Evaluation of Association Between the Severity of Temporomandibular Disorders and Quality of Sleep in a Selected Iranian Population
Abstract
Objectives: Temporomandibular disorder (TMD), as a prevalent condition, has been reported to be related to changes in sleep quality. This study aims to assess the association between TMD severities and sleep quality in a selected Iranian population by the application of the Helkimo index and the Pittsburgh Sleep Quality Index (PSQI) questionnaire.
Materials and Methods: This study comprised 50 non-TMD subjects and 150 TMD patients, which were equally selected from each TMD severity category. The study was conducted at the School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran. The patients were first examined and categorized into four TMD severity groups according to the Helkimo index: Non-TMD, mild, moderate, and severe. Then, the patients completed the PSQI questionnaire, which was a standard version translated into Persian and adjusted for Iranian patients.
Results: Comparison of mean PSQI scores of the four groups revealed a significant difference (P<0.001). Pairwise comparisons showed that the severe, moderate, and mild TMD groups and the control received the highest to the lowest PSQI scores (12.26±2.35, 8.20±1.92, 6.88±1.89, and 5.28±1.32, respectively). Similarly, regression analysis indicated that by controlling the effect of demographic variables, the mean PSQI significantly increased as TMD severity increased.
Conclusion: According to the results, all three categories of mild, moderate, and severe TMD patients showed poor quality of sleep in comparison with non-TMD controls. The higher the severity of the disease, the lower the sleep quality.
1- Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008 Apr 29;70(18):1630-5.
2- Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014 Winter;28(1):6-27.
3- Magalhães BG, de-Sousa ST, de Mello VVC, da-Silva-Barbosa AC, de-Assis-Morais MPL, Barbosa-Vasconcelos MMV, et al. Risk factors for temporomandibular disorder: Binary logistic regression analysis. Med Oral Patol Oral Cir Bucal. 2014 May;19(3):e232-e236.
4- Laskin DM. Temporomandibular disorders: a term past its time? J Am Dent Assoc. 2008 Feb;139(2):124-8.
5- Veiga DM, Cunali R, Bonotto D, Cunali PA. Sleep quality in patients with temporomandibular disorder: a systematic review. Sleep Sci. 2013;6(3):120-124.
6- Gonçalves DA1, Dal Fabbro AL, Campos JA, Bigal ME, Speciali JG. Symptoms of temporomandibular disorders in the population: an epidemiological study. J Orofac Pain. 2010 Summer;24(3):270-8.
7- Dawson PE. Functional Occlusion: From TMJ to Smile Design. Alberta, Canada, St Louis. MO: Mosby. 2007.
8- Badel T, Marotti M, Krolo I, Kern J, Keros J. Occlusion in patients with temporomandibular joint anterior disk displacement. Acta Clin Croat. 2008 Sep;47(3):129-36.
9- De Santis TO, Martins MD, Motta LJ, Amancio OMS, Fernandes KPS, Bussadori SK. Association between temporomandibular disorder and body mass index in institutionalized children. Braz J Oral Sci. 2010 Dec;9(4):459-463.
10- Huber MA, Hall EH. A comparison of the signs of temporomandibular joint dysfunction and occlusal discrepancies in a symptom-free population of men and women. Oral Surg Oral Med Oral Pathol. 1990 Aug;70(2):180-3.
11- Friction JR, Hathaway K, Kroening R. TMJ and Craniofacial Pain: Diagnosis and Management. St. Louis, Tokyo, Ishiyaku EuroAmerica, Inc., 1988.
12- Chalkoo AH, Ahmad MB. Possible role of estrogen in temporomandibular disorders in female subjects: A research study. J Indian Acad Oral Med Radiol. 2014 Sep;26(1):30-33.
13- Wahid A, Imran F, Mian A, Razzaq SA, Bokhari H, Kaukab T, et al. Prevalence and severity of temporomandibular disorders
(TMD) in undergraduate medical students using Fonseca's Questionnaire. Pakistan Oral Dent J. 2014 Mar1;34(1):3841.
14- Wang J, Chao Y, Wan Q, Zhu Z. The possible role of estrogen in the incidence of temporomandibular disorders. Med Hypotheses. 2008 Oct;71(4):564-7.
15- Bonjardim LR, Gavião MB, Pereira LJ, Castelo PM, Garcia RC. Signs and symptoms of temporomandibular disorders in adolescents. Braz Oral Res. 2005 Apr-Jun;19(2):93-8.
16- Oliveira LK, Almeida Gde A, Lelis ER, Tavares M, Fernandes Neto AJ.
Temporomandibular disorder and anxiety, quality of sleep, and quality of life in nursing professionals. Braz Oral Res. 2015 Jun;29(1):1-7.
17- Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008 Dec 18;359(25):2693-705.
18- Sessle BJ, Bryant PS, Dionne RA. Temporomandibular disorders and related pain conditions. Washington, DC, USA, IASP Press, 1995:92-3.
19- Truelove EL, Sommers EE, LeResche L, Dworkin SF, Von Korff M. Clinical diagnostic criteria for TMD New classification permits multiple diagnoses. J Am Dent Assoc. 1992 Apr;123(4):47-54.
20- LeResche L. Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Crit Rev Oral Biol Med. 1997 Feb;8(3):291-305.
21- Aggarwal VR, Lunt M, Zakrzewska JM, Macfarlane GJ, Macfarlane TV. Development and validation of the Manchester orofacial pain disability scale. Community Dent Oral Epidemiol. 2005 Apr;33(2):141-9.
22- Kempton CL, Wang M, Recht M, Neff A, Shapiro AD, Buckner T, et al. Pain Functional Impairment and Quality of Life (P-FIQ): an assessment of reliability of five patient reported outcome (PRO) instruments in Adult People with Hemophilia (PWH). Value Health. 2015 May;18(3):A301-A302.
23- Sanders AE, Akinkugbe AA, Bair E, Fillingim RB, Greenspan JD, Ohrbach R, et al. Subjective Sleep Quality Deteriorates Before Development of Painful Temporomandibular Disorder. J Pain. 2016 Jun;17(6):669-77.
24- Picchietti DL, England SJ, Walters AS, Willis K, Verrico T. Periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder. J Child Neurol. 1998 Dec;13(12):588-94.
25- Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol. 2015 Jan 3:66:143-72.
26- Maísa Soares G, Rizzatti-Barbosa CM. Chronicity factors of temporomandibular disorders: a critical review of the literature. Braz Oral Res. 2015 Jan;29(1):1-6.
27- Boscato N, Almeida R, Koller CD, Presta AA, Goettems ML. Influence of anxiety on temporomandibular disorders--an epidemiological survey with elders and adults in Southern. Brazil J Oral Rehabil. 2013 Sep;40(9):643-9.
28- Kobayashi F, Gaviao MB, Montes AB, Marquezin MC, Castelo PM. Evaluation of orofacial function in young subjects with temporomandibular disorders. J Oral Rehabil. 2014 Jul;41(7):496-506.
29- Greene CS. Etiology of temporomandibular disorders. Semin Orthod. 1995 Dec;1(4):222-8.
30- Solberg WK. Temporomandibular disorders: masticatory myalgia and its management. Br Dent J. 1986 May 24;160(10):351-6.
31- Ramfjord SP, Ash MM. Occlusion. Philadelphia, WB Saunders Co., 1983:177-87.
32- Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213.
33- Rener-Sitar K, John MT, Bandyopadhyay D, Howell MJ, Schiffman EL. Exploration of dimensionality and psychometric properties of the Pittsburgh Sleep Quality Index in cases with temporomandibular disorders. Health Qual Life Outcomes. 2014 Jan 21;12(1):10.
34- Rai B, Kaur J. Association between stress, sleep quality and temporomandibular joint dysfunction: simulated Mars mission. Oman Med J. 2013 May;28(3):216-9.
35- Smyth C. The Pittsburgh Sleep Quality Index (PSQI). Try this: Best practices in nursing care to older adults. New York University College of Nursing. Available at: https://consultgeri.org/try-this/general-assessment/issue-6.1.pdf /Accessed April 24, 2018.
36- Silveira A, Gadotti IC, Armijo-Olivo S, Biasotto-Gonzalez DA, Magee D. Jaw dysfunction is associated with neck disability and muscle tenderness in subjects with and without chronic temporomandibular disorders. Biomed Res Int. 2015 Apr;2015(3):512792.
37- Drabovicz PV, Salles V, Drabovicz PE, Fontes MJ. Assessment of sleep quality in adolescents with temporomandibular disorders. J Pediatr (Rio J). 2012 Mar-Apr;88(2):169-72.
38- Bertoli FM, Antoniuk SA, Bruck I, Xavier GR, Rodrigues DC, Losso EM. Evaluation of the signs and symptoms of temporomandibular disorders in children with headaches. Arq Neuropsiquiatr. 2007 Jun;65(2A):251-5.
39- Lima DR, Brunetti RF, Oliveira W. Study of the prevalence of craniomandibular dysfunction using Helkimo's index and having as variables sex, age and whether the subjects had or had not been treated orthodonticaly. Pós Grad Rev Fac Odontol São José Dos Campos. 1999;2:127-33.
40- Helkimo M. Studies on function and dysfunction of the masticatory system. I. An epidemiological investigation of symptoms of dysfunction in Lapps in the north of Finland. Proc Finn Dent Soc. 1974 Apr;70(2):37-49.
41- da Cunha SC, Nogueira RV, Duarte AP, Vasconcelos BC, Almeida Rde A. Analysis of helkimo and craniomandibular indexes for temporomandibular disorder diagnosis on rheumatoid arthritis patients. Braz J Otorhinolaryngol. 2007 Jan-Feb;73(1):19-26.
42- Rani S, Pawah S, Gola S, Bakshi M. Analysis of Helkimo index for temporomandibular disorder diagnosis in the dental students of Faridabad city: A cross-sectional study. J Indian Prosthodont Soc. 2017 Jan-Mar;17(1):48-52.
43- Su N, Liu Y, Yang X, Shen J, Wang H. Correlation between oral health-related quality of life and clinical dysfunction index in patients with temporomandibular joint osteoarthritis. J Oral Sci. 2016 Dec;58(4):483-90.
44- Perillo L, Femminella B, Farronato D, Baccetti T, Contardo L, Perinetti G. Do malocclusion and Helkimo Index≥ 5 correlate with body posture? J Oral Rehabil. 2011 Apr;38(4):242-52.
45- Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath. 2012 Mar;16(1):79-82.
46- Rener-Sitar K, John MT, Pusalavidyasagar SS, Bandyopadhyay D, Schiffman EL. Sleep quality in temporomandibular disorder cases. Sleep Med. 2016 Sep;25:105-12.
2- Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014 Winter;28(1):6-27.
3- Magalhães BG, de-Sousa ST, de Mello VVC, da-Silva-Barbosa AC, de-Assis-Morais MPL, Barbosa-Vasconcelos MMV, et al. Risk factors for temporomandibular disorder: Binary logistic regression analysis. Med Oral Patol Oral Cir Bucal. 2014 May;19(3):e232-e236.
4- Laskin DM. Temporomandibular disorders: a term past its time? J Am Dent Assoc. 2008 Feb;139(2):124-8.
5- Veiga DM, Cunali R, Bonotto D, Cunali PA. Sleep quality in patients with temporomandibular disorder: a systematic review. Sleep Sci. 2013;6(3):120-124.
6- Gonçalves DA1, Dal Fabbro AL, Campos JA, Bigal ME, Speciali JG. Symptoms of temporomandibular disorders in the population: an epidemiological study. J Orofac Pain. 2010 Summer;24(3):270-8.
7- Dawson PE. Functional Occlusion: From TMJ to Smile Design. Alberta, Canada, St Louis. MO: Mosby. 2007.
8- Badel T, Marotti M, Krolo I, Kern J, Keros J. Occlusion in patients with temporomandibular joint anterior disk displacement. Acta Clin Croat. 2008 Sep;47(3):129-36.
9- De Santis TO, Martins MD, Motta LJ, Amancio OMS, Fernandes KPS, Bussadori SK. Association between temporomandibular disorder and body mass index in institutionalized children. Braz J Oral Sci. 2010 Dec;9(4):459-463.
10- Huber MA, Hall EH. A comparison of the signs of temporomandibular joint dysfunction and occlusal discrepancies in a symptom-free population of men and women. Oral Surg Oral Med Oral Pathol. 1990 Aug;70(2):180-3.
11- Friction JR, Hathaway K, Kroening R. TMJ and Craniofacial Pain: Diagnosis and Management. St. Louis, Tokyo, Ishiyaku EuroAmerica, Inc., 1988.
12- Chalkoo AH, Ahmad MB. Possible role of estrogen in temporomandibular disorders in female subjects: A research study. J Indian Acad Oral Med Radiol. 2014 Sep;26(1):30-33.
13- Wahid A, Imran F, Mian A, Razzaq SA, Bokhari H, Kaukab T, et al. Prevalence and severity of temporomandibular disorders
(TMD) in undergraduate medical students using Fonseca's Questionnaire. Pakistan Oral Dent J. 2014 Mar1;34(1):3841.
14- Wang J, Chao Y, Wan Q, Zhu Z. The possible role of estrogen in the incidence of temporomandibular disorders. Med Hypotheses. 2008 Oct;71(4):564-7.
15- Bonjardim LR, Gavião MB, Pereira LJ, Castelo PM, Garcia RC. Signs and symptoms of temporomandibular disorders in adolescents. Braz Oral Res. 2005 Apr-Jun;19(2):93-8.
16- Oliveira LK, Almeida Gde A, Lelis ER, Tavares M, Fernandes Neto AJ.
Temporomandibular disorder and anxiety, quality of sleep, and quality of life in nursing professionals. Braz Oral Res. 2015 Jun;29(1):1-7.
17- Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008 Dec 18;359(25):2693-705.
18- Sessle BJ, Bryant PS, Dionne RA. Temporomandibular disorders and related pain conditions. Washington, DC, USA, IASP Press, 1995:92-3.
19- Truelove EL, Sommers EE, LeResche L, Dworkin SF, Von Korff M. Clinical diagnostic criteria for TMD New classification permits multiple diagnoses. J Am Dent Assoc. 1992 Apr;123(4):47-54.
20- LeResche L. Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Crit Rev Oral Biol Med. 1997 Feb;8(3):291-305.
21- Aggarwal VR, Lunt M, Zakrzewska JM, Macfarlane GJ, Macfarlane TV. Development and validation of the Manchester orofacial pain disability scale. Community Dent Oral Epidemiol. 2005 Apr;33(2):141-9.
22- Kempton CL, Wang M, Recht M, Neff A, Shapiro AD, Buckner T, et al. Pain Functional Impairment and Quality of Life (P-FIQ): an assessment of reliability of five patient reported outcome (PRO) instruments in Adult People with Hemophilia (PWH). Value Health. 2015 May;18(3):A301-A302.
23- Sanders AE, Akinkugbe AA, Bair E, Fillingim RB, Greenspan JD, Ohrbach R, et al. Subjective Sleep Quality Deteriorates Before Development of Painful Temporomandibular Disorder. J Pain. 2016 Jun;17(6):669-77.
24- Picchietti DL, England SJ, Walters AS, Willis K, Verrico T. Periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder. J Child Neurol. 1998 Dec;13(12):588-94.
25- Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol. 2015 Jan 3:66:143-72.
26- Maísa Soares G, Rizzatti-Barbosa CM. Chronicity factors of temporomandibular disorders: a critical review of the literature. Braz Oral Res. 2015 Jan;29(1):1-6.
27- Boscato N, Almeida R, Koller CD, Presta AA, Goettems ML. Influence of anxiety on temporomandibular disorders--an epidemiological survey with elders and adults in Southern. Brazil J Oral Rehabil. 2013 Sep;40(9):643-9.
28- Kobayashi F, Gaviao MB, Montes AB, Marquezin MC, Castelo PM. Evaluation of orofacial function in young subjects with temporomandibular disorders. J Oral Rehabil. 2014 Jul;41(7):496-506.
29- Greene CS. Etiology of temporomandibular disorders. Semin Orthod. 1995 Dec;1(4):222-8.
30- Solberg WK. Temporomandibular disorders: masticatory myalgia and its management. Br Dent J. 1986 May 24;160(10):351-6.
31- Ramfjord SP, Ash MM. Occlusion. Philadelphia, WB Saunders Co., 1983:177-87.
32- Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213.
33- Rener-Sitar K, John MT, Bandyopadhyay D, Howell MJ, Schiffman EL. Exploration of dimensionality and psychometric properties of the Pittsburgh Sleep Quality Index in cases with temporomandibular disorders. Health Qual Life Outcomes. 2014 Jan 21;12(1):10.
34- Rai B, Kaur J. Association between stress, sleep quality and temporomandibular joint dysfunction: simulated Mars mission. Oman Med J. 2013 May;28(3):216-9.
35- Smyth C. The Pittsburgh Sleep Quality Index (PSQI). Try this: Best practices in nursing care to older adults. New York University College of Nursing. Available at: https://consultgeri.org/try-this/general-assessment/issue-6.1.pdf /Accessed April 24, 2018.
36- Silveira A, Gadotti IC, Armijo-Olivo S, Biasotto-Gonzalez DA, Magee D. Jaw dysfunction is associated with neck disability and muscle tenderness in subjects with and without chronic temporomandibular disorders. Biomed Res Int. 2015 Apr;2015(3):512792.
37- Drabovicz PV, Salles V, Drabovicz PE, Fontes MJ. Assessment of sleep quality in adolescents with temporomandibular disorders. J Pediatr (Rio J). 2012 Mar-Apr;88(2):169-72.
38- Bertoli FM, Antoniuk SA, Bruck I, Xavier GR, Rodrigues DC, Losso EM. Evaluation of the signs and symptoms of temporomandibular disorders in children with headaches. Arq Neuropsiquiatr. 2007 Jun;65(2A):251-5.
39- Lima DR, Brunetti RF, Oliveira W. Study of the prevalence of craniomandibular dysfunction using Helkimo's index and having as variables sex, age and whether the subjects had or had not been treated orthodonticaly. Pós Grad Rev Fac Odontol São José Dos Campos. 1999;2:127-33.
40- Helkimo M. Studies on function and dysfunction of the masticatory system. I. An epidemiological investigation of symptoms of dysfunction in Lapps in the north of Finland. Proc Finn Dent Soc. 1974 Apr;70(2):37-49.
41- da Cunha SC, Nogueira RV, Duarte AP, Vasconcelos BC, Almeida Rde A. Analysis of helkimo and craniomandibular indexes for temporomandibular disorder diagnosis on rheumatoid arthritis patients. Braz J Otorhinolaryngol. 2007 Jan-Feb;73(1):19-26.
42- Rani S, Pawah S, Gola S, Bakshi M. Analysis of Helkimo index for temporomandibular disorder diagnosis in the dental students of Faridabad city: A cross-sectional study. J Indian Prosthodont Soc. 2017 Jan-Mar;17(1):48-52.
43- Su N, Liu Y, Yang X, Shen J, Wang H. Correlation between oral health-related quality of life and clinical dysfunction index in patients with temporomandibular joint osteoarthritis. J Oral Sci. 2016 Dec;58(4):483-90.
44- Perillo L, Femminella B, Farronato D, Baccetti T, Contardo L, Perinetti G. Do malocclusion and Helkimo Index≥ 5 correlate with body posture? J Oral Rehabil. 2011 Apr;38(4):242-52.
45- Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath. 2012 Mar;16(1):79-82.
46- Rener-Sitar K, John MT, Pusalavidyasagar SS, Bandyopadhyay D, Schiffman EL. Sleep quality in temporomandibular disorder cases. Sleep Med. 2016 Sep;25:105-12.
| Files | ||
| Issue | Vol 16, No 3 (2019) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v16i3.1592 | |
| Keywords | ||
| Temporomandibular Disorders Severity of Illness Index Sleep Hygiene | ||
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How to Cite
1.
Haghnegahdar A, Zamani A, Vossoughi M. Evaluation of Association Between the Severity of Temporomandibular Disorders and Quality of Sleep in a Selected Iranian Population. Front Dent. 2019;16(3):206-213.
