Is there an association between COVID-19 and an increased incidence of temporomandibular disorders?

In a recent review published in Brain Sciences, researchers assessed the association between coronavirus disease 2019 (COVID-19)-related stress, depression, anxiety, and temporomandibular disorders from childhood to adulthood.

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a member of the Coronaviridae family, which comprises non-branched single-stranded ribonucleic acid (RNA) viruses. Mild to severe respiratory difficulties and infections are caused by COVID-19. The virus possesses mechanisms that aid in postponing the immunological response of cells. The pathological process responsible for tissue deterioration is caused by the host's response.

The pandemic has intensified individuals’ susceptibility and concern, and stress levels. Thus highlighting how the COVID-19 pandemic and its related stress may have elevated the occurrence of temporomandibular problems.

About the study

In the present study, researchers assessed whether COVID-19-related anxiety has led to an increase in symptoms of temporomandibular dysfunction (TMD) in adults compared to children.

The admissibility of each study document was determined using the following criteria: population, exposure, comparator, and results (PECO).

1. (P) Participants included TMD patients.

2. (E) TMD patients who were examined with diagnostic criteria (DC)-TMD during the COVID-19 pandemic constituted the exposure group.

3. (C) The comparison group consisted of pre-COVID TMD patients.

4. (O) The outcome involved determining the prevalence of TMD during the pandemic. Comparing the prevalence and severity of TMD throughout the pandemic to the period before the pandemic was considered as the secondary outcome.

The authors carefully searched PubMed, Lilacs, Scopus, and Web of Science for papers published between 2019 and 30 September 2022. The terms "COVID-19" and "Temporomandibular disorders" were combined for the search. The sources were manually searched for past systematic reviews on the same topic. This systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions as well as the Preferred Reporting Items for Systematic Reviews (PRISMA) standards.

Drug Discovery eBook

Compilation of the top interviews, articles, and news in the last year.

Download a free copy

Two reviewers extracted data independently from the included papers using a customized Microsoft Excel sheet for data extraction. The following information was extracted: (1) initial author; (2) year of publication; (3) country of origin; (4) type of study; (5) type of TMD; (6) study sample size; (7) participant age; (8) principal findings; (9) changes in symptom intensity prior to and after the pandemic.

Results

A total of 198 studies were found through a search of four engines. During the last step of screening, the abstracts of 54 publications were assessed to determine if they satisfied PECO and the inclusion criteria. Only four studies were selected for inclusion in this systematic investigation involving 556 analyzed patients. The study designs employed in these studies included randomized clinical trials, retrospective studies, and prospective cohort research.

One of the studies comprised 288 patients who underwent a temporomandibular joint examination in accordance with TMD diagnostic criteria to determine the presence of symptoms. This analysis indicated a significant increase in parafunction among men and women. During COVID-19, diurnal as well as nocturnal bruxism was more prevalent among women.

Another study analyzed 182 subjects who underwent Axis II of the DC/TMD, which is a questionnaire that assesses chronic jaw pain, its impact on social life, and psychosocial stress. Examination of the questionnaire data showed that 40.7% of the individuals experienced TMD symptoms within the previous month.

Almost 60.8% of them experienced facial pain within the prior three months, while 51.4% noted that their symptoms had deteriorated in the past month, and 51.4% believed that their symptoms had deteriorated as a result of the lockdown.

A study also assessed the quality and intensity of life of a group of female TMD patients by evaluating their pain and the severity of the disorders prior to and throughout the pandemic. There were no statistically remarkable differences in pain severity and total OHIP-14 scores.

Another study examined the effect of COVID-19 on the severity and psychology of facial pain in TMD patients. Participants included 19 individuals with chronic TMD, along with 26 persons with acute/subcutaneous TMD. In patients with persistent TMD, the scale scores were significantly higher. There was a significant correlation between the alterations in chronic disease patients and the change in COVID Stress Scales (CSS) scores.

Conclusion

The study findings highlighted the correlation of COVID-19 with an elevated incidence of TMD. This systematic analysis demonstrated the state of uncertainty undergone by various populations throughout the pandemic, particularly as a result of stress, leading to muscle hyperactivity and a worsening of bruxism. Both of which are causal factors as well as symptoms of TMD.

The researchers conclude that occlusal therapy alone would prove insufficient in assisting medical professionals in resolving joint-related problems and that further research should be conducted on this topic.

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.