Association of psychosocial stress and temporomandibular disorders in the adolescent population

Objectives Research has shown an increasing number of adolescent patients who present with somatization of pain disorders. The importance of assessing a patient's psychological and behavioral status in diagnosing temporomandibular disorder (TMD) has been explored in adults; however, its application in adolescents is unclear. The objectives of this study are to determine the association between psychosocial stress and TMD among adolescents and to further investigate the type of psychosocial stress that has the highest impact on this population. Methods This is a prospective study targeting patients aged 10-19 years old who visit the oral medicine clinics at the University of Pennsylvania Health System. The study was approved by the University of Pennsylvania Institutional Review Board. All patients with complaints of jaw pain, headache, and/or earache were assessed using the same TMD evaluation form, including a validated psychosocial questionnaire, the modified 4-item Patient Health Questionnaire for anxiety and depression (PHQ-4), in the electronic medical record system. The information in the initial TMD evaluation form and relevant demographic information, such as age and sex, were used in statistical analysis, including chi-square tests, to identify trends within populations. Results To date, 30 patients (18 females, 12 males) aged 10-19 years have enrolled and participated in the study. On the basis of preliminary data analysis, patients who had a formal diagnosis of depression or anxiety or who had a moderate or severe score on the PHQ-4 (categorized as normal, mild, moderate, or severe) had moderate or severe myofascial pain upon clinical examination (69.1%; P Conclusions There is a statistically significant association between psychosocial stress and TMD symptoms in adolescents. Depression and anxiety had the highest impact on the severity of temporomandibular joint myofascial pain, with headache being the most frequent coexisting pain condition.