Association of Temporomandibular Disorders with Pain Sensitivity: a cohort study.

Abstract

BACKGROUND\nPain related to temporomandibular disorders (TMD) can be linked with multiple site pain (MSP), and may associate with increased pain sensitivity, more frequently among women than men. The aim of the study was to examine the associations of pressure pain threshold (PPT) and tolerance (PPTo) with TMD and associated MSP in the Northern Finland Birth Cohort 1966 (NFBC1966) study.\n\n\nMETHODS\nAltogether 1961 NFBC1966 subjects attended clinical medical and dental examination at the Institute of Dentistry, University of Oulu in 2012-2013. Clinical examinations were carried out using a modified Diagnostic Criteria for TMD protocol (DC/TMD). MSP was defined based on questions regarding body pain sites. Additionally, PPT and PPTo were assessed using algometer measurements. Mann-Whitney U-test and Tobit regression models were used to analyze associations between TMD sub-diagnoses, MSP, PPT, and PPTo, stratified by sex. Further models were adjusted with anxiety and depressive symptoms, which were assessed using Hopkins Symptom Checklist-25 (HSCL-25) and two-way interaction terms.\n\n\nRESULTS\nAmong females, lower PPT and PPTo associated with myalgia and arthralgia. Among males, lower PPT and PPTo associated with MSP-linked TMD. Tobit regression analysis showed significantly lower PPT and PPTo values in the myalgia and arthralgia subgroups among female TMD subjects. Among females, disc displacement with reduction had an inverse association with PPT and PPTo. Among males, lower PPTo associated with degenerative joint disease and MSP-linked TMD.\n\n\nCONCLUSIONS\nThe pain regulatory mechanisms behind TMD act differently between the sexes as local TMD among females and MSP-linked TMD among males associated with pain sensitivity.