Temporomandibular disorders and associated comorbidities among brazilian dental students during COVID-19

Aim: This study aimed to assess the prevalence of temporomandibular disorders (TMD) and psychosocial comorbidities in undergraduate dental students in a southern Brazilian university, during the COVID-19 pandemic. Also, it aimed to verify the association between psychosocial factors and TMD. Methods: Fonseca Anamnestic Index, Depression Anxiety Stress Scale (DASS-21), a socioeconomic questionnaire, and questions about academic performance and social distancing were applied. Poisson regression analysis was used to assess the association of predictive variables with TMD. Results: The prevalence of TMD was found to be 82.4%, and more than half of the students had some degree of stress, anxiety, and depression. Students who had symptoms of stress (RR 1.11; 95% CI 1.04-1.19), anxiety (RR 1.19; 95% CI 1.12-1.27) and reported academic performance worsening (RR 1.12; 95% CI 1.07-1.19) had higher TMD scores. Conclusion: The findings suggest that TMD was highly prevalent among dental students at a federal university in southern Brazil during the pandemic, being associated with high levels of stress, anxiety, poor academic performance, and greater social distancing

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.

Clinical factors affecting depression in patients with painful temporomandibular disorders during the COVID-19 pandemic.

Temporomandibular disorders (TMD) are a multifactorial condition associated with both physical and psychological factors. Stress has been known to trigger or worsens TMD. We aimed to investigate whether the novel coronavirus disease-2019 (COVID-19) pandemic aggravates depression in patients with painful TMD, and the factors that affect their level of depression. We included 112 patients with painful TMD (74 females, 38 males; mean age: 35.90 ± 17.60 years; myalgia [n = 38], arthralgia [n = 43], mixed joint-muscle TMD pain [n = 31]). TMD was diagnosed based on the Diagnostic Criteria for TMD Axis I. Physical pain intensity was recorded using the visual analog scale (VAS); psycho-emotional status (depression: Beck Depression Inventory [BDI], anxiety: Beck Anxiety Inventory [BAI], and generalized stress related to COVID19: Global Assessment of Recent Stress [GARS]) was investigated twice (before [BC] and after COVID-19 [AC]). Additionally, factors affecting BDI-AC were investigated. BDI (p < 0.001), BAI (p < 0.001), GARS (p < 0.001), and VAS (p < 0.01) scores were significantly increased at AC than BC. The depression, anxiety, and stress levels were significantly positively correlated, and the AC and BC values of each factor showed a high correlation. In the mixed TMD group, BDI-AC was positively correlated with VAS-AC (p < 0.001). In the multiple regression analysis, clenching habit was the strongest predictor of an increase in the BDI scores from moderate to severe, followed by psychological distress, muscle stiffness, female sex, BAI-AC, and TMJ sounds. COVID-19 has negatively affected the psycho-emotional state of patients with painful TMD, and several clinical factors, including female sex and clenching habits, have influenced depression.

Influence of the COVID-19 pandemic on pain and oral health-related quality of life in women with temporomandibular disorder.

OBJECTIVE: This study aimed to evaluate and compare pain intensity and Oral Health-related Quality of Life (OHRQoL) in women with temporomandibular disorder (TMD) before (T1) and during (T2) COVID-19 pandemic. MATERIALS AND METHODS: Sample was composed of forty-one female participants with painful TMD, who presented for TMD treatment. Subjects were asked to indicate their pain intensity and to answer the Oral Health Impact Profile-14 (OHIP-14). Participants data were collected twice: T1 (evaluation of medical records fulfilled before COVID-19 pandemic) and T2 (by means of an online form). Socio-demographic data were assessed in T1. Statistical analysis was performed with a significance level of 5% (Wilcoxon, chi-square or Fisher's exact tests, multiple linear regressions). RESULTS: No difference was found in pain intensity (p=0.26) and OHIP-14 global scores (p=0.53). Physical pain (p=0.03) and social disability (p=0.05) domains improved. In T1, subject's occupation was associated with OHIP-14 global score, physical pain, and physical disability domains. In T2, age was associated with OHIP-14 global scores as well as physical pain, psychological discomfort, and psychological disability domains. CONCLUSION: COVID-19 pandemic did not worsen pain intensity and OHRQoL in women with painful TMD, and it is suggested that socio-demographic characteristics influenced TMD patients coping skills during pandemic.

The Influence of SARS-CoV-2 Pandemic on TMJ Disorders, OSAS and BMI.

The pandemic of the 21st century had a significant influence on the lives of the world population in a negative way. This situation determined a change of lifestyle; it caused the necessity of social isolation for a great number of people. In fact, people tended to avoid crowded environments, social events, to reduce medical checks and sports activities, favoring sedentary life because of fear of the virus. This social attitude brought a high level of stress that worsened many health conditions. This study has the aim of evaluating the possible influence of the pandemic on temporomandibular joint (TMJ) disorders, obstructive sleep apnea syndrome (OSAS) and body mass index (BMI). An anonymized survey, available in two languages (Italian and English), was given to 208 patients from different private dental practices. In this questionnaire, the patients shared experiences about their life during the pandemic. The article highlighted that during this health emergency, there was an increase in body weight in the considered sample. This brought a worsening of OSAS in 65% of patients with a previous diagnosis. Eventually, an increase in TMJ disorders and orofacial pain was reported.

Associations between Bruxism, Stress, and Manifestations of Temporomandibular Disorder in Young Students.

Bruxism is a repetitive activity of the masticatory muscles, which determine teeth grinding or clenching, associated with rigidity, bracing, or thrusting of the mandibula. The aim of this study was to determine the prevalence of possible bruxism in 328 students attending the Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, and its associations with stress and other manifestations of the temporo-mandibular disorder. This was a questionnaire-based study to collect information on self-evaluation of bruxism presence, frequency of specific episodes, stress, anxiety, and other manifestations of temporo-mandibular disorder. Self-evaluated bruxism was identified in 39.33% from the entire study group, allowing us to define two subgroups for further analysis. Sleep bruxism was present in 16.28% of participants; awake bruxism was present in 68.99%, while 14.73% of participants presented a combined form. The main manifestation of bruxism was reported as teeth grinding. Fatigue was identified as a common clinical sign of bruxism and temporo-mandibular disorder. Group distribution analysis (Chi-Square) indicated significant associations between bruxism and stress, panic, restlessness, or increased stress during the COVID-19 pandemic (p < 0.05). Bruxism, and especially awake bruxism, has increased in prevalence among young students, and it has been associated with increased levels of stress.

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.

The Impact of SARS-CoV-2 Outbreak on the Polish Dental Community's Standards of Care-A Six-Month Retrospective Survey-Based Study.

Currently, SARS-CoV-2 is the primary pathogen worldwide, disrupting most of our everyday activities. The study aim was to evaluate its impact on the Polish dental community, standards of care, health, and welfare. METHODS: A Google Forms survey was conducted among 303 dental practitioners. RESULTS: Of respondents, 54.93% curbed the number of patients in the last six months, 34.21% declared no changes, and 10.86% reported an increase; whereas 70.7% of the respondents reported a treatment price increase within the same period (27.96% and 1.32% reported no changes and a decrease, respectively). Of the respondents, 15.5% did not close their businesses during the first wave of the pandemic. Most declared 1 or 2 month break, 30.7% and 34.7%, respectively. Some reported 3, 4, or 5 month breaks (15.84%, 1.32%, and 0.99%, respectively), and only two respondents (0.66%) did not admit patients at all. Headache episodes were more frequent among female dentists before the pandemic; after the pandemic, headache frequency increased among both sexes. Temporomandibular disorders (TMDs) were more frequent among women (p = 0.017). CONCLUSIONS: Most Polish dentists followed SARS-CoV-2 recommendations and restricted their practices to admitting only patients with pain or incomplete treatment. Decreased sleep parameters, head, back, and neck pain, were observed. This situation may affect dental health conditions in Polish society over time.

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.

Association of sleep quality and psychological aspects with reports of bruxism and TMD in Brazilian dentists during the COVID-19 pandemic.

BACKGROUND: Dentists are exposed to contamination by SARS-CoV-2 due to dental interventions, leading to a state of alert and potential risk of negative impact in mental health and sleep quality, associated with Temporomandibular Disorder (TMD) and bruxism. OBJECTIVE: to evaluate the psychosocial status, sleep quality, symptoms of TMD, and bruxism in Brazilian dentists (DSs) during the COVID-19 pandemic. METHODOLOGY: The sample (n=641 DSs) was divided into three groups (quarantined DSs; DSs in outpatient care; and frontline professionals), which answered an electronic form containing the TMD Pain Screening Questionnaire (Diagnostic Criteria for Temporomandibular Disorders - DC/TMD), the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety and Stress Scale (DASS-21), and the sleep and awake bruxism questionnaire. ANOVA test and Mann Whitney post-test were used, with Bonferroni adjustment (p<0.016) and a 95% confidence level. RESULTS: Probable TMD was found in 24.3% (n=156) of the participants, while possible sleep and awake bruxism were diagnosed in 58% (n=372) and 53.8% (n=345) of them, respectively. Among all variables evaluated, only symptoms of depression were significantly greater in the quarantined DSs group when compared to those who were working at the clinical care (p=0.002). Working DSs were significantly less likely (OR=0.630, p=0.001) to have depressive symptoms. Those who were not worried or less worried about the pandemic were less likely to experience stress (OR=0.360), anxiety (OR=0.255), and poor sleep quality (OR=0.256). Sleep had a strong positive and moderate correlation with psychological factors on frontline workers and DSs in outpatient care, respectively. CONCLUSION: The results suggest confinement may have a more negative impact on the life of DSs than the act of being actively working. The concern about Covid-19 and poor sleep quality was significantly prevalent and may negatively affect the quality of life of DSs. Thus, further research on the topic is needed.