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The relationship between temporomandibular disorders & stress-associated syndromes

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By Korszun A, Papadopoulos E, Demitrack M, Engleberg C, Crofford L • • October 5, 1998

OBJECTIVES: The purpose of this study was to determine the
comorbidity of temporomandibular disorders and other
stress-associated conditions in patients with chronic fatigue
syndrome and fibromyalgia.

STUDY DESIGN: Of 92 patients who fulfilled the criteria for chronic
fatigue syndrome or fibromyalgia (or both), 39 (42%) reported a prior
diagnosis of temporomandibular disorder. Further questionnaires
were sent to the members of this group, and 30 patients responded.

RESULTS: Of the original 92 patients, of whom 42% reported
temporomandibular disorders, 46% had histories of irritable
bowel syndrome, 42% of premenstrual syndrome, and 19% of
interstitial cystitis. Of the patients with temporomandibular
disorders, the great majority reported an onset of generalized
symptoms befor the onset of facial pain. Despite this, 75% had
been treated exclusively for temporomandibular disorders,
usually with bite splints.

CONCLUSIONS: Patients appearing for treatment with chronic facial
pain show a high comorbidity with other stress- associated syndromes.
The clinical overlap between these conditions may reflect a shared
underlying pathophysiologic basis involving dysregulation of the
hypothalamic-pituitary-adrenal stress hormone axis in predisposed
individuals. A multidisciplinary clinical approach to temporomandibular
disorders would improve diagnosis and treatment outcomes for this
group of patients.

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