Relationship assessment between mood disorders, headaches, and temporomandibular disorders in healthcare workers post-COVID-19 pandemic

Objectives: To evaluate the relationship between depression, anxiety, and stress levels, headaches, and symptoms of temporomandibular joint disorders in healthcare professionals in a post-pandemic setting. Method(s): A cross-sectional study conducted through an online questionnaire was distributed among healthcare professionals in Mainland Portugal. The sample's characterization was undertaken according to sociodemographic parameters. The following assessment instruments were used: 21-item Depression, Anxiety, and Stress Scale (DASS-21) for emotional parameters, namely depression, anxiety, and stress;International Classification of Headache Disorders (ICHD-3) for headache disorders;Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for temporomandibular joint dysfunction symptoms. Inferential analysis was performed using phi, Cramer's V, and gamma tests. Result(s): The sample comprised 118 individuals (93.2% female, 6.8% male). Results showed a prevalence of 38.1% for depression, 51.7% for anxiety, and 39.8% for stress. Regarding headaches, a prevalence of 62.7% was reported. Symptoms of temporomandibular disorders had a prevalence of 50%. Significant differences were found between headache and stress (p=0.034), headache and temporomandibular joint disorders symptoms (p=0.002), and symptoms of temporomandibular disorders and depression (p=0.009), anxiety (p=0.003), and stress levels (p=0.014). Conclusion(s): There seems to be a positive correlation between headaches and stress levels, between temporomandibular disorders symptoms and all psychosocial parameters, and between temporomandibular disorder symptoms and headaches. Data suggests that these symptoms worsened after the pandemic.Copyright © 2023 Sociedade Portuguesa de Estomatologia e Medicina Dentaria. Published by SPEMD.

The influence of the COVID-19 pandemic, sex, and age on temporomandibular disorders subtypes in East Asian patients: a retrospective observational study.

BACKGROUND: Despite its major existential, societal, and health impacts, research concerning the COVID-19 pandemic and Temporomandibular disorders (TMDs) is still limited. This study examined the effect of the pandemic on TMD subtypes and elucidated the influence of the pandemic, sex, and age on the prospect of pain-related (PT) and/or intra-articular (IT) TMDs in East Asian patients. METHODS: Data were accrued from consecutive new patients attending two university-based TMD/orofacial pain clinics in China and South Korea, 12 months before (BC; Mar 2019-Feb 2020) and during (DC; Mar 2020-Feb 2021) the COVID-19 pandemic. TMD diagnoses were derived from pertinent symptoms, signs, and radiographic findings according to the Diagnostic Criteria for TMDs (DC/TMD) methodology. Patients were subsequently categorized into those with PT, IT, and combined TMDs (CT) and also stratified by attendance period, sex, and age groups (adolescents/young adults [AY] and middle-aged/older adults [MO]) for statistical analyses using Chi-square/Mann-Whitney U tests and logistic regression analyses (α = 0.05). RESULTS: The BC and DC groups comprised 367 (75.2% females; 82.8% AY) and 471 (74.3% females; 78.3% AY) patients correspondingly. No significant differences in sex and age group distributions were observed. The DC group had significantly more PT/IT conditions with higher prevalence of myalgia, headache, and degenerative joint disease than the BC group. Univariate analyses showed that PT/CT was associated with sex and age, whereas IT was related to the pandemic and age. However, multivariate analyses indicated that the odds of PT were affected by sex (OR = 2.52) and age (OR = 1.04) while the odds of IT (OR = 0.95) and CT (OR = 1.02) were influenced by age only. CONCLUSIONS: The COVID-19 pandemic, as an impact event, did not influence the prospect of PT and/or IT. Sex and age appeared to play more crucial roles in the development of PT and IT/CT respectively.

Protective masks during the SARS-CoV-2 pandemic: Any relationship with temporomandibular disorders and orofacial pain?

BACKGROUND: Wearing protective face masks has been one of the indispensable measures to prevent droplets and aerosol particles transmission during the SARS-CoV-2 pandemic. OBJECTIVES: This observational cross-sectional survey investigated the different types and modalities of protective mask wearing and the possible association with referred signs of temporomandibular disorders and orofacial pain by respondents. METHODS: An online questionnaire was developed, calibrated and administered anonymously to subjects with an age of ≥18 years. It consisted of different sections: demographics, type and wearing modalities of the protective masks, pain in the preauricular area, noise at the temporomandibular joints and headache. Statistical analysis was performed using statistical software STATA. RESULTS: The questionnaire received 665 replies mainly from participants aged between 18 and 30 years (315 males and 350 females). The healthcare professionals were 37% of participants, 21.2% of them were dentists. The Filtering Facepiece 2 or 3 (FFP2/FFP3) mask was used by 334 subjects (50.3%), and 578 (87%) wore the mask with two elastics behind the ears. Pain while wearing the mask was referred by 400 participants, and 36.8% of them referred pain with a consecutive use of more than 4 h (p = .042). 92.2% of participants did not report any preauricular noise. Headache associated with the FFP2/FFP3 was referred by 57.7% of subjects (p = .033). CONCLUSION: This survey highlighted the increased referred the presence of discomfort in the preauricular area and headache possibly associated with a prolonged use of protective face masks for more than 4 h during the SARS-CoV-2 pandemic.

Impact of COVID-19 on Portuguese Dental Students: A Cohort Study.

INTRODUCTION: The goal of this study was to assess the impact of COVID-19 on Portuguese dental students on their depression, anxiety, temporomandibular dysfunction, academic degree, and oral behaviors. METHODS: The target of this population study was to enroll third-, fourth-, and fifth-year students of the Integrated Master's degree in Dental Medicine at the Universidade Católica Portuguesa-Faculty of Dental Medicine (Viseu, Portugal) in the academic year 2021-2022. Temporomandibular disorders (TMD) symptoms, oral behaviors, anxiety, and depression were assessed using validated questionnaires. The variables under study were (a) age, gender, marital status, academic level, academic degree, medication, and any existing pathologies; (b) questions related to taste changes or thoughts that would indicate (or not) worsening psychological conditions (anxiety and depression). After data collection (Google Forms®), data were transferred to an Excel file and entered into SPSS® software. A chi-square test allowed the independence between ordinal or nominal variables. The Spearman correlation test was used to analyze the relationship between variables in the study (significant if p ≤ 0.05). RESULTS: 98.2% of the students answered the questionnaire. TMD had a prevalence of 35%, and anxiety and depression a prevalence of 29% and 24%, respectively. The results showed that the female gender was the most affected by psychological and temporomandibular disorders. Statistically significant correlations were identified between variables, such as gender and anxiety, TDM, and depression (respectively, p = 0.0001, p = 0.014, and p = 0.026); between TDM and anxiety and depression (respectively, p = 0.001 and p < 0.001); and between performing oral behaviors and TMD, anxiety, and depression (respectively, p = 0.0001, p = 0.0001, and p = 0.006). The variables, such as age and academic degree, did not establish a statistically significant relationship with TMD, oral behaviors, and the two psychological conditions. CONCLUSIONS: It was possible to conclude that there was a moderate prevalence of TMD, anxiety, and depression in the period studied. Moreover, a statistically significant relationship was found between TMD, anxiety, and depression with gender and frequency of OBs; however, no significant association was found for TMD, anxiety, and depression with the age of students and with the academic degree.

The Association between COVID-19 Related Anxiety, Stress, Depression, Temporomandibular Disorders, and Headaches from Childhood to Adulthood: A Systematic Review.

Objective: The coronavirus belongs to the family of Coronaviridae, which are not branched single-stranded RNA viruses. COVID-19 creates respiratory problems and infections ranging from mild to severe. The virus features mechanisms that serve to delay the cellular immune response. The host's response is responsible for the pathological process that leads to tissue destruction. Temporomandibular disorders are manifested by painful jaw musculature and jaw joint areas, clicks, or creaks when opening or closing the mouth. All these symptoms can be disabling and occur during chewing and when the patient yawns or even speaks. The pandemic situation has exacerbated anxieties and amplified the vulnerability of individuals. Therefore, from this mechanism, how the COVID-19 pandemic may have increased the incidence of temporomandibular disorders is perceived. The purpose of this review is to evaluate whether COVID-19-related anxiety has caused an increase in temporomandibular dysfunction symptoms in adults to children. Methods: PubMed, Web of Science, Lilacs, and Scopus were systematically searched, until 30 July 2022, to identify studies presenting: the connection between COVID-19 with temporomandibular disorders. Results: From 198 papers, 4 studies were included. Literature studies have shown that the state of uncertainty and anxiety has led to an increase in the incidence of this type of disorder, although not all studies agree. Seventy-three studies were identified after viewing all four search engines; at the end of the screening phase, only four were considered that met the PECO, the planned inclusion, and the exclusion criteria. All studies showed a statistically significant correlation between temporomandibular disorders and COVID-19 with a p < 0.05. Conclusions: All studies agreed that there is an association between COVID-19 and increased incidence of temporomandibular disorders.

The impact of the COVID-19 pandemic on orofacial pain practice: Perceptions from a convenience sample of orofacial pain practitioners.

BACKGROUND: COVID-19 has had a substantial impact on people's lives. Increasing evidence indicates that patients with chronic pain particularly are being affected; however, few articles have examined how the pandemic has affected the care or clinical presentation of patients with orofacial pain. The aim of this study was to describe COVID-19-related changes in referral patterns and numbers, in patient demographics, in patients' seeking treatment for problems, and in administrative procedures in 3 orofacial pain clinical settings. METHODS: Practitioners participating in the American Academy of Orofacial Pain webinar titled "Practicing Orofacial Pain, Headache, and Sleep Care During the COVID-19 Pandemic" completed a voluntary anonymous online survey. Survey respondents completed general questions related to their orofacial pain practices and about perceptions of their patients' symptoms. For statistical analysis, the authors calculated frequencies and used analysis of variance for continuous variables or Likert scale variables and the χ2 test for dichotomous or categorical variables. Statistical significance was set at P value of .05 or below. RESULTS: Practitioners noted an increase in new patients with orofacial pain. Of the participants, 33% indicated the onset of their patients' pain was often or extremely often related to COVID-19. The 5 most common symptoms that providers felt were aggravated in their patients were masticatory muscle myalgia, anxiety, tension-type headache, bruxism, and insomnia or fragmented sleep. CONCLUSION: The COVID-19 pandemic has resulted in a marked increase in the number of patients seeking consultation for orofacial pain and associated symptoms. PRACTICAL IMPLICATIONS: Because of the COVID-19 pandemic, orofacial pain practitioners have noticed an increase in orofacial pain symptoms across practice settings.

Prevalence of self-reported symptoms of temporomandibular disorders and associated factors in the period of distance learning.

OBJECTIVE: Assess the prevalence of self-reported TMD symptoms and anxiety and check the quality of sleep and life during the distance learning period in university students at the University of Brasilia (UnB). MATERIALS AND METHODS: The participants were students from the Health Sciences College and Medicine College at UnB. Self-administered questionnaires were used to evaluate symptoms of TMD, quality of life, and sleep quality. One-way analysis of variance, followed by Bonferroni test, and Kruskal-Wallis test, followed by Dunn's test, were performed (P < 0.05). For qualitative data analysis, the chi-square test was applied (P < 0.05). RESULTS: Total 156 students were included; prevalence of TMD, anxiety, sleep disturbance, and poor sleep quality was 73.1%, 84%, 12.8%, and 62.8%, respectively. A greater prevalence of painful TMD was observed in students with severe anxiety (P = 0.007). Students with symptoms of painful TMD, severe anxiety, and sleep disorders had statistically worse quality of life. CONCLUSIONS: The implementation of distance learning in health courses to replace classroom teaching during the COVID-19 pandemic has impacted TMD prevalence, anxiety, quality of life, and sleep quality. CLINICAL RELEVANCE: Psychological factors are directly associated with TMD symptoms and quality of life, TMD conditions are related to quality of life as well. COVID-19 pandemic and the distance learning in health courses are new situations that can lead to a great impact on mental health and in consequence to TMD conditions and quality of life.

How Confinement and Back to Normal Affected the Well-Being and Thus Sleep, Headaches and Temporomandibular Disorders.

The COVID-19 pandemic is having negative consequences not only for people's general health but also for the masticatory system. This article aimed to assess confinement and its new normal impact on well-being, sleep, headaches, and temporomandibular disorders (TMD). An anonymous survey was distributed to a Spanish university community. Participants completed a well-being index (WHO-5), a questionnaire related to sleep quality (the BEARS test), a headache diagnostic test (the tension type headache (TTH) and migraine diagnosis test), and the DC-TMD questionnaire. Questions were addressed in three scenarios: before confinement, during confinement, and the new normal. A total of 436 responses were collected (70% women, 30% men). A reduction in well-being and sleep quality was recorded. Respondents reported more TTH and migraines during and after confinement. Overall, confinement and return to normal did not increase TMD symptoms, and only minor effects were observed, such as more intense joint pain and a higher incidence of muscle pain in women during confinement. Reduced well-being is correlated with sleep quality loss, headaches, and TMD symptoms. This study provides evidence that pandemics and confinement might have had a negative impact on population health. Well-being was strongly affected, as were sleep quality, depression risk, TTH, and migraine frequency. In contrast, the temporomandibular joint and muscles showed more resilience and were only slightly affected.

Orofacial and facial pain during the new coronavirus infection (COVID-19) pandemic. Choosing a non-steroid anti-inflammator – focus on nimesulide

Doctors of various specialties face orofacial and facial pain in their practice: dentists, maxillofacial surgeons, neurologists, neurosurgeons, otorhinolaryngologists, therapists, general practitioners, traumatologists, ophthalmologists, psychotherapists, physiotherapists, aesthetic medicine doctors, anesthesiologists, plastic surgeons and other specialists. The novel coronavirus infec-tion (COVID-19) pandemic, spread by the SARS-CoV-2 virus, has become a challenge for all medical specialties and health care systems around the world. The respiratory system is the dominant target of SARS-CoV-2. The oral mucosa is also highly susceptible to SARS-CoV-2 infection, due to the wide distribution of angiotensin-converting enzyme type II receptors in the oral cavity. We searched the literature for the period from the beginning of the pandemic until August 22, 2022, on the study of the association of orofacial pain with a new coronavirus infection COVID-19 in the electronic search engines PubMed and Scopus. Analysis of the found sources indicates an increase in the frequency of various types of orofacial pain associated with 1) violation of dentoalveolar and related structures during the COVID-19 pandemic;2) temporomandibular disorders;3) with damage or disease of the cranial nerves;and 4) like manifestations of primary headache. This growth is due both directly to the infection caused by SARS-CoV-2, its complications, and to a complex of biopsychosocial factors directly related to the pandemic. In the second part of the article, as part of the review, the possibility of using nimesulide for the treatment of orofacial and facial pain during the COVID-19 pandemic is discussed. The choice of nimesulide is supported by 1) the likely coadjuvant effect of nimesulide in the treatment of COVID-19;2) positive experience with the use of nimesulide in the treatment of facial and orofacial pain in the period preceding the COVID-19 pandemic;3) the safety of using nimesulide in comorbid patients, who are the main risk group for the development and severe course of COVID-19. © 2022, Remedium Group Ltd. All rights reserved.

The Prevalence and Predicting Factors of Temporomandibular Disorders in COVID-19 Infection: A Cross-Sectional Study.

Introduction During the pandemic of coronavirus disease 2019 (COVID-19), an increase in temporomandibular disorders (TMDs) was noticed in infected patients. In the present study, we aimed to assess the prevalence of TMDs during COVID-19 infection and to evaluate associated factors. Methods An observational cross-sectional online survey was conducted in April and May 2021 in order to estimate the prevalence of TMDs in participants who were previously infected with COVID-19. A multivariable logistic regression model was carried out to explore predicting factors of TMDs during COVID-19 infection. Results In total, the prevalence of TMDs during the COVID-19 infection period among participants was 41.9%. High fever episodes (adjusted odds ratio {aOR}: 3.25), gastro-esophageal reflux (aOR: 2.56), and toothache (aOR: 3.83) during COVID-19 illness were found to be positive predictors of TMDs, while vitamin D deficiency was found to be a negative predictor (aOR: 0.28). Conclusion Our study has highlighted a relatively high prevalence of TMDs in COVID-19-infected patients that may conclude TMDs as a possible COVID-19 symptom. Further studies are warranted to confirm the association between TMDs and COVID-19 infection and thereupon include TMDs among the known symptoms of COVID-19.

The utility of telemedicine in orofacial pain: Guidelines for examination and a retrospective review at a hospital-based practice.

BACKGROUND: Following the onset of the COVID-19 pandemic, telemedicine has become rapidly implemented into both medical and dental practices. While guidelines for examination through telemedicine have been described in similar fields of oral medicine and neurology, the framework for a comprehensive telemedicine examination for a patient with symptoms of orofacial pain has not yet been described. OBJECTIVE: The objective of this study is to introduce the format of a telemedicine examination for a new patient with orofacial pain as well as describe the success and utility of a telemedicine consultation in a hospital-based orofacial pain practice. METHODS: A retrospective review was performed of all new telemedicine consults from April 2, 2020, to March 29, 2021. Medical records were reviewed for patient demographics as well as details of the initial telemedicine consult and in-office follow up. RESULTS: Two hundred seventy new patients were seen. The most common diagnoses were myofascial pain of the masticatory muscles (37%), an articular disc disorder of the TMJ (21%), and TMJ arthralgia (16%), followed by obstructive sleep apnea (9%) and neuropathic orofacial pain (6%). 146 patients returned to the clinic for an in-office follow up, 78.8% of which had an accurate telemedicine diagnosis. Difficulty discerning between masticatory myofascial pain and TMJ arthralgia was the most common reason for inaccuracy during the telemedicine diagnosis. CONCLUSIONS: Telemedicine consultation for patients with orofacial pain can help facilitate an accurate diagnosis and expedite treatment for patients who face challenges presenting for an in-office consultation.

Temporomandibular Disorders, Bruxism, Perceived Stress, and Coping Strategies among Medical University Students in Times of Social Isolation during Outbreak of COVID-19 Pandemic.

The COVID-19 pandemic caught universities along with their students off-guard, enforcing online education. Fear of the unknown, disinformation, and isolation resulted in an increased stress level in the entire population. Medical university students are particularly endangered with high stress levels and developing TMD. Temporomandibular disorders (TMD) are of multifactorial etiology, and manifest with jaw dysfunction, masticatory muscle tension or pain, as well as headache. Though bruxism can act as an exacerbating factor for TMD, stress can also play crucial role in the onset. The study aimed to measure occurrence of TMD and bruxism symptoms in the medical student population, asses the stress level, and evaluate adopted stress-coping strategies during the COVID-19 pandemic outbreak. A survey study was performed among 1018 students at Medical University of Lodz during April 2020. A self-designed questionnaire for screening TMD and bruxism symptoms, Perceived Stress Scale (PSS-10), and Brief-COPE questionnaires were applied. TMD and bruxism symptoms were observed in the majority of subjects during social isolation. The perceived stress levels were significantly higher in those experiencing TMD and bruxism symptoms. Mostly maladaptive, emotion-focused coping strategies were chosen by study subjects experiencing high levels of stress. Choosing Self-Blaming as a coping strategy is the strongest predictor of perceived stress.

Difference in the occurrence and intensification symptoms of stomatognathic system between women and men in medical staff working with patients infected with COVID-19.

BACKGROUND: One of the groups most exposed to potentially harmful effects of the current pandemic on physical and mental health is medical personnel, in particular those working directly with patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or suffering from coronavirus disease 2019 (COVID-19). OBJECTIVES: The response of the body to a persisting threat, constant contact with dying people and frequent deaths of patients is chronic stress syndrome. Its symptoms may take the form of psychosomatic or somatic reactions. The aim of the study was to determine the effect of stress on the severity of temporomandibular syndrome (TMD) in medical personnel. MATERIAL AND METHODS: The study included a group of 160 people - 120 women and 40 men aged 35-60 years, working at the hospital wards as doctors, nurses and support staff, directly with patients infected with SARS-CoV-2 and suffering from COVID-19. The research was conducted in the form of a cross-sectional survey with the use of anonymous questionnaire. The final questionnaire was developed based on the tools commonly used for TMD, bruxism, anxiety, and depression assessment - 8Q/TMD and the Patient Health Questionnaire-8 (PHQ-8). RESULTS: After checking the significance of differences in responses to individual questions among men and women and applying the Bonferroni correction for multiple comparisons, Fisher's test and p-values for individual responses, an increase in pathological reactions was shown. The results showed that the COVID-19 pandemic has caused significant adverse effects on the psychoemotional status and causes or aggravates TMD symptoms. CONCLUSION: The aggravation of the psychoemotional status caused by the COVID-19 pandemic can result in intensification of TMD symptoms and other symptoms in the stomatognathic system in medical staff working with patients infected with COVID-19.

Impact of the COVID-19 Pandemic on Stress, Sleep, and Oral Health in University Students.

Background: The COVID-19 pandemic, a disease caused by Sars-CoV-2, has become a worldwide stressor, especially as it represents a new viral infection, which spreads quickly and easily, without prior knowledge about vaccination, and absence, to this moment, of a medication that is totally effective against the disease. Objective: The aim of this observational study was to provide a general evaluation, through a questionnaire applied to students in the health field of the Federal University of Rio de Janeiro, on the psychological impacts and behavioral changes generated by the COVID-19 pandemic on oral health, especially the triggering or exacerbation of bruxism and temporomandibular disorders (TMD). Methods: In order to verify the impacts of the pandemic on the health of UFRJ healthcare students, a non-randomized survey was performed with 370 students. Results: It was found that 72% of the students had their sleep routine altered, 65% had greater difficulty in keeping their spirits up, there was a statistically significant increase in emotional stress, headaches, and daytime teeth clenching. Conclusion: It was possible to conclude that the outbreak of COVID-19 resulted in psychological, physiological and behavioral impacts on students.

Painful Temporomandibular Disorders, Bruxism and Oral Parafunctions before and during the COVID-19 Pandemic Era: A Sex Comparison among Dental Patients.

AIM: To evaluate the effect of the current coronavirus pandemic on the prevalence of bruxism, oral parafunctions and painful Temporo-Mandibular Disorders (TMDs) and to evaluate the influence of the pandemic on both sexes. METHODS: This retrospective study included 288 dental patients who underwent complete anamnesis and examination according to the Diagnostic Criteria for TMD. The study evaluated two patient populations according to the date of examination: (a) pre-COVID-19 pandemic era (108 patients); (b) COVID 19 pandemic era, where 180 patients were examined during the pandemic. RESULTS: A significant increase in parafunction activity was found in both men and women (p < 0.001) during the COVID-19 pandemic. Awake bruxism (AB) and sleep bruxism (SB) was more prevalent during the COVID-19 pandemic solely in women (AB-p < 0.001; SB-p = 0.014). CONCLUSIONS: Men and women were affected by the ongoing stress due to the COVID-19 pandemic, yet women showed a higher influence as compared to men. The long-term exposure to elevated levels of anxiety and stress may aggravate or trigger stomatognathic detrimental conditions. Dentists should be aware and regularly monitor their patients regarding the possible existence and consequences of bruxism and TMD.

COVID-19 and Its Repercussions on Oral Health: A Review.

In 2019, a new type of coronavirus, SARS-CoV-2, the causing agent of COVID-19, was first detected in Wuhan, China. On 11 March 2020, the World Health Organization declared a pandemic. The manifestations of COVID-19 are mostly age-dependent and potentially more severe in cases with involved co-morbidities. The gravity of the symptoms depends on the clinical stage of the infection. The most common symptoms include runny nose and nasal congestion, anosmia, dysgeusia or hypogeusia, diarrhea, nausea/vomiting, respiratory distress, fatigue, ocular symptoms, diarrhea, vomiting, and abdominal pain. These systemic conditions are often accompanied by skin and mucosal lesions. Oral lesions reported in patients with COVID-19 include: herpex simplex, candidiasis, geographic tongue, aphthous-like ulcers, hemorrhagic ulcerations, necrotic ulcerations, white hairy tongue, reddish macules, erythematous surfaces, petechiae, and pustular enanthema. It is still unclear if these manifestations are a direct result of the viral infection, a consequence of systemic deterioration, or adverse reactions to treatments. Poor oral hygiene in hospitalized or quarantined COVID-19 patients should also be considered as an aggravating condition. This narrative review is focused on presenting the most relevant data from the literature regarding oral manifestations related to SARS-CoV-2, as well as the challenges faced by the dental system during this pandemic. A routine intraoral examination is recommended in COVID-19 patients, either suspected or confirmed, as, in certain cases, oral manifestations represent a sign of severe infection or even of a life-threatening condition. It is our belief that extensive knowledge of all possible manifestations, including oral lesions, in cases of COVID-19 is of great importance in the present uncertain context, including new, currently emerging viral variants with unknown future impact.

COVID-19 pandemic and the psyche, bruxism, temporomandibular disorders triangle.

OBJECTIVE: To investigate the effect of the Coronavirus pandemic on the report of psychological status, bruxism, and TMD symptoms. METHODS: An online survey was drafted to report the presence of psychological status, bruxism activities, and reported symptoms of TMDs perceived during the COVID-19 pandemic in a population of 506 individuals. RESULTS: Mental health is not positive during the Coronavirus pandemic: almost half the subjects reported an increase in bruxism behaviors, while up to one-third reported an increase in their symptoms involving the TMJ and jaw muscles. Specifically, 36% and 32.2% of participants reported increased pain in the TMJ and facial muscles, respectively, and almost 50% of the subjects also reported more frequent migraines and/or headaches. CONCLUSION: Increased psychosocial distress during the COVID-19 pandemic can increase the frequency of TMD symptoms and bruxism behaviors, which, in turn, constitute a triangle of mutually interacting factors with the psychological and emotional status.

COVID-19 pandemic and Zagreb earthquakes as stressors in patients with temporomandibular disorders.

OBJECTIVE: To evaluate stress effect of COVID-19 pandemic and Zagreb earthquakes on symptoms of temporomandibular disorders (TMD). MATERIALS AND METHODS: One hundred and two previously diagnosed TMD patients were contacted by email to participate in an online survey about impact of those events on current and/or new symptoms, perceived stress, anxiety and symptom intensity in time-points at the baseline, following pandemic and following earthquake. We compared data between earthquake-affected and non-affected respondents. RESULTS: Response rate was 79.4%. Effects stress had on deterioration of symptoms were significantly different between earthquake-affected and non-affected (p = .024). In earthquake-affected, numerical pain rating scale (NPRS) scores significantly increased between baseline and after COVID-19 (p > .001) and between baseline and after earthquakes (p > .05). However, scores insignificantly dropped from COVID-19 to after earthquakes time-points. In earthquake-affected, positive correlation was found between impact of COVID-19 on stress and NPRS (p < .001) and between earthquakes' impact on stress and NPRS (p < .001). Earthquake-affected respondents reported significantly more new behavioral habits when compared to non-affected (p = .048). CONCLUSIONS: A series of stressful events do not necessarily have a cumulative effect, but are likely to have a complex interaction (e.g., acute stress might trigger the protective mechanisms), which could have decreased pain scores after the earthquakes.

One year into the COVID-19 pandemic - temporomandibular disorders and bruxism: What we have learned and what we can do to improve our manner of treatment.

The coronavirus disease 2019 (COVID-19) pandemic has drastically changed the routine way of life and challenged the ways in which health and dental services are provided. During the 1st lockdown, practiced in most of the countries, routine dental procedures were suspended. Even after the lockdown was eased, visiting crowded dental clinics was still considered health-threatening, especially among populations at high risk of developing a severe reaction to COVID-19. Regretfully, in most cases, temporomandibular disorders (TMD) and bruxism were not included under the definition of emergency, leaving many patients without the possibility of consulting their dentists. A literature search, performed about 10 months after the declaration of the pandemic, found only a few studies dealing with TMD and bruxism during COVID-19. Most of the studies indicate adverse effects on subjects' psycho-emotional status (stress, anxiety, depression), which in turn lead to the intensification of subjects' TMD and bruxism symptoms, and increased orofacial pain. Unlike other oral pathologies, which require manual interventions, chronic orofacial pain can be addressed, at least at its initial stage, through teledentistry and/or consultation. Remote first aid for patients suffering from orofacial pain includes various kinds of treatment, such as the self-massage of tense and painful areas, stretching, thermotherapy, drug therapy, relaxation techniques, meditation, and mindfulness, all of which can be administered through the phone and/or the Internet. Relevant legal and ethical issues should be considered while using remote modes for the triage, diagnosis and treatment of chronic orofacial pain patients.