Title

PTSD Is a Risk Factor for the Development of TMD and a Decline in Oral Health Conditions

Clinical Question

In adults, would having PTSD increase the likelihood of developing a temporomandibular disorder and experiencing a decline in oral health conditions, compared to those who do not have PTSD?

Clinical Bottom Line

Adults with PTSD are more likely to develop a temporomandibular disorder and experience a decline in oral health conditions, in comparison to adults who do not have PTSD. This is supported by a case-control study of 50 patients who were diagnosed with PTSD compared to 50 patients without PTSD. This study demonstrated that the PTSD patient group displayed more TMD diagnoses, in comparison to the control group. More so, patients in the PTSD group exhibited deteriorating oral hygiene and periodontal health compared to the control group. Dentists can advise specific patients to have their PTSD effectively treated in order to improve their TMD symptoms and overall oral health condition.

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
17207072	Muhvić-Urek/2007	50 male patients diagnosed with PTSD and 50 age-matched men who did not have PTSD	Case Control Study
Key results	There were two groups of patients: 50 soldiers with a history of war-induced PTSD and 50 patients of the same age without PTSD, serving as the controls. All patients completed the Research Diagnosis Criteria for Temporomandibular Disorder history questionnaire. These forms requested information relating pain symptoms in the jaw region, as well as their oral health status. The PTSD group demonstrated a widespread diagnosis of myofascial pain (48%) compared to the control group, whose most prevalent TMD diagnosis was disc displacement with reduction (8%). Each group had one patient that was fully edentulous. There was no statistical significant difference between the two groups for the DMFT index (P=0.36); nevertheless, the group with the PTSD patients had more missing teeth, more decay present, and less filled teeth than the control group (P<0.05 for all). The group with the PTSD patients also had fewer teeth compared to the control patients (P=0.041).

Evidence Search

("Stress Disorders, Post-Traumatic"[Mesh]) AND "Temporomandibular Joint Disorders"[Mesh]

Comments on
The Evidence

Validity: A strength of this study was the use of a highly skilled examiner, which performed every clinical exam without having the knowledge of the TMD history questionnaire results. This provided a more blinded approach and bolsters the credibility of this study. Nevertheless, a weakness of the study was the lack of variability in demographics used in the study. The patient population was strictly Croatian. Perhaps they could have utilized a more widespread representation of PTSD sufferers from other countries. Moreover, they did not thoroughly explain the criteria they used to determine whether a subject qualified as having PTSD or not. They did not disclose the exact parameters they used to determine if the PTSD patients had the same level of PTSD. This study did not state any competing interests of importance. Perspective: Based on the study, it is reasonable to conclude that PTSD is a risk factor for the development of TMD and a decline in oral health conditions. Overall, the study was informative and valid; however, it could have used a more variable population instead of only Croatian patient subjects.

Applicability

This study suggests that PTSD patients are more vulnerable to experiencing a decline in their oral health and an exacerbation of their current TMD symptoms. PTSD is a serious and prevalent mental health problem in our society. The consequences for untreated PTSD can be fatal. Thus, it is imperative that dentists encourage their patients to take their PTSD diagnosis seriously. Dentists should strongly encourage their PTSD patients to have their PTSD effectively and appropriately treated, in order to reduce the level of repercussions on their oral health and TMD. This study suggested a more proactive treatment approach from dentists, where PTSD patients are more frequently seen for evaluations, have routine fluoride treatments, and receive positive encouragement to practice good oral health measures.

Specialty

(General Dentistry)

Keywords

Temporomandibular disorder, PTSD, Oral Health

ID#

3189

Date of submission

03/29/2017

E-mail

hurtadodemen@live.uthscsa.edu

Author

Bolivia Hurtado De Mendoza

Co-author(s)

Co-author(s) e-mail

Faculty mentor

Edward F. Wright, DDS, MS

Faculty mentor e-mail

WrightE2@uthscsa.edu

Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

None available