Association between temporomandibular joint dysfunction signs and symptoms, mental health indices, and magnetic resonance imaging diagnoses: should we scan patients?

Abstract

Temporomandibular joint dysfunction (TMD) is a common condition, yet multifactorial in nature. Our understanding of the interplay between clinical symptoms in relation to magnetic resonance imaging (MRI) findings and quality of life is limited. Our primary objective therefore was to identify features of TMD that contribute to anxiety and depression. Our secondary objective was to determine whether clinical symptoms, baseline characteristics, and mental health outcomes are associated with underlying disease severity, as determined by MRI. A retrospective analysis of 202 TMD patients was performed. Mental health outcomes were quantified using the Integrating Mental and Physical Healthcare: Research, Training and Services (IMPARTS) questionnaires, Generalised Anxiety Disorder Assessment (GAD-7), and Patient Health Questionnaire (PHQ-9), and pain was judged by the Brief Pain Inventory (BPI). Patients were categorised based on the severity of temporomandibular joint pathology (normal, anterior disc displacement with reduction, anterior disc displacement without reduction, and severe degeneration). On multivariate analyses, both higher anxiety (GAD-7) (p < 0.001) and depression (PHQ-9) (p < 0.001) scores on the IMPARTS assessment were associated with worst perceived pain on a visual analogue scale (VAS). Unilateral joint involvement (OR 2.48; 95% CI 1.20 to 5.46; p = 0.018), locking (OR 4.28; 95% CI 1.63 to 13.63; p = 0.006), and clicking (OR 2.14; 95% CI 1.05 to 4.60; p = 0.006) were significantly associated with increased odds of an abnormal TMJ on MRI, whereas higher anxiety scores (OR 0.93; 95% CI 0.88 to 0.99; p = 0.006) and male gender (OR 0.35; 95% CI 0.15 to 0.79; p = 0.012) were statistically significantly indicative of a normal joint morphology on MRI. Our findings support a complex interplay between patient symptomatology, mental health outcomes, and objective radiologically-defined joint pathology in the TMD patient population.

Keywords: Anxiety; Depression; Imaging; MRI; Pain; Temporomandibular joint disorders.