. Bortolleto PPB, Manfredi APSM, Madureira PR. Análise dos hábitos parafuncionais e associação com Disfunção das Articulações Temporomandibulares. Rev Assoc Paul Cir Dent 2013; 67(3):216-221.	Analysis of parafunctional habits and association with temporomandibular joint dysfunction	Paper – Cross-sectional	To verify the prevalence of the most common parafunctional habits found among students and servants of the State University of Campinas (Unicamp), São Paulo, Brazil and to analyze its association with TMD in this population	Bruxism, which has one of its etiologies in stress, is a risk factor for the development of TMD
Campi et al., 2013⁷7. Campi LB, Camparis CM, Jordani PC, Gonçalves DAG. Influência de abordagens biopsicossociais e autocuidados no controle das disfunções temporomandibulares crônicas. Rev. Dor 2013;14(3):219-222.	Influence of biopsychosocial approaches and self-care in the control of chronic temporomandibular disorders	Paper - Literature review	To carry out a literature review on the impact of education and simple modes of self-care on pain and dysfunction related to chronic painful TMD.	Positive results regarding the application of education and self-care methods in chronic painful TMD, contributing to the improvement of pain symptoms and discomfort.
Figueiredo et al., 2009⁵5. Figueiredo VM, Cavalcanti AL, Farias ABL, Nascimento SR. Prevalência de sinais, sintomas e fatores associados em portadores de disfunção temporomandibular. Acta Scientiarum. Helth Sciences 2009; 31(2):159-163.	Prevalence of signs, symptoms and associated factors in patients with temporomandibular dysfunction	Paper - Cross-sectional	To analyze the prevalence of signs, symptoms and associated factors in patients with temporomandibular dysfunction.	TMD patients are afflicted with a high prevalence of signs and symptoms that can directly affect quality of life.
Goyatá et al., 2010¹⁶16. Goyatá FR, Taira NV, Almeida S, Martin e Silva D, Taira CV. Avaliação de sinais e sintomas de Disfunção Temporomandibular entre os acadêmicos do curso de Odontologia da Universidade Severino Sombra, Vassouras-RJ. Int. J Dent. 2010; 9(4):181-187.	Evaluation of signs and symptoms of Temporomandibular Dysfunction among the students of the course of Dentistry of Severino Sombra University, Vassouras-RJ	Paper - Cross-sectional	To evaluate the clinical signs and symptoms of temporomandibular dysfunction among the students enrolled in the course of Dentistry of the Severino Sombra University	Correlation between emotional factors and temporomandibular dysfunction
Kuroiwa et al., 2011³⁰30. Kuroiwa DN, Marinelli JG, Rampani MS, Oliveira W, Nicodemo D. Desordens temporomandibulares e dor orofacial: estudo da qualidade de vida medida pelo Medical Outcomes Study 36 - Item Short Form Health Survey. Rev. dor 2011; 12(2):93-98.	Temporomandibular disorders and orofacial pain: a study on the quality of life as measured by the Medical Outcomes Study 36 - Item Short Form Health Survey	Paper - Cross-sectional	To evaluate the quality of life of patients with temporomandibular dysfunction and / or orofacial pain	Patients with TMD and OFP had a negative impact on quality of life due to impairment of physical and mental aspects.
Manfredi et al., 2006²⁵25. Manfredi APS, Bortolleto PPB, Silva AA, Araújo IEM, Araújo S, Vendite LL. Enviromental stress and temporomandibular disorder (TMD) among members of a public university in Brazil. Braz J Oral Sci 2006; 5(18):1074-1078.	Enviromental stress and temporomandibular disorder (TMD) among members of a public university in Brazil	Paper - Cross-sectional	To identify individuals with TMD and correlate with environmental stress among members of a public university	Positive association between TMD and environmental stress
Martins et al., 2007³3. Martins RJ, Garcia AR, Garbin CAS, Sundefeld MLMM. Associação entre classe econômica e estresse na ocorrência da disfunção temporomandibular. Rev. Bras. Epidemiol. 2007; 10(2):215-222	Association between economic class and stress in the occurrence of temporomandibular dysfunction	Paper - Cross-sectional	To verify the association between economic class and stress with the occurrence of TMD	Economy class does not influence the occurrence of TMD, but there is a direct association between stress and temporomandibular dysfunction
Michelotti et al., 2010²⁸28. Michelotti A1, Cioffi I, Festa P, Scala G, Farella M. Oral parafunctions as risk factors for diagnostic TMD subgroups. J. Oral Rehabil 2010; 37(3):157-162.	Oral parafunctions as risk factors for diagnostic TMD subgroups	Paper - Case control	To investigate the possible association between parafunctional habits (grinding teeth and nail biting) and TMD	Teeth grinding is a significant risk factor for the occurrence of TMD
Monteiro et al., 2011²⁶26. Monteiro DR, Zuim PRJ, Pesqueira AA, Ribeiro PP, Garcia AR. Relationship between anxiety and chronic orofacial pain of Temporomandibular Disorder in a group of university students. J Prosthodont Res 2011; 55(3):154-158.	Relationship between anxiety and chronic orofacial pain of Temporomandibular Disorder in a group of university students	Paper - Cross-sectional	To evaluate the relationship between anxiety levels and degrees of severity of TMD chronic orofacial pain in Brazilian university students.	Possible relationship between TMD chronic orofacial pain and anxiety
Schmidt, 2007²⁷27. Schmidt CM. Disfunção temporomandibular associado ao estresse [monografia]. Piracicaba: Universidade Estadual de Campinas; 2007.	Temporomandibular dysfunction associated with stress	Monography – Literature review	To show through the national and international bibliographic survey the relationship between temporomandibular dysfunction, its possible causes, signs, symptoms, diagnoses and possible treatments suggested in the literature related to stress	TMDs have multifactorial causes and are directly related to stress; they are found with higher prevalence in females.

Author, Year	Title	Type of document – Type of study	Objective	Principal findings on stress as a risk factor for TMD in police officers
Caria et al., 2014²³23. Caria PHF, Faria RJA, Faria CRS, Croci CS, Negrão Filho R. Efficiency of occlusal splints on police officers with TMD. Braz. J. Oral Sci. 2014; 13(4):292-296.	Efficiency of occlusal splints on police officers with TMD	Paper – Cross-sectional	To evaluate the effect of two occlusal splints on different police officers with TMD	Police officers are highly likely to develop chronic diseases and disorders such as TMD because they are exposed to extremely high levels of stress
Carvalho et al., 2008³³33. Carvalho SCA, Carvalho ALA, Lucena SC, Coelho JPS, Araújo TPB. Associação entre bruxismo e estresse em policiais militares. Rev. Odonto. Ciênc. 2008; 23(2):125-129.	Association between bruxism and stress in military police	Paper – Cross-sectional	To measure the prevalence of bruxism and stress in military police officers and their possible association	Citation of a study that related bruxism, biopsychosocial symptoms (stress, sleep disorders and pain symptoms) and smoking to TMD symptoms
Cavalcanti et al., 2011³²32. Cavalcanti MOA, Lima JMC, Batista AUD, Oliveira LMC, Lucena LBS. Grau de severidade da disfunção temporomandibular e hábitos parafuncionais em policiais militares. Rev. Gaúch. Odontol. 2011; 59(3):351-356.	Degree of severity of temporomandibular dysfunction and parafunctional habits in military police officers	Paper – Cross-sectional	To estimate the occurrence of TMD and its degree of severity, as well as the presence of parafunctional habits in a population of non-patients represented by military police officers	Significant association between temporomandibular dysfunction and parafunctional habits of grinding or clenching teeth and biting objects (linked to stress)
Faria, 2006³¹31. Faria RJA. Avaliação clínica e eletromiográfica de músculos da mastigação, em policiais militares com DTM, antes e após o uso de dispositivos inter-oclusais [dissertação]. Campinas: Universidade Estadual de Campinas; 2006.	Clinical and electromyographic evaluation of chewing muscles in military police with TMD, before and after the use of inter-occlusal devices	Dissertation - Cross-sectional	To investigate, through clinical and electromyographic examination, the behavior of the temporal, masseter and suprahyoid muscles in Military Police Officers of the 18th Military Police Battalion of the State of São Paulo, with myogenic or mixed TMD, before and after use of different inter-occlusal devices for four weeks	High incidence of TMD in military police officers, more frequent in women
Graciola e Silveira, 2013³⁴34. Graciola J, Silveira AM. Avaliação da Influência do Estresse na Prevalência de Disfunções Temporomandibulares em Militares Estaduais do Rio Grande do Sul. J. Oral Invest. 2013; 2(1):32-37.	Evaluation of the influence of stress on the prevalence of temporomandibular disorders in the state military of Rio Grande do Sul	Paper – Cross-sectional	To verify the influence of a professional activity seen as quite stressful, as is the case of military police officers, and its correlation with the prevalence of temporomandibular dysfunction	Medium correlation between TMD and stress

Country	Police officers - 2015

	Total workforce	Deaths while on duty
Brazil	256,053	91 (0.03%)
United States	402,978	41 (0.01%)
United Kingdom	207,140	4 (0.001%)

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[1] Collaborations

G Urbani was responsible for researching and writing the article, LF Jesus was responsible for the methodology and writing of the article, EM Cozendey-Silva was responsible for the methodology and final review.