Influence of psychosocial risk factors on the dynamics of indicators of temporomandibular disorders

Abstract

Aim. To analyze the influence of psychosocial risk factors on the dynamics of indicators characterizing temporomandibular disorders.

Methods. 61 clinical cases of temporomandibular disorders with chronic pain were investigated (18 % of the total number of observations of temporomandibular disorders). Diagnostic criteria of temporomandibular disorders were used: axis II, computed tomography and magnetic resonance imaging of temporomandibular joint. Interviewing method was used for clinical diagnosis of psychological phenomena and testing attitude to the disease, identifying communicative deviations according to R.C. Rogers (2002). Patients were divided into 2 groups: group A - patients with nociceptive pain, social adaptation is not disturbed; group B - patients with neuropathic pain, psychosomatization on the background of mental rigidity. In both groups, an identical treatment regimen was implemented for two years. Statistical processing of the obtained data was carried out using IBM SPSS 21 and included comparison of related groups by Friedman analysis and paired Wilcoxon test, comparison of independent groups by Mann-Whitney-Wilcoxon criterion, and comparison of the qualitative features by contingency tables by Chi-square Pearson.

Results. The radiological semiotics of temporomandibular joint in both groups is similar in the structure of nosology. At the beginning of the treatment cycle, the pain intensity and the temporomandibular index are similar. After 2 years of follow-up, patients in group A showed a significantly higher positive response to the therapy compared to patients in group B: pain intensity in group A was 15.36±2.53 and in group B - 37.32±3.45 (p<0.001); depression on the SCL-90-R scale - 0.29±0.04 and 1.12±0.12 (p<0.001), the degree of disability on the GCPS scale - 0.68±0.08 and 1.17±0.10 (p=0.001), temporomandibular index - 0.15±0.01 and 0.23±0.02 (p<0.001), respectively.

Conclusion. In patients of group B, affective disorders form the psychosomatic structure of personality and affect the outcome of therapy. When formulating the final diagnosis and planning the treatment in patients with temporomandibular disorders, it is necessary to take into account the psychosocial characteristics of the patient.

Keywords

temporomandibular joint / affective disorders / temporomandibular disorders / cognitive behavioral therapy

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