Original Article

Evaluating the role of stress and anxiety with clinical symptoms in TMD patients


Introduction: The etiology of TMD is complex and multifactorial, but it is thought that psychological factors contribute to the etiology and persistence of TMD. Therefore, the aim of this study was to investigate the role of anxiety and depression in the development of temporomandibular joint disorders in patients referred to Tehran University of Medical Sciences, School of Dentistry, International Campus. Materials and Methods: This cross-sectional study was performed on patients referred to Tehran University of Medical Sciences, School of Dentistry, International Campus who had temporomandibular joint disorder. Hence the number of 224 people easily selected at random. They were given 3 questionnaires to assess their anxiety and depression (9-PHQ, 4-PHQ7 and-GAD-7). After collecting data using SPSS software version 22 and considering the error level at 0.50% probability and one-way analysis of variance and frequency analysis were performed. Results: The rate of depression in patients with TMD was 8.83 according to the 9-PHQ questionnaire and 4.72 according to the 4-PHQ questionnaire, and the level of anxiety in patients withTMD according to the 7-GAD questionnaire was equal to 8.95 There was no significant relationship between patients’ gender and their level of anxiety (p<0.50), but there was a significant relationshipbetween patients’ age and their level of anxiety (p>0.50). Conclusion: Age and gender are not significantly associated with temporomandibular joint disorders.  Also, anxiety and depression are positively related and there is a significant value achieved with the incidence of TMD in the participants. A reduction in the level of anxiety and depression within people, can have a great impact on the treatment of TMDs in individuals. Keywords: Temporomandibular joint disorder; Anxiety; Depression.
1. Dworkin SF. Temporomandibular Disorder (TMD) pain–related disability found related to depression, nonspecific physical symptoms, and pain duration at 3 international sites. Journal of Evidence Based Dental Practice. 2017;11(3):143-4.
2. Rantala M. Temporomandibular disorders and related psychosocial factors in non patients: A survey and a clinical follow-up study based on the RDC/TMD. 2018.
3. de Leeuw R, Klasser GD. Orofacial pain: guidelines for assessment, diagnosis, and management: Quintessence Chicago; 2016.
4. Burket LW, Greenberg MS, Glick M. Burket's oral medicine: diagnosis & treatment: PMPH-USA; 2019.
5. Okeson JP. Management of Temporomandibular Disorders and Occlusion-E-Book: Elsevier Health Sciences; 2016.
6. Jacobs T, Sawaengkit P. National Institute of Dental and Craniofacial Research efficacy trials of bionator Class II treatment: a review. The Angle orthodontist. 2017;72(6):571-5.
7. Lam DK, Lawrence HP, Tenenbaum HC. Aural symptoms in temporomandibular disorder patients attending a craniofacial pain unit. Journal of orofacial pain. 2020;15(2).
8. Eversole LR, Stone CE, Matheson D: Psychometric profiles and facial Pain. Oral Surg. Oral Med. Oral Pathol. 2016 Sep;60(3):269-74 .
9. Kleinknecht RA, Mahoney ER, Alexander LD: Psychosocial correlates of temporomandibular disorders and related symptoms: An assessment of community and clinical findings. Pain 2017 June;29(3):313-24.
10. Kinney RK, Gatchel RJ, Ellis E, Halot C: Major Psychological disorders in chronic TMD patients: implications for successful management.J Am Dent Assoc. 2009 Oct;123(10):49-54.
11. Evaskus DS, Laskin DM: A biochemical measure of stress in patients with myofacial pain dysfunction syndrome. J Dent Res. 2015 Sep-Oct;51(5):1464-6.
12. Greene CS, Olson RE, Laskin DM: Psychological factors in the etiology, progression and treatment of MPD syndrome. J Am Dent Assoc. 2018 Sep;105(3):443-8.
13. Steed PA: TMD treatment: outcomes. A statistical assessment of the effects of psychological variables. Cranio. 2016 Jul:16(3)138-42.
14. Yap Au, Tan KB, Chua EK. Depression and somatization in patients with temporomandibular disorders. J Prosthet Dent. 2015 Nov;88(5):479-84.
15. Schurr RF , Brooke RI , Rollman GB: Psychosocial correlates of temporomandibular joint pain and dysfunction. Pain 2018 Aug;42(2):153-65.
16. Stephen MA, Laskin DM: Depression Pain, exposure to stressful life events and long term outcome in TMD patients. J Oral Maxillofac Surg. 2016 June; 59(6), 628-33.
17. Roy R, Thoms M , Matas M. Chronic pain and depression: a review. J Com Psychiatry. 2004 May; 25(3): 69-90.
18. White SC, Pharoah MJ. Oral Radiology: Principles and Interpretation. 6 th ed. St. Louis: Mosby Co; 2014. P. 530-60.
19.Manfredini D, Segù M, Bertacci A, Binotti G, Bosco M. Diagnosis of temporomandibular disorders according to RDC/TMD axis I findings, a multicenter Italian study. Minerva Stomatol 2004; 53(7-8): 429-38.
20. Minghelli B, Morgado M, Caro T. Association of temporomandibular disorder symptoms with anxiety and depression in Portuguese college students. J Oral Sci 2014; 56(2): 127-33.
21. Blanco Aguilera A, Gonzalez Lopez L, Blanco Aguilera E, De la Hoz Aizpurua JL, Rodriguez Torronteras A, Segura Saint-Gerons R, et al. Relationship between self reported sleep bruxism and pain in patients with temporomandibular disorders. J Oral Rehabil 2014; 41(8): 564-72.
22 .Magalhães BG, de-Sousa ST, de Mello VV, daSilva-Barbosa AC, de-Assis-Morais MP, BarbosaVasconcelos MM, Caldas-Júnior AD. Risk factors for temporomandibular disorder: binary logistic regression analysis. Med Oral Patol Oral Cir Bucal 2014; 19(3): e232-6.
23. Ferendiuk E, Zajdel K, Pihut M. Incidence of otolaryngological symptoms in patients with temporomandibular joint dysfunctions. Biomed Res Int 2014: 86-95.
24. Greenberg S. Burket’s oral medicine. 10th ed. USA: Bc Decker, 2003; P: 279. 25.Tabatabaian F, Saboury A, Kaseb Ghane H. The Prevalence of Temporomandibular Disorders in Patients Referred to the Prosthodontics Department of Shahid Beheshti Dental School in Fall 2010. J Dent Sch. 2013; 31 (1) :52-59.
26. Sönmez H, Sari S, Oksak Oray G, Camdeviren H. Prevalence of temporomandibular dysfunction in Turkish children with mixed and permanent dentition. J Oral Rehabil 2001; 28(3): 280-5.
27.Kordian Staniszewski, Henning Lygre, Ersilia Bifulco, Siv Kvinnsland, LisaWillassen, Espen Helgeland, Trond Berge and Annika Rose´n. Temporomandibular Disorders Related to Stress and HPA-Axis Regulation.2018;15(2):1-7.
28. Patil DJ, Dheer DS, Puri G, Konidena A, Dixit A, Gupta R. Psychological appraisal in temporomandibular disorders: A cross-sectional study. Indian J Pain 2016;30:13-8.
29.Lakshmi S ,Dyasanoor S. Association between psychological distress and occlusion among temporomandibular disorder patients – a clinical study. 2016;5(2):1198-1207.
30.Viviane Gontijo Augusto, Keity Cristina Bueno Perina, Daniel Silva Gontijo Penha, Daiane Carolina Alves dos Santos, Valéria Aparecida Souza Oliveira. Temporomandibular Dysfunction, Stress And Common Mental Disorder In University Students. 2016;24(6):330-333.
31. Letícia Bojikian CALIXTRE, Bruno Leonardo da Silva GRÜNINGER, Thais Cristina CHAVES, Ana Beatriz de OLIVEIRA. Is there an association between anxiety/ depression and temporomandibular disorders in college students? .2014;22(1):15-21.
32. Basir Shabestari, S.; Shirin Beck, I.; Sefidi, F.; Deliri Sherkat, H. (2013). Investigating the relationship between social adjustment and academic achievement of dentistry students in the academic year 2010-2011. Journal of Medical Education Development, 6 (11), 1-10.
33.Vojdani M, Dehbozorgi G, Mohammadzadeh S, Akbari Jahromi A. Comparison of anxiety and depression in patients with temporomandibular disorders and healthy individuals. The Journal of Islamic Dental Association of IRAN (JIDA) . 2007; 19 (1) :90-96
34. Lavaf S,Azizi A, Allameh E.Comparison of the effect of occlusal interactions and psychological problems in patients with TMD symptoms and healthy individuals referred to Ahvaz University of Medical Sciences. Scientific Journal of Medicine, Volume 6, Number 1, Spring 2009
35.Phillips JM, Gatchel RJ. Clinical implication of sex in acute temporomandibular disorder. J Am Dent Assoc. 2001 Jan;132(1):49-57.
36.Greene CS. Diagnosis and treatment of temporomandibular disorders: emergence of a new care guidelines statement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(2):137-9.
37.Greene CS, Marbach JJ. Epidemiologic studies of mandibular dysfunction. J Prosthet Dent. 1982 Agu;48(2):184-190.
38Helkimo M. Epidemiological surveys of dysfunction of masticatery system. Oral Sci Reve. 1976; 7:54-69.
39.Okeson JP. Management of temporomandibular disorder and occlusion. 6th Ed. Printed in United State Of America; Elsevier Mosby; 2008.
40. Gesch D, Bernhardt O, Kocher T, John U, Hensel E, Alte D. Association of malocclusion and functional occlusion with signs of temporo-mandibular disorders in adults: results of the population-based study of health in Pomerania. Angle Orthod 2005; 75(2): 183-190
41. Dawson PE. Functional occlusion: From TMJ to smile design. Florida: Mosby; 2007.
42.Rudy TE, Turk DC, Kubinski JA, Zaki HS. Differential treatment responses of TMD patients as a function of psychological characteristics. Pain 1995 Apr;61(1):103-12.
43. Nillson M, List T, Drangsholt M. Prevalence of temporomandibular pain and subsequent dental treatment in Swedish adolescents. J Orofac Pain. 2005 Spring;19(2):144- 150.
44. Suvinen TI, Nystrom M. An 8-year follow-up study of temporomandibular disorder and psychosomatic symptoms from adolescence to young adulthood. J Orofac Pain. 2004 Spring;18(2):126-30.
45. Plesh O, Curtis D. Amitriptyline treatment of chronic pain in patients with temporomandibular disorders. J Oral Rehabil. 2000 Oct;27(10):834-41
IssueVol 7, No 4 (Autumn 2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jcr.v7i4.5557
Temporomandibular joint disorder; Anxiety; Depression.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Najafi S, Faraji Z. Evaluating the role of stress and anxiety with clinical symptoms in TMD patients. J Craniomaxillofac Res. 7(4):213-221.