To what extent are the characteristics of painful temporomandibular disorders predictors of self-reported limitations in jaw function?

OBJECTIVE: The study evaluated the extent to which the source, intensity, and duration of temporomandibular disorder (TMD) pain are predictors of limitations in jaw function. METHODS: The sample included 166 subjects (12-69 years) who self-administered the Jaw Function Limitation Scale (JFLS) and underwent clinical examinations. RESULTS: In univariate correlations, global limitation (long-form JFLS) as well as mastication, mobility, and communication had the highest correlation with headache attributed to TMD (r = 0.362-0.415; p < 0.001). Correlation was higher for pain intensity than chronicity. In multiple regression analysis, significant predictors of jaw limitations (long-form JFLS) were only headache and increasing age (p < 0.001), when controlling for demographic variables, the characteristics of pain, source of pain, and presence of intraarticular disorders. DISCUSSION: Limitation in jaw function is influenced more by pain than by the intracapsular condition and even more so by pain intensity than chronicity.

Changes in quality of life induced by tooth whitening are not influenced by global self-esteem: a randomized double-blind placebo-controlled trial.

The purpose of this paper is to investigate which elements of tooth colour are most influenced by whitening and to identify the short-term changes in satisfaction with smile aesthetics and quality of life induced by tooth whitening and the role of global self-esteem. Sixty participants were randomly assigned to a treated or a placebo group (each group N = 30). Their anterior teeth were bleached with a photo-activated whitening gel, or subjected to a placebo. Lightness, chroma and the translucency of teeth were assessed before and 1 week after the procedure using a spectrophotometer. The Self-Esteem Scale, Psychosocial Impact of Dental Aesthetics Questionnaire, the Orofacial Aesthetic Scale and the Oral Health Impact Profile were administered to subjects. Changes in colour and chroma were greater in the treated than the placebo group (3.8 ± 1.5 vs. 1.7 ± 1.5 and - 3.2 ± 1.5 vs. 0.0 ± 1.1; p < 0.001). The treated group reported increased satisfaction with appearance and a decrease in psychological and social impacts (p < 0.05). In the placebo group there was no objective change in colour but the subjects reported an increase in satisfaction and dental self-confidence, as well as a decrease in psychological impact (p < 0.05). Self-esteem did not have a moderation nor a mediation effect. In conclusion, patients are not able to accurately detect the colour change induced by tooth whitening after 1 week, but they are also largely suggestible when evaluating the changes in quality of life. Changes in quality of life induced by tooth whitening are not influenced by global self-esteem.ClinicalTrials.gov Identifier NCT03380702.

Tooth Color as a Predictor of Oral Health-Related Quality of Life in Young Adults.

PURPOSE: Smiling plays an important role in social interaction. The purpose of this research was to explore the extent to which objective parameters of color of one's own teeth affected the social and emotional dimensions of young adults' lives. MATERIALS AND METHODS: The sample included 134 subjects-students of the University of Rijeka, Croatia (65% female) aged 19 to 28 years (median 21). All subjects had six intact maxillary anterior teeth without restorations or severe malocclusions and healthy gingiva with no signs of inflammation. Tooth color was assessed intraorally using a spectrophotometer. Lightness, chroma, and translucency of the right maxillary central incisors (the reference teeth) were calculated and used for analysis. Subjects reported dimensions of their oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile (OHIP), Orofacial Esthetic Scale (OES), and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Linear relationships between elements of tooth color and OHRQoL were explored using Pearson correlations. Multiple linear regression, while controlling for the influence of age and gender, was also calculated. ANOVA with a Tukey post hoc test was employed to test whether nonlinear relationships existed between OHRQoL and categories of color elements. RESULTS: Dental self-confidence, esthetic concerns, orofacial appearance, social impact and psychological impact were not related to lightness, chroma, or translucency of the subjects' teeth. Neither linear nor nonlinear relationships were detected between those aspects. Satisfaction with smile esthetics was only related to translucency where subjects with moderate translucency were least likely to be satisfied (p = 0.033). Women tended to report greater psychosocial impacts than men (p < 0.05), regardless of their tooth color. CONCLUSION: According to the results of this study objective, measurable, quantitative parameters of tooth color did not accurately predict psychosocial dimensions of OHRQoL in dentate young adults.

Changes in Quality of Life Induced by Tooth Whitening are Moderated by Perfectionism: A Randomized, Double-Blind, Placebo-Controlled Trial.

PURPOSE: To explore the influence of perfectionism on the short-term changes in satisfaction with smile esthetics and quality of life (QoL) induced by tooth whitening. MATERIALS AND METHODS: A total of 60 subjects were analyzed: 30 in the active group, in which the subject's anterior teeth were whitened with a photoactivated gel, and 30 in the placebo group. The Smile Esthetics-Related Quality of Life and Multidimensional Perfectionism Scale questionnaires were administered to all participants. RESULTS: The active group demonstrated an increase in dental self-confidence and a decrease in dissatisfaction with color (P < .05). The amount of color change did not correlate linearly with change in dissatisfaction or with QoL. In subjects with higher perfectionism, increasing the color change led to more decrease in dental self-consciousness. CONCLUSION: Perfectionism moderates perception of smile esthetics.

Smile Aesthetics Satisfaction Scale: development and validation of a new brief five-item measure of satisfaction with smile aesthetics in adults and the elderly.

OBJECTIVE: To create and validate a brief questionnaire designed for the assessment of satisfaction with smile aesthetics and to test its efficiency as a patient-centred outcome measure of aesthetic interventions in dentistry. MATERIALS AND METHODS: A team of three specialists - two from prosthodontics and one psychologist - used a self-evaluation scale consisting of five elements in order to rate self-perceived smile aesthetics. A total of 671 subjects (63% female), 18-86 years of age, were included in the investigation. The internal consistency, validity and stability of the questionnaire, along with the responsiveness induced by the tooth-whitening procedure, were evaluated. The relationship between self-perceived satisfaction with the smile aesthetics and the clinical status of the dentition was assessed. RESULTS: The questionnaire had one dimension accounting for 64.3% of variance and showed a high level of reliability (Cronbach α = 0.859). It measured a construct similar to concern with tooth appearance and the desire to improve this appearance (r = -0.403 and r = -0.353, respectively; P < 0.001). High test-retest reliability was demonstrated (intraclass correlation coefficient = 0.985). The questionnaire was able to detect an increase in satisfaction with smile aesthetics as a result of the tooth-whitening procedure (P = 0.016). Clinical predictors of greater satisfaction with smile aesthetics were greater tooth display when smiling, decreased chroma and the absence of gingivitis, as well as absence of crowded, fractured and restored teeth in the anterior segment. CONCLUSIONS: A new questionnaire, titled the Smile Aesthetics Satisfaction Scale (SASS), showed good psychometric properties and its use can be recommended.

Development and validation of a new condition-specific instrument for evaluation of smile esthetics-related quality of life.

OBJECTIVE: Orofacial esthetics raises psychosocial issues. The purpose was to create and validate new short instrument for psychosocial impacts of altered smile esthetics. MATERIALS AND METHODS: A team of an orthodontist, two prosthodontists, psychologist, and a dental student generated items that could draw up specific hypothetical psychosocial dimensions (69 items initially, 39 in final analysis). The sample consisted of 261 Caucasian subjects attending local high schools and university (26% male) aged 14 to 28 years that have self-administrated the designed questionnaire. Factorial analysis, Cronbach's alpha, Pearson correlation, paired samples t-test and analysis of variance were used for analyses of internal consistency, construct validity, responsiveness, and test-retest. RESULTS: Three dimensions of psychosocial impacts of altered smile esthetics were identified: dental self-consciousness, dental self-confidence and social contacts that can be best fitted by 12 items, 4 items in each dimension. Internal consistency was good (α in range 0.85-0.89). Good stability in test-retest was confirmed. In responsiveness testing, tooth whitening induced increase in dental self-confidence (P = 0.002), but no significant changes in other dimensions. CONCLUSION: The new instrument, Smile Esthetics-Related Quality of Life (SERQoL), is short and has proven to be a good indicator of psychosocial dimensions related to perception of smile esthetics. CLINICAL SIGNIFICANCE: Smile Esthetics-Related Quality of Life questionnaire might have practical validity when applied in esthetic dental clinical procedures.

A Cross-Sectional Study of the Influence of Tooth Color Elements on Satisfaction with Smile Esthetics.

PURPOSE: This study investigated the influence of tooth color on patients' satisfaction with the esthetics of their smiles. MATERIALS AND METHODS: A shade guide was used to determine the color of the maxillary anterior teeth in 671 participants. Self-reported satisfaction was assessed through five criteria: tooth appearance, color, shape, and position and appearance of the gingiva. The Psychosocial Impact of Dental Aesthetics Questionnaire and an Oral Impact on Daily Performances questionnaire were also used. RESULTS: The predictors of higher patient satisfaction were lower chroma, higher lightness, and uniform color of all maxillary anterior teeth. These are significant but weak predictors of satisfaction with smile esthetics. CONCLUSION: Color has a low level of influence on satisfaction with a smile's esthetics.

Predictors of Job Satisfaction in Dental Professionals of the Bosnia and Herzegovina Federation.

INTRODUCTION: Working in a healthy work environment is the ultimate goal of every employee. Dentistry is a stressful career, and the reasons for dissatisfaction are numerous. AIM: The aim of this study was to determine the factors of work satisfaction in dental professionals of the Bosnia and Herzegovina Federation. MATERIALS AND METHODS: A total of 134 dental professionals selected randomly from the Registry of Dental Chamber of Bosnia and Herzegovina Federation were included in the study. All of them filled out the Demographic Questionnaire and Job Satisfaction Scale (JSS). RESULTS: An increase in the influence of work on the quality of life as well as an increase in its frequency results in leaving the job and significantly reducing the overall job satisfaction. General dental practitioners are significantly more satisfied as compared with specialists. Significant predictors of the job satisfaction are employment status, type of the practice, and availability of dental assistants. General dental practitioners with a dental assistant employed at a private practice are more likely to be satisfied with their jobs. CONCLUSIONS: Employment status, practice type and availability of dental assistants are significant predictors of job satisfaction. General dental practitioners working in a private practice with a dental assistant are most likely to be satisfied.

Translation and validation of the Croatian version of the Oral Impacts on Daily Performances (OIDP) scale.

Background/Aim: Among numerous sociodental indicators the Oral Impacts on Daily Performance (OIPD) is one of the most broadly applied. The aim of this study was to develop and test psychometric properties of a Croatian version of OIDP scale. Methods: The OIDP instrument was translated from English to Croatian in a forward-backward method. The Croatian version was tested for reliability, construct validity and responsiveness on a sample of 702 participants (255 men), aged 18-86 years. Results: Internal consistency of Croatian version of the OIDP was acceptable (alpha = 0.80) and 69.4% of the examinees had oral impacts relating to one or several performances. The most frequently affected performance was eating (53.7%). The test-retest reliability was high (r = 0.99; 95% CI: 0.97-0.99), the mean difference between the OIDP summary scores in two-week interval was not statistically significant. In construct validity testing there was statistically significant correlation between OIDP and self-assessed general and oral health, somatisation, depression and Oral Health Impact Profile ranging from 0.157 to 0.516. Responsiveness was confirmed by a significant reduction of oral impacts on daily performances in subjects before and after treatment of acute dental pain (p < 0.001). Conclusion: The Croatian OIDP index showed good psychometric properties in terms of construct validity, internal consistency, test-retest reliability and responsiveness confirming its appropriateness for use among Croatian population.

The Comparison of Malocclusion Prevalence Between Children with Cerebral Palsy and Healthy Children.

This study sets out to examine the prevalence of malocclusion and habits in a group of children with cerebral palsy and to compare it with a control group of healthy children. The presence of an anterior open bite was statistically significantly higher in the cerebral palsied group. The presence of aposterior crossbite was not significantly different between the examined groups, as was the case for a lingual crossbite. The occurrence of visceral swallowing, incompetent lips and oral respiration was significantly higher in the cerebral palsied group. The current study cannot satisfactorily sustain the issue of a higher prevalence of posterior and lingual crossbite in children with cerebral palsy because of no significant differences between groups, but it certainly can for an anterior openbite. The present study also adds to the evidence that there is an increased prevalence of oral breathing, visceral swallowing and lip incompetence in children with cerebral palsy.

The psychosocial impact of dental aesthetics questionnaire--translation and cross-cultural validation in Croatia.

PURPOSE: To perform a translation and validation of the psychosocial impact of dental aesthetics questionnaire (PIDAQ) in the Croatian cultural context. METHODS: A total of 262 subjects (34 % males) aged 18-30 years (mean age 22.7 ± 2.6) were included. The questionnaire included the PIDAQ, a self-assessment of satisfaction with dental aesthetics, a self-perceived dental treatment need assessment, self-reported malocclusion, an aesthetic component of index of orthodontic treatment need (IOTN AC) and an oral health impact profile (OHIP-14 CRO). The subjects' orthodontic treatment needs were assessed by a dentist using the dental health and aesthetic component of the IOTN. The internal consistency, test-retest reliability, validity and responsiveness were assessed. Little's Irregularity index was used to correlate the amount of resolution of dental crowding by orthodontic treatment with the change in PIDAQ domains. RESULTS: The domains of the Croatian version of the PIDAQ showed satisfactory internal consistency (α ranging from 0.79 to 0.95) and high test-retest reliability (r > 0.85). The significant association between the PIDAQ domains and self-reported satisfaction with teeth appearance, IOTN AC and OHIP-14 CRO (p < 0.001) confirmed the convergent validity. The domains were able to detect differences in the subjects' psychosocial impact related to orthodontic treatment that improved dental aesthetics in responsiveness testing (p < 0.001). CONCLUSION: The Croatian version of the PIDAQ demonstrated good psychometric properties, similar to those of the original.

Gender, age, and psychosocial context of the perception of facial esthetics.

OBJECTIVE: To explore the effects of gender, age, and psychosocial context on the perception of facial esthetics. METHODS: The study included 1,444 Caucasian subjects aged 16 to 85 years. Two sets of color photographs illustrating 13 male and 13 female Caucasian facial type alterations, representing different skeletal and dentoalveolar components of sagittal maxillary-mandibular relationships, were used to estimate the facial profile attractiveness. The examinees graded the profiles based on a 0 to 10 numerical rating scale. The examinees graded the profiles of their own sex only from a social perspective, whereas opposite sex profiles were graded both from the social and emotional perspective separately. RESULTS: The perception of facial esthetics was found to be related to the gender, age, and psychosocial context of evaluation (p < 0.05). The most attractive profiles to men are the orthognathic female profile from the social perspective and the moderate bialveolar protrusion from the emotional perspective. The most attractive profile to women is the orthognathic male profile, when graded from the social aspect, and the mild bialveolar retrusion when graded from the emotional aspect. The age increase of the assessor results in a higher attractiveness grade. CONCLUSIONS: When planning treatment that modifies the facial profile, the clinician should bear in mind that the perception of facial profile esthetics is a complex phenomenon influenced by biopsychosocial factors. CLINICAL SIGNIFICANCE: This study allows a better understanding of the concept of perception of facial esthetics that includes gender, age, and psychosocial context.

The effect of frequent removable partial denture wearing on alveolar bone resorption.

AIM: To determine the influence of frequent removable partial denture (RPD) wearing on the alveolar bone density changes around the abutment teeth. METHODS: Fifty examinees of both genders, wearing partial dentures, were included in the study. Thirty one of the examinees (62%) were wearing the dentures 24 hours a day, while nineteen (34%) of them were wearing them only during the day. The changes in the bone density around the abutment teeth were determined by the intraoral microdensitometry method. Standard retroalveolar radiographs were performed twice. The first one before the removable partial denture delivery and the second one after a period of three-month denture wearing. A copper step wedge consisting of five steps (0.1-0.5 mm) was attached to the radiograph in order to calibrate it. Seven points, regions of interest (ROI) close to the root of the abutment tooth, all ten pixels in size, were selected on each radiograph. Grey areas in the regions of interest were measured and converted into the copper step wedge thickness equivalents in order to estimate the change in the alveolar bone density and measure the difference in alveolar bone density between two radiographs. RESULTS: The results indicated that there is not any statistically relevant change (t-value less than 2,011; t(49,0.05) / F less than 4,0426; F0.05(1,48)) in the alveolar bone density depending on the frequency of removable partial denture wearing. CONCLUSION: The frequency of removable partial denture wearing does not cause any changes in the alveolar bone density around the abutment teeth in the period of three-month denture wearing.

Coronally advanced flap alone or with connective tissue graft in the treatment of single gingival recession defects: a long-term randomized clinical trial.

BACKGROUND: Numerous surgical approaches for the treatment of single gingival recession (GR) defects are documented in the literature. The aim of this 5-year, split mouth-design, randomized clinical trial was to evaluate the effectiveness of coronally advanced flap (CAF) alone versus CAF with connective tissue graft (CAF+CTG) in the treatment of single Miller Class I and II GR defects. METHODS: Thirty-seven patients with 114 bilateral, single Miller Class I and II GR defects were treated with CAF on one side of the mouth and CAF+CTG on the other side. Clinical measurements (GR length [REC], keratinized tissue width [KT], complete root coverage [CRC], and percentage of root coverage [PRC]) were evaluated before surgery and after 6, 12, 24, and 60 months. RESULTS: There was a significant reduction of REC and increase of KT after surgery in both groups. CAF+CTG showed significantly better results for all evaluated clinical parameters in all observed follow-up periods. Miller Class I defects showed better results in terms of REC, CRC, and PRC, whereas Miller Class II showed better results in KT, both in favor of CAF+CTG. Miller Class I defects showed better results than Miller Class II GR defects regardless of the surgical procedure used. CONCLUSIONS: Both surgical procedures were effective in the treatment of single Miller Class I and II GR defects. The CAF+CTG procedure provided better long-term outcomes (60 months postoperatively) than CAF alone. Long-term stability of the gingival margin is less predictable for Miller Class II GR defects compared to those of Class I.

Multivariate analysis of different factors affecting the patient general satisfaction with complete dentures.

The aim of the study was to investigate different factors that affect the level of patient's general satisfaction with maxillary and mandibular complete dentures (CDs) using a multivariate analysis. A total of 100 CD wearers participated in this study. There were 46 men (37-77 years old; mean age 62.6 +/- 9.2) and 54 women (34-77 years old; mean age 60.9 +/- 9.3). In the questionnaire the patients answered the questions regarding gender, age, number of previous CDs worn, the present dentures' age and denture-wearing habits. Participants rated the level of their satisfaction with the esthetics, retention, speech, mastication, sense of taste, comfort and general satisfaction with their CDs. More than 70% of the examined patients claimed all the examined variables to be the best-score category. Of the 9 factors examined, satisfaction with the mastication and esthetics, denture-wearing habits and satisfaction with retention in the maxilla explained the variability of the patients's general satisfaction with their CDs by 72%. Satisfaction with the mastication, denture-wearing habits and satisfaction with speech and comfort in mandible explained the variability of the patients's general satisfaction with their CDs by 79%. These findings suggest that the general patient satisfaction with maxillary CDs is related more to the mastication and retention abilities, as well as with esthetics and denture-wearing habits, while in the mandible CDs is related to mastication and speaking abilities, denture-wearing habits and comfort of wearing.

Alterations in the masseter muscle and plasma IL-6 level following experimentally induced occlusal interference and chronic stress--a study in rats.

This study was undertaken to examine the alteration of masseter and plasma interleukin-6 after inducing occlusal interference and chronic stress. Male Wistar rats were submitted to chronic stress procedure, exposed to occlusal interference, or exposed to both mentioned procedures. Whole blood and masseter tissue were collected to determine interleukin-6 level, measured by means of ELISA. Masseter pain was evaluated using the orofacial formalin test. Masseter interleukin-6 level was significantly higher in animals submitted to combination of occlusal interference and chronic stress than in the control group (p<0.05). There was positive and significant correlation between pain response and masseter interleukin-6 level (r=0.5741; p<0.0003). No significant differences in plasma interleukin-6 level were found between groups (p>0.05), as well as no correlation with pain (p>0.05). Combination of occlusal interference and chronic stress leads to strong local reaction characterized by high levels of masseter interleukine-6. High concentrations of muscle interleukin-6 and its correlation with pain point to inflammatory background of masticatory muscle pain.

Influences of age and maxillary anterior teeth status on patient's satisfaction with dental appearance and tooth colour.

OBJECTIVES: To study the impact of age, gender, tooth colour and maxillary anterior teeth status on patient's satisfaction with their dental appearance. MATERIAL AND METHODS: A total of 259 Caucasian subjects participated in the study (119 men, mean age 56 years; 140 women, mean age 61 years) divided into three age groups (young <35 age; middle aged 35-54 age; old ≥55 age). Their maxillary anterior teeth status was classified into three groups: (1) natural teeth (NTG) group; (2) composite filling group (CFG) and (3) porcelain-fused-to-metal fixed prosthodontic restoration group (FPDG). The participants judged appearance and tooth colour using a scale with three categories: completely dissatisfied, moderately dissatisfied and completely satisfied. RESULTS: Almost half of the participants were completely satisfied with their dental appearance and tooth colour. Half of the 'young' and 'middle-aged' participants with natural maxillary anterior teeth were completely satisfied and half of the 'old' participants were moderately satisfied with their dental appearance and tooth colour. The majority of participants with composite restorations (45-51%) were moderately satisfied with their dental appearance, one-third of 'young' and 'middle-aged' participants were moderately satisfied or dissatisfied with their tooth colour and more than 70% of older participants were dissatisfied with their tooth colour (p > 0.05). CONCLUSIONS: Satisfaction with the appearance of the maxillary anterior teeth differed both between individuals of different age and different dental status.

Factors influencing a patient's decision to choose the type of treatment to improve dental esthetics.

BACKGROUND/AIM: Interest in dental esthetics has increased rapidly during the last few decades among both patients and dentists, and the creation of a natural dental appearance has become an important task in all fields of dentistry, especially in prosthodontics and restorative dentistry. The aim of this research was to investigate factors influencing a patient's decision to choose the type of treatment to improve dental esthetics. METHODS: A total of 700 Caucasian subjects participated in the cross-sectional study (261 men, 439 women, aged 18-86 years, mean age 46.2 +/- 18.6). The study included clinical examination and a self-administrated questionnaire based on self-perceived esthetics, satisfaction with the appearance of their maxillary anterior teeth and previous dental experience. Multiple logistic regression was used in statistical analysis. RESULTS: Hiding teeth during smile was the most important predictor for choosing fixed prosthetic restorations (OR 9.1), followed by self-perceived bad fixed prosthesis, malpositioned teeth and female gender (OR 2.9, 2.4, and 1.5, respectively). The increase in satisfaction with dental appearance and previous orthodontic therapy reduced chances for seeking prosthetic therapy (each OR 0.4). The significant predictors for bleaching choosing were hiding teeth during smiling, already done bleaching, female gender, lower levels of satisfaction with dental appearance and the absence of the previous orthodontic therapy (OR 5.8, 2.4, 1.8, 0.5 and 0.4, respecitively). Hiding teeth during smile, self-perceived malposition and crowding, and lower levels of satisfaction, were significant predictors for choosing orthodontic treatment (OR 3.1, 2.4, 2.2 and 0.6, respectively). None of current dental statuses was statistically significant predictor for choosing prosthodontic, bleeching nor orthodontic therapy. CONCLUSION: The psychological elements and female gender are the main predictors of seeking dental therapy. Understanding the prevalence of dissatisfaction with the present esthetics and desired treatments to improve esthetics can be a guide for strategies for intervention to improve esthetics.

Dental health and dental care in children with cerebral palsy.

The aim of this study was to determine a difference between children with cerebral palsy (CP) and healthy children, regarding health condition of teeth and oral tissuses. Disfunction of masticatory system, in children with CP, causes many problems with mastication. Nonfunctional mastication is related with the consumption of mushy food and decreased selfcleaning of occlusal and aproximal surfaces. All that leads to higher incidence of dental caries. Comparing the DMTF/dft (decayed, missing, filled tooth) index, it is evident that there is no statistically significant difference in a tooth morbidity between the group of healthy children and group of children with CP. The healthy children have statistically significant more teeth with fillings with respect to children with CP. Extractions are more common in children with CP. There is no statistically significant difference between those two groups regarding decayed teeth, one of components of DMFT index. Decayed components are more common than the extractions and fillings in both groups, which shows the insufficient curative care for all children in both groups. It can be concluded that there is a certain need of early beginning and a better organization of the preventive pediatric and dental care, in order to decrease the appearence of dental decay and increase the level of dental health, in this challenged population.

Masticatory muscle and temporomandibular joint pain in Croatian war veterans with posttraumatic stress disorder.

The aim of this study was to investigate the prevalence and intensity of masticatory muscle and temporomandibular joint (TMJ) pain in Croatian war veterans with posttraumatic stress disorder (PTSD). The examined group consisted of 100 Croatian war veterans, in whom PTSD had previously been diagnosed. Patients were compared with 92 subjects who had not taken part in the war and in whom PTSD was excluded by psychiatric examination. The clinical examination consisted of palpation of the masticatory muscles, the prominent neck musculature, and TMJ. The examination technique used and the definition of items were previously tested for reliability and validity. 93% of the subjects with PTSD had masticatory muscle tenderness compared to 45.65% of the subjects in the control group (chi2 = 51.46, p < 0.0001). The most frequent painful location in the subjects with PTSD was the left lateral pterygoid site in 88%, and in subjects of the control group the right lateral pterygoid site in 28.26% of cases. The most painful location in the PTSD group was the left lateral pterygoid site in 72%, and in the control group the left posterior digastric in 4.35% of cases. 58% of the subjects with PTSD had TMJ tenderness compared to 3.26% of subjects in the control group (chi2 = 66.23, p < 0.0001). The most frequent painful location of TMJ in both groups was the left posterior capsule; in the PTSD group 38% and in subjects in the control group 2.17% of cases. The most painful location was the left posterior capsule in 28% of subjects with PTSD, while not one subject in the control group reported severe painful sensitivity. The very high frequency and intensity of pain in subjects with PTSD confirms the effect of stress on muscle and joint sensitivity, i.e. perception of pain.