Incident injury is strongly associated with subsequent incident temporomandibular disorder: results from the OPPERA study

Abstract

Cross-sectional studies confirm, as expected, a positive association between jaw injury and painful temporomandibular disorders (TMDs), but prospective evaluations are lacking. We prospectively assessed incident jaw injury, injury type, and development of TMD in adults aged 18 to 44 years. Data were collected from 3258 individuals from communities surrounding 4 US academic institutes between 2006 and 2008. At enrollment, participants reported no TMD history and no facial injuries in the previous 6 months. Quarterly, follow-up questionnaires assessed incident jaw injury, which was classified as intrinsic (attributed to yawning or prolonged mouth opening) or extrinsic (attributed to other causes). Examiners classified incident TMD during a median follow-up period of 2.8 years (range 0.2-5.2 years). Cox regression models used jaw injury as a time-dependent covariate to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association with incident TMD. Among 1729 participants with complete data, 175 developed TMD. Eighty percent of injuries were intrinsic. Temporomandibular disorder annual incidence was nearly twice as high in those experiencing jaw injury (5.37%) compared with those who did not (3.44%). In the Cox model that accounted for timing of injury, the corresponding HR was 3.94 (95% CI = 2.82-5.50) after adjusting for study site, age, race, and sex. Hazard ratios did not differ (P = 0.91) for extrinsic injuries (HR = 4.03, 95% CI = 2.00-8.12) and intrinsic injuries (HR = 3.85, 95% CI = 2.70-5.49). Jaw injury was strongly associated with incident TMD. If surveillance and intervention after jaw injury is to be effective in preventing TMD, they should focus on both intrinsic and extrinsic injuries.

Figure 1.

Flowchart of participants.

Figure 2.

Schematic showing time-dependent first jaw injury and first onset TMD within the OPPERA study design. ① Individuals exposed to first injury and develop first-onset painful TMD, contribute to time at risk in the non-exposed group and to time at risk in the exposed group. ② Individuals not exposed to injury and develop first-onset painful TMD, contribute to time at risk in the non-exposed group. ③ Individuals exposed to first injury and do not develop first-onset painful TMD, contribute to time at risk in the non-exposed group and to time at risk in the exposed group. ④ Individuals not exposed to injury and do not develop first-onset painful TMD, contribute to time at risk in the non-exposed group.