Anxiety and depression associated with pain and discomfort of temporomandibular disorders

Soares, Lélio Fernando Ferreira; Coelho, Lucas Machioni; Moreno, Amália; Almeida, Daniel Augusto de Faria; Haddad, Marcela Filié

doi:10.5935/2595-0118.20200029

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ORIGINAL ARTICLE • BrJP 3 (2) • Jan-Mar 2020 • https://doi.org/10.5935/2595-0118.20200029 copy

Anxiety and depression associated with pain and discomfort of temporomandibular disorders

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

The etiology of temporomandibular disorders includes local and systemic factors, with an emphasis on the occlusal condition, trauma, parafunctional activities, and emotional stress, deriving signs of anxiety and depression. These, in turn, are more likely to develop in the university population, due to the changes required when entering university and the demand for good performance. This study aimed to evaluate the correlation between anxiety and depression symptoms and the existence of symptoms associated with temporomandibular disorders in university students.

METHODS:

An epidemiological, randomized, and cross-sectional clinical study conducted with 100 university students. The Research Diagnostic Criteria for Temporomandibular Disorders: Axis II and the Hospital Anxiety and Depression Scale questionnaires were applied. For the statistical analysis, the Chi-square tests and the Logistic regression model were used.

RESULTS:

The results of the present study consisted of responses from 79 women and 21 men, with a mean age of 19 years. The following associations were observed: general health status and depression; anxiety and pain in the face/ clicking; habit of grinding/clenching teeth when sleeping, and a “yes” answer to anxiety; discomfort with your teeth and depression; state of anguished/worried about all anxiety issues; depression and thoughts about death, difficulty in breathing and feeling discouraged about the future.

CONCLUSION:

From the data obtained, it was possible to conclude that the presence of symptoms related to anxiety and depression interfere with the painful symptoms of temporomandibular disorders in the addressed population.

Keywords:
Signs and symptoms; Psychological stress; Temporomandibular joint disorders

	HADS-A							HADS-D
	No		Yes		Total			No		Yes		Total
	n	%	n	%	n	%	p-value^† † Chi-square test;	n	%	n	%^a a Values expressed as percentage in line; b Values expressed as percentage.	n	%	p-value^† † Chi-square test;
Facial pain during the last four weeks	19	45.2	23	54.8	42	42.0	0.044^* * Significant; p<0.05.	27	64.3	15	35.7	42	42.0	0.758 ^ns ns Not significant; p>0.05;
No	15	25.9	43	74.1	58	58.0		39	67.2	19	32.8	58	58.0
Yes	15	25.9	43	74.1	58	58.0		39	67.2	19	32.8	58	58.0
Hearing clicking while chewing, opening or closing the mouth
No	17	47.2	19	52.8	36	36.0	0.036^* * Significant; p<0.05.	24	66.7	12	33.3	36	36.0	0.916 ^ns ns Not significant; p>0.05;
Yes	17	26.6	47	73.4	64	64.0	0.036^* * Significant; p<0.05.	42	65.6	22	34.4	64	64.0	0.916 ^ns ns Not significant; p>0.05;
Gnashing/squeezing teeth while sleeping
No	20	45.5	24	54.5	44	44.0	0.032^* * Significant; p<0.05.	29	65.9	15	34.1	44	44.0	0.986 ^ns ns Not significant; p>0.05;
Yes	14	25.0	42	75.0	56	56.0	0.032^* * Significant; p<0.05.	37	66.1	19	33.9	56	56.0	0.986 ^ns ns Not significant; p>0.05;
Feeling discomfort with the way the teeth touch each other
No	25	38.5	40	61.5	65	65.0	0.199 ^ns ns Not significant; p>0.05;	48	73.8	17	26.2	65	65.0	0.024^* * Significant; p<0.05.
Yes	9	25.7	26	74.3	35	35.0	0.199 ^ns ns Not significant; p>0.05;	18	51.4	17	48.6	35	35.0	0.024^* * Significant; p<0.05.
Total	34	34.0	66	66.0	100	100.0		66	66.0	34	34.0	100	100.0

	HADS-A							HADS-D
	No		Yes		Total			No		Yes		Total
	n	%^a a Values expressed as percentage in line;	n	%^a a Values expressed as percentage in line;	n	%^b b Values expressed as percentage.	p-value^† † Chi-square test;	n	%^a a Values expressed as percentage in line;	n	%^a a Values expressed as percentage in line;	n	%^b b Values expressed as percentage.	p-value^† † Chi-square test;
Loss of sexual interest or pleasure							0.004^* * Significant; p<0.05.							0.058 ^ns ns Not significant; p>0.05;
No	27	45.0	33	55.0	60	60.0		44	73.3	16	26.7	60	60.0
Yes	7	17.5	33	82.5	40	40.0		22	55.0	18	45.0	40	40.0
Feeling "tightness'' in the chest or heart
No	20	48.8	21	51.2	41	41.0	0.009^* * Significant; p<0.05.	29	70.7	12	29.3	41	41.0	0.405 ^ns ns Not significant; p>0.05;
Yes	14	23.7	45	76.3	59	59.0	0.009^* * Significant; p<0.05.	37	62.7	22	37.3	59	59.0	0.405 ^ns ns Not significant; p>0.05;
Having thoughts about death
No	28	48.3	30	51.7	58	58.0	0.000^* * Significant; p<0.05.	49	84.5	9	15.5	58	58.0	<0.0001^* * Significant; p<0.05.
Yes	6	14.3	36	85.7	42	42.0	0.000^* * Significant; p<0.05.	17	40.5	25	59.5	42	42.0	<0.0001^* * Significant; p<0.05.
Feeling lonely
No	16	53.3	14	46.7	30	30.0	0.008^* * Significant; p<0.05.	26	86.7	4	13.3	30	30.0	0.009^* * Significant; p<0.05.
Yes	18	25.7	52	74.3	70	70.0	0.008^* * Significant; p<0.05.	40	57.1	30	42.9	70	70.0	0.009^* * Significant; p<0.05.
Feeling sad
No	13	59.1	9	40.9	22	22.00	0.005^* * Significant; p<0.05.	19	86.4	3	13.6	22	22.0	0.043^* * Significant; p<0.05.
Yes	21	26.9	57	73.1	78	78.00	0.005^* * Significant; p<0.05.	47	60.3	31	39.7	78	78.0	0.043^* * Significant; p<0.05.
Breathing difficulty
No	31	49.2	32	50.8	63	63.0	<0.0001^* * Significant; p<0.05.	49	77.8	14	22.2	63	63.0
Yes	3	8.1	34	91.9	37	37.0	<0.0001^* * Significant; p<0.05.	17	45.9	20	54.1	37	37.0	0.001^* * Significant; p<0.05.
Feeling "something stuck inside the throat"
No	23	53.5	20	46.5	43	43.0	0.000 ^* * Significant; p<0.05.	33	76.7	10	23.3	43	43.0	0.049 ^ns ns Not significant; p>0.05;
Yes	11	19.3	46	80.7	57	57.0	0.000 ^* * Significant; p<0.05.	33	57.9	24	42.1	57	57.0	0.049 ^ns ns Not significant; p>0.05;
Feeling discouraged about the future
No	16	69.6	7	30.4	23	23.0	<0.0001^* * Significant; p<0.05.	21	91.3	2	8.7	23	23.00	0.008^* * Significant; p<0.05.
Yes	18	23.4	59	76.6	77	77.0	<0.0001^* * Significant; p<0.05.	45	58.4	32	41.6	77	77.00	0.008^* * Significant; p<0.05.
Total	34	34.0	66	66.0	100	100.0		66	66.0	34	34.0	100	100.0

Variables ^≠ ≠ List of all variables considered in a step by step interactive procedure,	HADS (zero FOR NO and 1 FOR YES)
	HADS-A ^‡ ‡ Only variables statistically significant after procedure,			HADS-D ^‡ ‡ Only variables statistically significant after procedure,
	OR [CI 95%]	ES (SE)	p-value	OR [CI 95%]	ES (SE)	p-value
(Intercept)	0,317	-1,149 (0,494)	0,020^* * Significant; p<0.05.	0,576	-0,552 (0,602)	0,359 ^ns ns Not significant p>0.05;
Breathing difficulty
No	1 [Reference]
Yes	8,467 [2,264;31,662]	2,136 (0,673)	0,002^* * Significant; p<0.05.	-	-	-
Feeling discouraged about the future
No	1 [Reference]
Yes	5,422 [1,793;16,399]	1,691 (0,565)	0,003^* * Significant; p<0.05.	-	-	-
General health
Terrible/regular/bad				1 [Reference]
Good	-	-	-	0,109 [0,030;0,397]	-2,212 (0,658)	0,001^* * Significant; p<0.05.
Great	-	-	-	0,312 [0,052;1,885]	-1,165 (0,918)	0,204 ^ns ns Not significant p>0.05;
Feeling discomfort with the way the teeth touch each other
No				1 [Reference]
Yes	-	-	-	3,780 [1,239;11,528]	1,330 (0,569)	0,019^* * Significant; p<0.05.
Having thoughts about death
No				1 [Reference]
Yes	-	-	-	5,858 [2,042;16,800]	1,768 (0,538)	0,001^* * Significant; p<0.05.

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