Eastmaninstitutet Department of Oral and Maxillofacial Surgery, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden.
Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.
BMC Public Health. 2022 May 9;22(1):916. doi: 10.1186/s12889-022-13329-z.
Temporomandibular disorders (TMD) are common and affect approximately 10% of the adult population. TMD is usually associated with headache, pain in the masticatory muscles and/or the temporomandibular joint, clicking or crepitations during mandibular movement as well as painful and/or reduced mouth opening. This study aimed to investigate the level TMD-patients use social insurance benefits before and after their first time of diagnosis or first surgical event, compared to the general population. Furthermore, the aim was to investigate the differences in the use of social insurance benefits between surgically and non-surgically treated TMD-patients that were diagnosed in a hospital setting.
All Swedish citizens aged 23-59 diagnosed with TMD in a hospital setting and/or surgically treated for the condition during 1998-2016 were identified via the Swedish National Board of Health and Welfare. A non-exposed comparison cohort was collected via the Total Population Registry. Outcome and sociodemographic data were collected via Statistics Sweden. Main outcome was annual net days on sick leave and disability pension five years before (-T5) and five years after (T5) diagnosis and/or surgical treatment (T0). Regression analysis was conducted with generalized estimated equations.
The study included 219 255 individuals (73% female) - 19 934 in the exposed cohort and 199 321 in the comparison cohort. The exposed group was classified into three subgroups: non-surgical, surgically treated once, and surgically treated twice or more. The mean annual net days of sick leave and disability pension combined during the ten-year follow-up was 61 days in the non-surgical group, 76 days in the surgically treated once group, and 104 days in the surgically treated twice or more subgroup. The corresponding number for the non-exposed comparison cohort was 32 days.
Patients diagnosed with TMD in a hospital setting are 2-3 times more dependent on the use of social benefits than the general population. The reliance on sick leave and disability pension is seen as early as five years before diagnosis, and the reliance remains after surgical treatment. The reliance is stronger in patients with several surgical interventions. These findings indicate that patients diagnosed with TMD constitute a patient group with a high burden of health issues causing long-term dependence on social security benefits.
颞下颌关节紊乱病（TMD）是一种常见疾病，影响约 10%的成年人。TMD 通常与头痛、咀嚼肌疼痛和/或颞下颌关节疼痛、下颌运动时的咔哒声或爆裂声以及张口疼痛和/或受限有关。本研究旨在调查 TMD 患者在首次诊断或首次手术治疗前后与普通人群相比使用社会医疗保险福利的情况。此外，本研究还旨在调查在医院环境中诊断出的接受手术和非手术治疗的 TMD 患者在使用社会医疗保险福利方面的差异。
通过瑞典国家卫生福利委员会，确定了 1998 年至 2016 年间在医院环境中诊断为 TMD 并接受手术治疗的所有 23-59 岁的瑞典公民。通过总人口登记册收集了一个非暴露对照队列。通过瑞典统计局收集了结果和社会人口学数据。主要结果是 T0 前五年（-T5）和 T0 后五年（T5）的每年净病假和残疾抚恤金天数。使用广义估计方程进行回归分析。
本研究共纳入 219255 人（73%为女性）-暴露组 19934 人，对照组 199321 人。暴露组分为三组：非手术组、单次手术组和两次或多次手术组。在十年的随访期间，非手术组的年净病假和残疾抚恤金天数为 61 天，单次手术组为 76 天，两次或多次手术组为 104 天。非暴露对照组的相应数字为 32 天。
在医院环境中诊断出的 TMD 患者比普通人群更依赖于社会福利的使用，依赖程度高达 2-3 倍。早在诊断前五年就出现对病假和残疾抚恤金的依赖，并且在手术后仍持续存在。在接受多次手术干预的患者中，这种依赖更为严重。这些发现表明，诊断为 TMD 的患者构成了一个健康问题负担沉重的患者群体，导致长期依赖社会保障福利。
