Clinical Manifestations, Imaging Features, and Pathogenic/Prognostic Risk Factors for Temporomandibular Disorders (TMD): A Case-Control Study Based on Psychogenic Factors of Patients

Abstract

Objective: To survey the clinical manifestations and imaging features of temporomandibular disorders (TMD) and analyze the risk factors for pathogenesis/prognosis through a case-control study based on psychogenic factors of patients.

Methods: According to the inclusion criteria, 200 adult patients were randomly enrolled from the maxillofacial department of our hospital from January 2020 to May 2021, including 100 patients with TMD as the study group and 100 healthy patients as the control group. The study group can be assigned into four subgroups according to their clinical manifestations: (1) articular area or/and masticatory muscle pain group, (2) mandibular movement abnormality group, (3) joint murmur group, and (4) two or more symptom groups. Based on the study of psychogenic factors of patients, the clinical manifestations and imaging features of TMD were determined, and the risk factors for pathogenesis/prognosis were analyzed.

Results: The distribution of psychological status in the TMD group was higher than that in the control group (P < 0.05). The distribution of anxiety, depression, and somatic symptoms in the TMD group was significantly different from that in the control group (P < 0.05). Anxiety, depression, and somatic symptoms were the risk factors for TMD. Compared with the control group, the incidence of abnormal MRI images in patients with temporomandibular disorders was significantly different (P < 0.05). There were significant differences in psychological status (anxiety, depression, and somatic symptoms) among the three groups (P < 0.05). Anxiety, depression, and somatic symptoms were the risk factors for abnormal mandibular movement and joint tremor and murmur (P < 0.05). Somatic symptoms were the risk factors for various clinical symptoms of TMD (P < 0.05). Depression was the risk factor for pain (P < 0.05).

Conclusion: In patients with TMD, MRI can early identify disc abnormalities and other related imaging features, which is helpful for more comprehensive clinical evaluation and treatment of TMD patients. There exhibits no significant difference in psychological status (anxiety, depression, and somatic symptoms) of patients with different clinical symptoms, and abnormal psychological status may be one of the risk factors leading to different clinical symptoms and development of different types of TMD patients.

Figure 1

Diagnostic roadmap in axis I.

Figure 2

The reducible articular disc moves forward, the closed position in (a) demonstrates that the articular disc moves forward, the demarcation angle of the disc is about 30°, and the articular disc is enlarged in the posterior zone. The opening position in (b) demonstrates that the relationship between the articular disc and the condyle returns to normal.

Figure 3

The irreducible articular disc moves forward, the posterior zone of the joint is located in front of the condyle in the opening position (a) and the closed position (b), the posterior zone of the articular disc is enlarged, and the high signal effusion shadow can be seen in the supra-articular cavity.

Figure 4

(a) Irreducible articular disc (arrow) displacement with thickening of the attachment point of the inferior branch of the lateral pterygoid muscle (curved arrow) and condylar hyperosteogeny (straight arrow). (b) Contralateral reducible articular disc (arrow) anterior displacement with normal lateral pterygoid muscle attachment point (curved arrow).

Figure 5

Psychological differences among different clinical symptoms of temporomandibular joint disorder syndrome.

Figure 6

Differences in psychological distribution among different clinical symptoms of temporomandibular joint disorder syndrome. Note: group 1: abnormal mandibular movement; group 2: articular bounce or tenderness; group 3: pain; and group 4: two or more symptoms.