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<\/figure>\n<\/div>\n\n\nTMD 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.\u00a0<\/p>\n\n\n\n
TMD and Mental Health Challenges<\/h2>\n\n\n\n
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; Rei\u00dfmann et al., 2008; Manfredini et al., 2011). Anxiety levels are also higher in TMD patients (Florja\u0144ski and Orzeszek, 2021). Depression and anxiety are often found together, and it’s possible that either one could initiate the other. <\/p>\n\n\n\n
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; S\u00f3jka 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.<\/p>\n\n\n
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Image by Phimchanok Srisuriyamart<\/a> from Pixabay<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n
Mental Health Treatment for TMD<\/h2>\n\n\n\n
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.<\/p>\n\n\n\n
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References<\/p>\n\n\n\n
Augusto, V. G., Perina, K. C. B., Penha, D. S. G., Dos Santos, D. C. A., & Oliveira, V. A. S. (2016). Temporomandibular dysfunction, stress and common mental disorder in university students. Acta Ortopedica Brasileira<\/em>, 24<\/em>(6), 330\u2013333. https:\/\/doi.org\/10.1590\/1413-785220162406162873<\/a>\u00a0<\/p>\n\n\n\n Auerbach, S.M., Laskin, D. M., Frantsve, L. M. E., & Orr, T. (2001). Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients. Journal of Oral and Maxillofacial Surgery, 59<\/em>(6), 628\u2013633. https:\/\/doi.org\/10.1053\/joms.2001.23371<\/a>\u00a0<\/p>\n\n\n\n Di Giacomo, P., Ferrato, G., Serritella, E., Polimeni, A., & Di Paolo, C. (2020). Muscular pattern in patients with temporomandibular joint disc displacement with reduction: an electromyographical assessment. Clinica Terapeutica, 171<\/em>(5), e414\u2013e420. https:\/\/doi.org\/10.7417\/CT.2020.2251<\/a>\u00a0<\/p>\n\n\n\n Fenton, B. T., Goulet, J. L., Bair, M. J., Cowley, T., & Kerns, R. D. (2018). Relationships between temporomandibular disorders, MSD conditions, and mental health comorbidities: Findings from the veterans musculoskeletal disorders cohort. Pain Medicine (Malden, Mass.)<\/em>, 19<\/em>(suppl_1), S61\u2013S68. https:\/\/doi.org\/10.1093\/pm\/pny145<\/a>\u00a0<\/p>\n\n\n\n Florja\u0144ski, W. & Orzeszek, S. (2021). Role of mental state in temporomandibular disorders: A review of the literature. Dental and Medical Problems<\/em>, 58<\/em>(1), 127\u2013133. https:\/\/doi.org\/10.17219\/DMP\/132978\u00a0<\/a><\/p>\n\n\n\n Kindler, S., Samietz, S., Houshmand, M., Grabe, H. J., Bernhardt, O., Biffar, R., Kocher, T., Meyer, G., V\u00f6lzke, H., Metelmann, H.-R., & Schwahn, C. (2012). Depressive and anxiety symptoms as risk factors for temporomandibular joint pain: A prospective cohort study in the general population. The Journal of Pain, 13<\/em>(12), 1188\u20131197. https:\/\/doi.org\/10.1016\/j.jpain.2012.09.004\u00a0<\/a><\/p>\n\n\n\n Li, D.T.S., & Leung, Y. Y. (2021). Temporomandibular disorders: Current concepts and controversies in diagnosis and management. Diagnostics (Basel), 11<\/em>(3), 459. https:\/\/doi.org\/10.3390\/diagnostics11030459<\/a>\u00a0<\/p>\n\n\n\n Manfredini, D., Ahlberg, J., Winocur, E., Guarda-Nardini, L., & Lobbezoo, F. (2011). Correlation of RDC\/TMD axis I diagnoses and axis II pain-related disability. A multicenter study. Clinical Oral Investigations, 15<\/em>(5), 749\u2013756. https:\/\/doi.org\/10.1007\/s00784-010-0444-4\u00a0<\/a><\/p>\n\n\n\n Mottaghi, A., & Zamani, E. (2014). Temporomandibular joint health status in war veterans with post-traumatic stress disorder. Journal of Education and Health Promotion<\/em>, 3<\/em>, 60\u201360. https:\/\/doi.org\/10.4103\/2277-9531.134765<\/a>\u00a0<\/p>\n\n\n\n Namvar, M.A., Afkari, B. F., Moslemkhani, C., Mansoori, K., & Dadashi, M. (2021). The relationship between depression and anxiety with temporomandibular disorder symptoms in dental students. M\u00e6dica, 16<\/em>(4), 590\u2013594. https:\/\/doi.org\/10.26574\/maedica.2021.16.4.590<\/a>\u00a0<\/p>\n\n\n\n Plesh, O., Sinisi, S. E., Crawford, P. B., & Gansky, S. A. (2005). Diagnoses based on the Research Diagnostic Criteria for Temporomandibular Disorders in a biracial population of young women. Journal of Orofacial Pain, 19<\/em>(1), 65\u201375. <\/p>\n\n\n\n Rei\u00dfmann, D. R., John, M. T., Wassell, R. W., & Hinz, A. (2008). Psychosocial profiles of diagnostic subgroups of temporomandibular disorder patients. European Journal of Oral Sciences, 116<\/em>(3), 237\u2013244. https:\/\/doi.org\/10.1111\/j.1600-0722.2008.00528.x<\/a>\u00a0<\/p>\n\n\n\n Restrepo, C., Ortiz, A. M., Henao, A. C., & Manrique, R. (2021). Association between psychological factors and temporomandibular disorders in adolescents of rural and urban zones. BMC Oral Health, 21<\/em>(1), 140\u2013140. https:\/\/doi.org\/10.1186\/s12903-021-01485-4<\/a>\u00a0<\/p>\n\n\n\n S\u00f3jka, A., Stelcer, B., Roy, M., Mojs, E., & Pryli\u0144ski, M. (2019). Is there a relationship between psychological factors and TMD? Brain and Behavior, 9<\/em>(9), e01360\u2013n\/a. https:\/\/doi.org\/10.1002\/brb3.1360\u00a0<\/a><\/p>\n\n\n\n Stocka, A. Sierpinska, T., Kuc, J., & Golebiewska, M. (2018). Relationship between depression and masticatory muscles function in a group of adolescents. Cranio, 36(6), 390\u2013395. https:\/\/doi.org\/10.1080\/08869634.2017.1364030<\/a><\/p>\n\n\n\n Tartaglia, G.M., Lodetti, G., Paiva, G., Felicio, C. M. D., & Sforza, C. (2011). Surface electromyographic assessment of patients with long lasting temporomandibular joint disorder pain. Journal of Electromyography and Kinesiology, 21<\/em>(4), 659\u2013664. https:\/\/doi.org\/10.1016\/j.jelekin.2011.03.003<\/a>\u00a0<\/p>\n\n\n\n Turk, D.C., Rudy, T. E., Kubinski, J. A., Zaki, H. S., & Greco, C. M. (1996). Dysfunctional patients with temporomandibular disorders. Journal of Consulting and Clinical Psychology, 64<\/em>(1), 139\u2013146. https:\/\/doi.org\/10.1037\/0022-006X.64.1.139<\/a>\u00a0<\/p>\n\n\n\n