Center for Future Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.
Dental Research Institute, Seoul National University, Seoul, Korea.
BMC Oral Health. 2024 Apr 12;24(1):447. doi: 10.1186/s12903-024-04168-y.
The Coronavirus 2019 disease (COVID-19) caused drastic changes in people's lifestyle that affected TMD characteristics through its physical and psychological influences. The aim of this study was to define the clinical and psychological characteristics of a large group of well-defined TMD patients and seek their differences between before and during the COVID-19 pandemic to establish points of care to be emphasized in the post-pandemic era.
TMD patients diagnosed by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) aged ≥ 18 were analyzed. Samples between September, 2017 to July, 2019 (n = 455) and March, 2021 to June, 2022 (n = 338) were collected to represent before and during COVID-19, respectively. The Graded Chronic Pain Scale (GCPS) and Symptom Checklist-90-Revision (SCL-90-R) were used to evaluate disability levels and psychological status. Clinical indices were compared between COVID periods and factors related to higher pain levels were investigated according to pandemic period.
More patients reported pain on palpation of the masticatory muscles during the pandemic (p = 0.021) while the number decreased for neck muscles (p = 0.001) and TMJ (p < 0.001) areas. Patients reporting nocturnal bruxism (23.3-29.6%) and clenching (45.1-54.7%) significantly increased during the pandemic. TMD patients with pain without disability were more common during the pandemic regardless of pain intensity (p < 0.001). The number of patients expressing interference in daily activities decreased drastically during COVID-19 regardless of disability level (p < 0.001). Factors associated with higher than moderate pain intensity (CPI ≥ 50) were insomnia (odds ratio [OR] = 1.603, p = 0.047) and somatization (OR = 1.082, p < 0.001) before the pandemic. During the pandemic, age (OR = 1.024, p = 0.007), somatization (OR = 1.070, p = 0.006), and paranoid ideation (OR = 1.117, p = 0.003) were significantly associated with higher pain intensity.
The results of our study underline the importance of evaluating psychological profiles of TMD patients, especially somatization, paranoid ideation and psychoticism, in exceptional situations that may cause a change in individual mental status. This will lead to a better understanding of the individual TMD patient and help in planning personalized treatment strategies that will assist the patient in adjusting to changes occurring in special environments such as the COVID-19 pandemic.
2019 年冠状病毒病（COVID-19）导致人们的生活方式发生了巨大变化，通过其生理和心理影响影响了 TMD 的特征。本研究的目的是确定一组大量明确界定的 TMD 患者的临床和心理特征，并寻求其在 COVID-19 大流行前后的差异，以确定在大流行后时代需要强调的护理要点。
对符合颞下颌关节紊乱诊断标准（DC/TMD）的年龄≥18 岁的 TMD 患者进行分析。分别收集 2017 年 9 月至 2019 年 7 月（n=455）和 2021 年 3 月至 2022 年 6 月（n=338）的样本，以代表 COVID-19 大流行之前和期间。使用慢性疼痛分级量表（GCPS）和症状清单 90-修订版（SCL-90-R）评估残疾水平，并根据大流行期间调查与更高疼痛水平相关的因素。
在大流行期间，更多的患者报告咀嚼肌触诊时疼痛（p=0.021），而颈部肌肉（p=0.001）和 TMJ（p<0.001）区域的患者数量减少。报告夜间磨牙（23.3-29.6%）和紧咬牙（45.1-54.7%）的 TMD 患者在大流行期间明显增加。无论疼痛强度如何，大流行期间疼痛但无残疾的 TMD 患者更为常见（p<0.001）。无论残疾程度如何，在 COVID-19 期间，表达日常生活活动受干扰的患者数量急剧减少（p<0.001）。与中度以上疼痛强度（CPI≥50）相关的因素包括失眠（优势比[OR] = 1.603，p=0.047）和躯体化（OR=1.082，p<0.001）在大流行之前。在大流行期间，年龄（OR=1.024，p=0.007）、躯体化（OR=1.070，p=0.006）和偏执观念（OR=1.117，p=0.003）与更高的疼痛强度显著相关。
我们研究的结果强调了评估 TMD 患者心理特征的重要性，特别是躯体化、偏执观念和精神病态，因为特殊情况可能导致个人精神状态发生变化。这将有助于更好地了解个体 TMD 患者，并有助于制定个性化的治疗策略，帮助患者适应 COVID-19 等特殊环境中的变化。
