Prevalence of painful temporomandibular disorders in endodontic patients with tooth pain

• Published in: Journal of oral rehabilitation 2023-07, Vol.50 (7), p.537-547
• Main Authors: Daline, Iryna H., Slade, Gary D., Fouad, Ashraf F., Nixdorf, Donald R., Tchivileva, Inna E.
• Format: Article
• Language: English
• Subjects: arthralgia; Comorbidity; Cross-Sectional Studies; diagnosis; Facial Pain - epidemiology; Facial Pain - etiology; Humans; Medical diagnosis; musculoskeletal pain; myalgia; orofacial pain; Pain; Periodontitis; Prevalence; Regression analysis; root canal therapy; Root canals; Teeth; Temporomandibular joint; Temporomandibular joint disorders; Temporomandibular Joint Disorders - complications; Temporomandibular Joint Disorders - diagnosis; Temporomandibular Joint Disorders - epidemiology; Toothache - complications; Toothache - epidemiology
• ISSN: 0305-182X; 1365-2842
• DOI: 10.1111/joor.13457

Background Pain from temporomandibular disorders (TMDs) may mimic endodontic pain, but its prevalence in endodontic patients is unknown. Objectives This cross‐sectional study investigated the prevalence of painful TMDs in patients presenting for endodontic treatment of a painful tooth. Contribution of TMD pain to the chief complaint and characteristics associated with TMD prevalence were also assessed. Methods Patients reporting tooth pain in the 30 days before attending university clinics for nonsurgical root canal treatment or retreatment were enrolled. Before endodontic treatment, they completed questionnaires and a board‐certified orofacial pain specialist/endodontic resident diagnosed TMD using published Diagnostic Criteria for TMD. Log‐binomial regression models estimated prevalence ratios to quantify associations with patient characteristics. Results Among 100 patients enrolled, prevalence of painful TMDs was 54%. In 26% of patients, TMD pain was unrelated to endodontic pain; in 20%, TMD contributed to their chief pain complaint; and in 8%, TMD was a sole aetiology for pain. TMD prevalence was associated with greater intensity, frequency and duration of the chief pain complaint; pain in more than one tooth; tenderness to tooth percussion and palpation; a diagnosis of symptomatic apical periodontitis; pain medication use; and psychological distress. Conclusion A majority of patients with tooth pain seeking endodontic treatment had painful TMDs; one quarter had TMD as a component or sole cause of their pain. TMD prevalence was associated with more severe symptoms and signs of tooth pain and with psychological factors. The high frequency of TMD comorbidity warrants consideration in management of endodontic patients with history of toothache. Over one half of patients presenting for RCT of a painful tooth had TMD. In over a quarter of the patients, painful TMD either contributed to or was a sole etiology of their chief pain complaint. TMD prevalence was associated with characteristics of presenting pain, dental exam findings, periapical diagnosis, and psychological factors. High comorbidity of TMD and endodontic pain warrants routine screening for TMD in patients with history of toothache regardless of the presence of obvious endodontic pathosis.