Prevalência e intensidade de distúrbios emocionais e fatores associados em indivíduos com disfunção temporomandibular

Abstract

Despite the existence of various studies demonstrating the relationship between psychoemotional states of anxiety and depression with the development or intensity of temporomandibular disorders (TMDs), the literature is still uncertain whether the prevalence and intensity of these factors on different types and diagnoses of TMD, which may vary from the muscular to the articular spheres, as well as their combination. Moreover, reports on the occurrence of psychological distress and possible associations with pain in TMD sufferers under treatment at the Federal University of Juiz de Fora (UFJF) are still scarce, highlighting the importance of investigating the foregoing aspects. Hence, the present study had two purposes: (i) to demonstrate by means of a systematic review whether the occurrence and intensity of anxiety and depression is greater in one specific diagnosis of TMD as compared to other TMD types; and (ii) to evaluate the prevalence of anxiety, depression and severe pain in TMD sufferers under treatment at the Serviço-ATM from School of Dentistry at UFJF. Concerning the systematic review, studies from the following databases were retireved using appropriate keywords: MEDLINE/PubMed, Scopus, Web of Science, Scielo, Lilacs and Ibecs. The last search was conducted in December 2019. The inclusion criteria were the use of the RDC/TMD or DC/TMD instruments for diagnosing TMD, and the studies should have demonstrated prevalence or intensity data of anxiety/depression for at least two distinct diagnoses of TMD. The included studies were analyzed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using the software RevMan version 3.5.3 with p<0.05. Regarding the crosssectional study, patients under first attendance at the Serviço-ATM (UFJF) were invited to participate when properly diagnosed with TMD and if they were aged from 18 to 90 years old. For elegibility criteria, the participants could not have been taking medication for anxiety and/or depression conditions. In the systematic review, 22 studies were included, from which 19 were submitted to meta-analysis. Overall, the occurrence of anxiety and depression was higher among individuals diagnosed with muscular TMD. Also, painful types of TMD resulted in greater occurrence of psychoemotional distress when compared to non-painful TMDs. In the cross-sectional study, 35 participants were investigated in total. The prevalence of anxiety was high (~63%) in the sample, followed by the occurrence of severe pain symptomatology (40%), and last but not least the presence of depression (~29%). The signs and symptoms of TMD more frequently (>70% of the sample) observed were muscular pain (89%), back pain (83%), articular pain (77%), cervical pain (77%) and tinnitus (74%). Amongst the investigated 11 factors, the greater the quantity of signs and symptoms of TMD, the greater the likelihood of the TMD sufferer being anxious (p=0.007); and bruxomars have ~5.7 times greater chance of experiencing severe pain (p=0.025). In conclusion, states of anxiety and depression are more prevalent and more severe in TMD sufferers with a muscular involvement or painful experience. From the investigated sample in the cross-sectional study, anxiety and severe pain were highly prevalent.