Pain and temporomandibular disorders in patients with eating disorders

SOUZA, Samanta Pereira; ANTEQUERDDS, Reynaldo; ARATANGY, Eduardo Wagner; SIQUEIRA, Silvia Regina Dowgan Tesseroli; CORDÁS, Táki Athanássios; SIQUEIRA, José Tadeu Tesseroli

doi:10.1590/1807-3107bor-2018.vol32.0051

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Original Research • Braz. oral. res. 32 • 2018 • https://doi.org/10.1590/1807-3107bor-2018.vol32.0051 copy

Pain and temporomandibular disorders in patients with eating disorders

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Orofacial pain and temporomandibular dysfunction may cause chronic facial pain, which may interfere with the emotional state and food intake of patients with eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN). Sixty-four patients were assigned to four groups: Group A (AN – restricting subtype): 07; Group B (AN – purging subtype ): 19; Group C (BN): 16; and Group D (control): 22. Complaints of pain are more prevalent in individuals with eating disorders (p<0.004). There are differences between the presence of myofascial pain and the number of hospitalizations (p = 0.046) and the presence of sore throat (p=0.05). There was a higher prevalence of masticatory myofascial pain and complaints of pain in other parts of the body in ED patients; however, there was no difference between ED subgroups. There was no difference in the number of self-induced vomiting between ED patients with and without myofascial pain.

Feeding and Eating Disorders; Facial Pain; Temporomandibular Joint Disorders; Anorexia Nervosa; Bulimia Nervosa

Variable	Group A (n = 7)	Group B (n = 19)	Group C (n = 16)	Group D (n = 22)	P
Age (years)	37 (20–47)	33 (25–40)	33 (24–41)	26 (22–30)	0.062*
Sex (%)
Female	7 (100)	17 (89.5)	13 (81.3)	17 (77.3)	0.300**
Male	0 (0)	2 (10.5)	3 (18.8)	5 (22.7)
Marital status (%)
Married	0 (0)	3 (15.8)	5 (31.3)	3 (13.6)	0.272**
Single	7 (100)	14 (73.7)	9 (56.3)	18 (81.8)
Divorced	0 (0)	2 (10.5)	2 (12.5)	1 (4.5)
Educational level (%)
Less than high school	0 (0)	1 (5.3)	1 (6.3)	0 (0)	0.007**
Completed high school	4 (57.1)	9 (47.4)	4 (25)	3 (13.6)
Incomplete high school	0 (0)	0 (0)	2 (12.5)	0 (0)
Completed university	0 (0)	3 (15.8)	6 (37.5)	9 (40.9)
Incomplete university	3 (42.9)	5 (26.3)	1 (6.3)	6 (27.3)
Graduate degree completed	0 (0)	1 (5.3)	2 (12.5)	4 (18,2,5)
Inactive work	2 (28.6)	5 (26.3)	5 (31.3)	0 (0)	0.009**

Variable	Group A (n = 7)	Group B (n = 19)	Group C (n = 16)	P*
Duration (< 10 y)	4 (57%)	6 (31.5%)	5 (31.4%)	< 0.001
Duration (10–20 y)	0 (0%)	6 (31.6%)	8 (50%)
Duration (> 20 y)	3 (42.9%)	7 (36.8%)	3 (18.8%)
Use of laxative	0 (0%)	4 (21.1%)	3 (18.8%)	0.241
Use of diuretics	0 (0%)	4 (21.1%)	1 (6.3%)	0.163
Depression	5 (71.4%)	4 (28.6%)	4 (25%)	0.088
Obsessive-compulsive disorder	1 (16.7%)	2 (14.3%)	0 (0%)	0.152
Borderline personality disorder	0 (0%)	3 (21.4%)	3 (20%)	0.637
Benzodiazepine dependence	0 (0%)	1 (50%)	1 (50%)	0.351
Rumination	3 (42.9%)	6 (31.6%)	8 (50%)	0.535
Alcoholism	0 (0%)	1 (5.3%)	2 (12.5%)	0.423
Smoking	1 (14.3%)	4 (21.1%)	5 (31.3%)	0.627
Illicit drugs	0 (0%)	2 (10.5%)	1 (6.3%)	0.510

Pain complaints	Group A (n = 7)	Group B (n = 19)	Group C (n = 16)	Group D (n = 22)	P*
Face	5 (71.4%)	9 (47.4%)	9 (56.3%)	2 (9.1%)	0.001
Ear	4 (57.1%)	8 (44.4%)	9 (56.3%)	1 (4.54%)	0.001
Throat	0 (0%)	3 (15.8%)	7 (43.8%)	3 (13.6%)	0.036
Head	5 (71.4%)	8 (44.4%)	9 (56.3%)	1 (4.54%)	0.002
Burning in the mouth	0 (0%)	8 (42.1%)	3 (18.8%)	0 (0%)	0.005
Other regions of the body	5 (71.4%)	7 (38.8%)	7 (43.8%)	1 (4.54%)	0.003

RDC/TMD Axis I –Diagnosis	Group A (n = 7)	Group B (n = 16)	Group C (n = 14)	Group D (n = 22)	P**
Muscle disorders
Myofascial pain	2 (28.6%)	3 (18.8%)	6 (42.9%)	2 (9.1%)	0.010
Myofascial pain with limited opening	0 (0%)	3 (18.8%)	3 (21.4%)	0 (0%)

Demographic and general characteristics	Myofascial pain		P

	No (n = 20)	Yes (n = 7)
Age (years)	29 (24-41)	34 (30-43)	0.437*
Sex			1.000**
Female	18 (90%)	15 (88.2%)
Male	2 (10%)	2 (11.8%)
Marital status			0.021***
Married	2 (10%)	6 (35.3%)
Single	18 (90%)	9 (52.9%)
Divorced	0 (0%)	2 (11.8%)
Educational level			0.589***
Less than high school	1 (10%)	1 (5.9%)
Completed high school	9 (40%)	6 (35.3%)
Incomplete high school	2 (10%)	0 (0%)
Completed university	4 (20%)	5 (29.4%)
Incomplete university	4 (20%)	3 (17.6%)
Graduate degree completed	0 (0%)	2 (11.8%)

Clinical features	Myofascial pain		P

	No (n = 20)	Yes (n = 17)
Self-induced vomiting	14 (70%)	14 (82.4%)	0.462*
It has been hospitalized	16 (80%)	12 (70.6%)	0.703*
Number of hospitalizations			0.046**
0	4 (20%)	5 (29.4%)
1	3 (15%)	5 (29.4%)
2	4 (20%)	5 (29.4%)
3	3 (15%)	0 (0%)
4	1 (5%)	0 (0%)
5	0 (0%)	2 (11.8%)
6	3 (15%)	0 (0%)
7	1 (5%)	0 (0%)
20	1 (5%)	0 (0%)
Rumination	8 (40%)	6 (35.3%)	0.769***
Duration (< 10 y)	10 (50%)	4 (23.5%)
Duration (10-20 y)	4 (20%)	7 (41.1%)	0.425**
Duration (> 20 y)	6 (30%)	6 (35.3%)
NCCL	11 (55%)	11 (68.8%)	0.400
Sore throat	2 (10%)	7 (41.2%)	0.050
BMI	20.1±4.3	23.4±8.6	0.268

Chronic pain grade	Group A (n = 7)	Group B (n = 17)	Group C (n = 15)	P***
Grade 0*	5 (71.4%)	9 (52.9%)	6 (40%)	0.292
Low disability
Grade I – Low intensity	0 (0%)	1 (5.9%)	5 (33.3%)
Grade II – High intensity	2 (28.6%)	4 (23.5%)	2 (13.3%)
High disability
Grade III – Moderately limiting	0 (0%)	2 (11.8%)	1 (6.7%)
Grade IV – Severely limiting	0 (0%)	1 (5.9%)	1 (6.7%)

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[1] Corresponding Author: José Tadeu Tesseroli de Siqueira. E-mail: jose.ttsiqueira@hc.fm.usp.br