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July JADA evaluates psychosocial measures as predictors of chronic TMD

June 24, 2019

By Mary Beth Versaci

While psychosocial measures are important predictors of whether a person will develop a temporomandibular disorder, a study published in the July issue of The Journal of the American Dental Association found they do not predict whether the disorder will become persistent.

The cover article, "Clinical Predictors of Persistent TMD in People with First-onset TMD: a Prospective Case-control Study," found clinical measures –– such as jaw mobility, temporomandibular joint dysfunction noises and palpation pain in masticatory muscles, neck and other sites –– can be used to successfully identify patients at a higher risk of having persistent TMD. When psychosocial measures are considered as well, they do not add meaningfully to the predictive capacity of the clinical measures.

"This finding is somewhat surprising, given that TMDs are known to be complex multifactorial diseases, and the onset of painful TMD is associated with multiple psychosocial measures," the authors stated, adding the study’s finding contrasts with previous studies in which psychosocial measures –– such as physical and psychological functioning, depression, anxiety and oral overuse behaviors –– were significantly worse in patients with chronic TMD.

However, because psychosocial status is a strong predictor of TMD onset, continued psychosocial distress once TMD develops may not have additional predictive power when it comes to chronicity, the authors stated. The association between worse psychosocial measures and chronic TMD could reflect those measures' contribution to chronic pain, as well as the impact of persistent pain on psychosocial functioning.

The researchers also warned one limitation of their findings was that those with first-onset TMD pain in the study were research participants, not patients seeking care, who may experience more severe psychosocial distress because of greater pain and worry over their prognosis.

The study, which started with 3,258 TMD-free adults, was conducted from May 2006 through November 2008 at four U.S. sites. Participants responded to quarterly health updates, and those reporting TMD symptoms were invited to return for a clinical examination. Of those reporting symptoms, 260 participants developed examiner-verified TMD, and they were invited to attend a follow-up examination, conducted at least six months after baseline.

To read the article, visit

Other articles in the July issue of JADA include a feature on the ethical implications of negative online reviews, a case report on the two-visit placement of immediate dentures with the help of dental technologies and an article on how comprehensive oral care improves the treatment outcomes of patients with substance use disorder.

Every month, JADA articles are published online at in advance of the print publication.