Exaggerated facial feedback from Temporomandibular disorders (TMD) may be involved in the development of mental health disorders. Temporomandibular joint (TMJ) disorder and other TMDs are often associated with teeth clenching during sleep but can develop from many other causes, such as orthodontics, difficult dental procedures, soft-tissue disorders, or even stress. People frown instinctively during distress. During times of ongoing or extreme distress, frequent or intense frowning could lead to the development of TMD.
TMD and Facial Malfunction
TMD is painful, and patients with TMD also have facial-muscular alterations and malfunctions due to their facial injuries. Studies using electromyography (EMG) to measure facial muscle activity have found altered temporalis and masseter muscle recruitment in TMD patients (compared to people without TMD) during clenching and gum chewing (Tartaglia et al., 2011; Di Giacomo et al., 2020). Some facial-muscular alterations may influence emotional states. Stocka et al. (2018) found that study participants’ increased masseter muscle activity while clenching correlated with increased depression scores. This correlation is noteworthy, as facial-muscle alterations may be the basis of depression and anxiety symptoms often associated with TMD. Specific facial-muscular alterations may impact mood and instigate emotional dysfunction.
TMD and Mental Health Challenges
TMD is frequently associated with mental health challenges such as depression and anxiety. The relationship between pain intensity, disability, depression, anxiety, and stress in TMD patients has been found to be significant. Depression levels were twice as likely in patients with muscular TMD than without TMD (Wieckiewicz et al.,2022). Several studies found that depression levels in TMD patients ranged from 39% – 62% (Yap et al., 2003; Plesh et al., 2005; Reißmann et al., 2008; Manfredini et al., 2011). Anxiety levels are also higher in TMD patients (Florjański and Orzeszek, 2021). Depression and anxiety are often found together, and it’s possible that either one could initiate the other.
While TMD may develop from many causes, stress is the most common. Emotional challenges may be bi-directional with TMD, causing and maintaining the other. A five-year study by Kindler et al. (2012) found that depressed subjects were more than twice as likely as non-depressed people to develop TMJ pain. It is unsurprising that people in high-stress situations often have TMD and mental health challenges. University students have been shown to have higher rates of TMD and depression or anxiety (Augusto et al., 2016; Sójka et al., 2019; Namvar et al., 2021). The teen years can be very challenging, and one researcher found that 40% of randomly selected teens had TMD. Of those, 54.42% also had depression, and 45.47% had anxiety (Restrepo et al., 2021). Likewise, war veterans have significantly elevated rates of comorbid TMD and mental health challenges (Mottaghi et al., 2014; Fenton et al., 2018). Female veterans with TMD experience more than double the depression rates of male veterans (Fenton et al., 2018). If these conditions are linked, it is possible that treating one may treat the other.
Image by Phimchanok Srisuriyamart from Pixabay
Mental Health Treatment for TMD
Mental health treatment for TMD patients, such as psychological counseling, cognitive therapy, biofeedback, and stress management, not only reduce depression and anxiety but can help heal TMD (Turk et al., 1996; Auerbach et al., 2001; Li and Leung 2021). Cognitive therapy helps patients reassess their negative reactions to stress and life adversities, reducing stress and depression. It is important to note that more positive thoughts will also result in more relaxed and positive facial expressions. It is also likely that TMD treatment may help heal mental health challenges. Additional research and treatment trials are needed for confirmation.
References
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