Marchesi Alessandro, Sardella Andrea, Khijmatgar Shahnawaz
Department of Gnathology, San Paolo Dental Building, University of Milan, Milan, Italy.
Policlinico Ospedale Maggiore, Fondazione IRCCS Cà Granda, University of Milan, Milan, Italy.
J Int Soc Prev Community Dent. 2025 Jun 30;15(3):257-264. doi: 10.4103/jispcd.jispcd_236_24. eCollection 2025 May-Jun.
Temporomandibular disorders (TMDs) are often associated with psychological distress and altered pain perception. However, the relationship between depression, anxiety, and sensory/pain thresholds in TMD remains underexplored. The present study aimed to assess the association of depression and anxiety with sensory and pain thresholds in adults with and without TMD using standardized electrical stimulation.
This observational case-control study included 56 adults with TMD and 56 matched healthy controls. Psychological distress was evaluated using the SCL-90-R questionnaire. Sensory and pain thresholds were assessed via electrical stimulation of the dental pulp. The sensory threshold was the minimum intensity of a stimulus, and pain threshold is the minimum intensity of a stimulus that triggers the perception of pain. Statistical analyses included Mann-Whitney U, Kruskal-Wallis, Spearman correlation, and multivariate logistic regression, adjusted for age and gender.
TMD subjects demonstrated significantly higher depression and anxiety scores than controls ( < 0.01). Pain thresholds were negatively correlated with depression and anxiety in both groups ( ≈ -0.63 to -0.66, < 0.001), while anxiety correlated with lower sensory thresholds in TMD subjects only ( = -0.37, < 0.01). Multivariate analysis revealed that a low pain threshold was independently associated with moderate/severe depression (OR = 4.38; 95% CI: 1.13-17.04), while a low sensory threshold was linked with moderate/severe anxiety, TMD status, female gender, and older age.
Depression is independently associated with reduced pain thresholds in both TMD and healthy subjects. Anxiety is specifically linked to sensory threshold reduction in TMD patients. These findings underscore the need to integrate psychological assessment in chronic orofacial pain management.
颞下颌关节紊乱病（TMDs）常与心理困扰和疼痛感知改变相关。然而，TMD中抑郁、焦虑与感觉/疼痛阈值之间的关系仍未得到充分研究。本研究旨在使用标准化电刺激评估有和无TMD的成年人中抑郁和焦虑与感觉及疼痛阈值的关联。
这项观察性病例对照研究纳入了56名患有TMD的成年人和56名匹配的健康对照。使用SCL-90-R问卷评估心理困扰。通过对牙髓进行电刺激来评估感觉和疼痛阈值。感觉阈值是刺激的最小强度，疼痛阈值是引发疼痛感知的刺激的最小强度。统计分析包括曼-惠特尼U检验、克鲁斯卡尔-沃利斯检验、斯皮尔曼相关性分析以及经年龄和性别校正的多变量逻辑回归分析。
TMD受试者的抑郁和焦虑评分显著高于对照组（<0.01）。两组中疼痛阈值均与抑郁和焦虑呈负相关（≈-0.63至-0.66，<0.001），而仅在TMD受试者中焦虑与较低的感觉阈值相关（=-0.37，<0.01）。多变量分析显示，低疼痛阈值与中度/重度抑郁独立相关（OR=4.38；95%CI：1.13-17.04），而低感觉阈值与中度/重度焦虑、TMD状态、女性性别和年龄较大相关。
抑郁在TMD患者和健康受试者中均与疼痛阈值降低独立相关。焦虑与TMD患者的感觉阈值降低特别相关。这些发现强调了在慢性口面部疼痛管理中纳入心理评估的必要性。
