499: Anxiety and Depression Moderate Temporomandibular Disorder Pain and Oral Health Quality of Life

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary orofacial pain, Psychology, Epidemiology

Background and Aims: Systematic reviews and meta-analyses have confirmed the impact of TMDs on OHRQoL. Moreover, recent cross-sectional studies have shown that pain-related TMDs are negatively correlated with OHIP-TMDs scores and positively correlated with anxiety and depression. This suggests that anxiety and depression may influence the impact of TMDs on OHRQoL in patients, especially since the psychosocial domains of OHRQoL are frequently affected. This study aims to explore the mechanisms underlying the association between pain intensity and oral health-related quality of life (OHRQoL) in patients with temporomandibular disorders (TMDs), particularly the roles of anxiety and depression.

Methods: A total of 463 adult TMD patients participated in this study, including 367 females and 96 males, with a median age of 26.0 years. Patients were asked to provide sociodemographic information and complete the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Oral Health Impact Profile - TMDs (OHIP-TMDs), and the pain intensity section of the Graded Chronic Pain Scale questionnaire. Pain intensity was measured using the characteristic pain intensity (CPI). Moderated mediation models were employed to analyze the complex relationships among pain intensity, anxiety, depression, and OHRQoL.

Results: Patients in the high OHIP group (OHIP-TMDs score ≥ 33.0) had significantly higher scores on CPI, GAD-7, and PHQ-9 compared to those in the low OHIP group (p<0.001). Anxiety mediated the association between TMD pain intensity and OHRQoL (mediating effect: 0.736, 95% CI: 0.160-1.386; mediating proportion: 12.2%, 95% CI: 2.7-21.9%; at the mean level of depression). Depression moderated this mediating effect. Specifically, the mediating effect was significant only at PHQ-9 scores ≥ 4 and demonstrated a saturation effect, initially increasing and then leveling off with higher depression levels.

Conclusions: This study demonstrates that both anxiety and depression play distinct yet interconnected roles in the association between TMD pain intensity and OHRQoL. Anxiety mediates the association between TMD pain intensity and OHRQoL, while depression moderates this mediation and exhibits a saturation effect. These findings underscore the importance of addressing both anxiety and depression in therapeutic interventions for TMDs, particularly given the synergistic potential of such approaches.

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28. Blanco-Aguilera A, Blanco-Aguilera E, Serrano-Del-Rosal R, et al. Influence of clinical and psychological variables upon the oral health-related quality of life in patients with temporomandibular disorders. Med Oral Patol Oral Cir Bucal. 2017;22(6):e669-e678. doi:10.4317/medoral.21746
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1. Durham J, Newton-John TRO, Zakrzewska JM. Temporomandibular disorders. BMJ. 2015;350:h1154. doi:10.1136/bmj.h1154
2. Zieliński G, Pająk-Zielińska B, Ginszt M. A Meta-Analysis of the Global Prevalence of Temporomandibular Disorders. J Clin Med. 2024;13(5):1365. doi:10.3390/jcm13051365
3. Yao L, Sadeghirad B, Li M, et al. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ. 2023;383:e076226. doi:10.1136/bmj-2023-076226
4. Zheng Y, Zhou X, Huang Y, et al. Low income is associated with impaired jaw function via anxiety and depression in patients with temporomandibular disorders. Journal of Oral Rehabilitation. 2023;50(12):1373-1381. doi:10.1111/joor.13579
5. Manfredini D, Lombardo L, Siciliani G. Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era? J Oral Rehabil. 2017;44(11):908-923. doi:10.1111/joor.12531
6. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014;28(1):6-27. doi:10.11607/jop.1151
7. Lei J, Yap AU, Zhang M, Fu KY. Temporomandibular disorder subtypes, emotional distress, impaired sleep, and oral health-related quality of life in Asian patients. Community Dent Oral Epidemiol. 2021;49(6):543-549. doi:10.1111/cdoe.12643
8. Yap AU, Cao Y, Wong MCM, Fu KY. Rasch validation of the oral health impact profile for temporomandibular disorders. Oral Diseases. 2023;29(2):714-724. doi:10.1111/odi.14011
9. Sischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. J Dent Res. 2011;90(11):1264-1270. doi:10.1177/0022034511399918
10. John MT, Omara M, Su N, et al. RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS. J Evid Based Dent Pract. 2022;22(1):101619. doi:10.1016/j.jebdp.2021.101619
11. Yule PL, Durham J, Playford H, et al. OHIP-TMDs: a patient-reported outcome measure for temporomandibular disorders. Community Dent Oral Epidemiol. 2015;43(5):461-470. doi:10.1111/cdoe.12171
12. He S lin, Wang JH. Validation of the chinese version of the oral health impact profile for TMDs (OHIP- TMDs-C). Med Oral Patol Oral Cir Bucal. 2015;20(2):e161-166. doi:10.4317/medoral.20243
13. Qamar Z, Alghamdi AMS, Haydarah NKB, et al. Impact of temporomandibular disorders on oral health-related quality of life: A systematic review and meta-analysis. J Oral Rehabil. 2023;50(8):706-714. doi:10.1111/joor.13472
14. Oghli I, List T, Su N, Häggman-Henrikson B. The impact of oro-facial pain conditions on oral health-related quality of life: A systematic review. J Oral Rehabil. 2020;47(8):1052-1064. doi:10.1111/joor.12994
15. Ning W, Schmalz G, Li P, Huang S. Oral health-related quality of life in patients with osteoarthritis of the temporomandibular joint-Results of a systematic review. J Oral Rehabil. 2022;49(11):1106-1114. doi:10.1111/joor.13363
16. Cao Y, Yap AU, Lei J, Zhang MJ, Fu KY. Oral health-related quality of life of patients with acute and chronic temporomandibular disorder diagnostic subtypes. J Am Dent Assoc. 2022;153(1):50-58. doi:10.1016/j.adaj.2021.07.011
17. Gerrits MMJG, van Oppen P, van Marwijk HWJ, Penninx BWJH, van der Horst HE. Pain and the onset of depressive and anxiety disorders. Pain. 2014;155(1):53-59. doi:10.1016/j.pain.2013.09.005
18. Luo LY, Lee J, Li KY, Leung YY, Li DTS. Psychological Outcomes on Anxiety and Depression after Interventions for Temporomandibular Disorders: A Systematic Review and Meta-Analysis. Diagnostics (Basel). 2023;13(4):653. doi:10.3390/diagnostics13040653
19. Zhang W, Singh SP, Clement A, Calfee RP, Bijsterbosch JD, Cheng AL. Improvements in Physical Function and Pain Interference and Changes in Mental Health Among Patients Seeking Musculoskeletal Care. JAMA Netw Open. 2023;6(6):e2320520. doi:10.1001/jamanetworkopen.2023.20520
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26. Warzocha J, Gadomska-Krasny J, Mrowiec J. Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) from 2018 to 2022. Healthcare (Basel). 2024;12(5):575. doi:10.3390/healthcare12050575
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Presenting Author: Xin Xiong
Submitting Author: Xin Xiong

Senior Author: Jun Wang

IASP 2026 Global Year theme of Neuropathic Pain: No

• Yunhao Zheng: M. D. S. - West China School of Stomatology, Sichuan University
• Adrian Ujin Yap: Ph.D. - Division of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore
• Liandi Cheng: B. D. S. - West China School of Stomatology, Sichuan University
• Jun Wang: DDS - West China School of Stomatology, Sichuan University