Psychological Factors and Temporomandibular Outcomes
Gerald B. Wexler, B.Sc., D.D.S.; Pamela A Steed, D.D.S., M.S.D.
ABSTRACT: This study examines the effect of psychological
dysfunction as an etiological factor in temporomandibular disorder (TMD). It
employs a thoroughly validated psychometric measurement system, the TMJ
Scale (Pain Resource Center, Inc. Durham, North Carolina), to determine the
effects of pretreatment stress and psychological dysfunction upon presenting
symptom levels. The study also addresses these parameters for the eventual
treatment outcome. During the course of this study, 2,074 patients were
evaluated. Seven hundred and fifty-four by Dr. Steed and 1.320 by Dr.
Wexler. Both practices address essentially identical patient populations and
focus special interest in craniofacial pain and the diagnosis and Phase I
treatment of temporomandibular dysfunction. Of the patients in the study who
were found to have clinically treatable temporomandibular disorders, 561
consecutive patients completed treatment and were deemed to have reached
Maximum Medical Improvement (MMI). The TMJ Scale was re-administered to this
post-treatment population. This study summarized findings pertinent to the
four primary issues: 1. Pre-treatment psychological factors and stress,
which seem to be moderately related to presenting pain levels and overall
TMD levels (excepting joint function); 2. Treatment outcomes which appeared
to be unrelated to the initial psychosocial symptom severity; 3. Physical
symptoms outcomes and psychosocial outcomes which appeared to be
significantly related and; 4. Intracapsular symptom improvement which
appeared to be unrelated to psychological functioning changes but mildly
related to stress.
0886-634/1602-072
The Journal of Craniomandibular Practice, Copyright © 1998 by Chroma, Inc.
Manuscript received October 27,
1997; revised manuscript received January 20, 1998; accepted February 23,
1998.
Dr. Gerald B. Wexler received
his B.S.C. and D.D.S. degrees from McGill University, Montreal, Quebec. He
has been in private dental practice in Ottawa, Ontario since 1970,and has
been treating temporomandibular joint problems since 1979. He is a fellow in
the Academy of General Dentistry, a member of the American Equilibration
Society, and a member of the American Academy of Orofacial Pain. He is
consulting staff of the Ottawa Civic Hospital Dental Department, where he
directed operation of the Temporomandibular Joint Treatment Clinic from
1984-1993.
Dr. Pamela A. Steed received
her D.D.S. and M.S.D. degrees from the Indiana University School of
Dentistry at Indianapolis in 1983 and 1990, respectively, She limits her
private practice to oral medicine/temporomandibular dysfunction with special
interest in obstructive sleep apnea. Dr. Steed is a fellow in the American
Academy of Head, Neck and Facial Pain and the International College of
Cranio-mandibular Orthopedics, and a member of the American Academy of
Functional Orthodontics.