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Female adolescents suffer more from temporomandibular joint-associated pain

Girls are more likely to report temporomandibular disorder pain and self-treat symptoms with non-prescription painkillers than boys, according to a new study. (Image: Antonio Guillem/Shutterstock)

OSLO, Norway: Temporomandibular disorder (TMD) pain afflicts younger people more disproportionally than adults, and up to 28% of children globally have reported TMD pain at some point. To draw more attention to TMD pain, investigate the pervasiveness of pain in the temporomandibular joint (TMJ) and face, and assess oral function in adolescents, researchers in Oslo evaluated a large group of young patients. They found that female patients were more likely than male patients to experience pain and that they experienced more pain than their male counterparts did.

TMD pain registers for many patients as pain in the joint or face, and the condition causes headaches and limits range of motion. Causes are classified as either extra- or intra-articular. Myofascial pain is an extra-articular factor, and arthritis, arthrosis and disc displacement fall under the category of intra-articular. TMD usually has an impact on maximal mouth opening capacity and maximal incisal opening (MIO) and is often associated with depression, painkiller consumption and a number of comorbid complaints.

Through dental examinations and collected survey data of 957 adolescent patients in three age cohorts—14-, 16- and 18-year-olds—the researchers were able to assess where patients were experiencing TMD pain and the degree of the pain that they were experiencing. Higher reported pain in the face or jaw, more pain on mouth opening and chewing, visual analogue scale pain intensity and pain on masseter muscle palpation were correlated with a smaller MIO. A decreased MIO was not associated with other muscles of mastication. There was a significant positive correlation between male sex and MIO, in addition to MIO and lateral movement. The number of days with pain and MIO showed a significant negative correlation, as did reported facial or jaw pain in the last three months and MIO, pain upon mouth opening and MIO, pain upon chewing and MIO, and pain intensity and MIO.

TMJ clicking sounds were reported in 47.1% of the adolescents surveyed, and this occurred more often in 18-year-olds. The researchers suggested that asymptomatic clicking of the TMJ may not actually be a meaningful diagnostic criterion for TMD, though noise was more frequent when pain was present.

Reported restriction of maximal mouth opening capacity in the past month was higher for females (4.1%) than males (0.8%). Facial pain in the last three months was reported by 47.0% of the adolescents, and females again reported a higher frequency of pain at 5.3%, compared with just 1.7% of males. This increased significantly with age. For other associated pain in the last month, headache was the most predominant for 74.7% of all adolescent patients and for 19.6% of females, compared with 5.7% of males, again increasing with age. The use of non-prescription painkillers to manage the associated pain was reported by 57% of the patients.

Older adolescent females were more likely to use non-prescription painkillers and reported overall more pain and a lower sense of personal well-being. Regarding well-being, 17.3% of females and 11.6% of males reported decreased interest in activities or less joy in doing things. The well-being reports overall reflected views similar to those of the general population, and the researchers noted that their findings contrasted with previous research indicating a significantly worse quality of life for adolescents with TMD.

When asked to rate their general health, just 3.2% of those surveyed said that they were in bad or very bad health and 56.9% reported very good health. General health was noted to have a negative correlation with pain intensity and duration, pain upon oral function, facial pain, the use of non-prescription drugs, and headaches.

The researchers hope that their study will aid dentists, dental hygienists and general medical practitioners in the early identification and diagnosis of TMJ-related pain and thereby prevent chronic pain development that could potentially lower quality of life.

The study, titled “Temporomandibular pain and quality of life assessment in adolescents in a Norwegian cohort”, was published online in Clinical and Experimental Dental Research on 26 May 2023.

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