The effects of trauma-focused treatment on painful temporomandibular disorders, awake bruxism and sleep bruxism in patients with severe post-traumatic stress disorder

BackgroundChronic painful temporomandibular disorders (TMD), awake bruxism and sleep bruxism are often comorbid with post-traumatic stress disorder (PTSD), but the implications for treatment are unknown.Objective(s)To explore the effects of PTSD treatment on these conditions. We hypothesized that chronic painful TMD, pain intensity, pain interference, awake bruxism and sleep bruxism would decrease after evidence-based trauma-focused treatment and that this decrease would be maintained at the 6-month follow-up.MethodsIndividuals referred for PTSD treatment were assessed for chronic painful TMD (temporomandibular disorder pain screener), pain intensity, pain interference (Graded Chronic Pain Scale 2.0), awake bruxism and sleep bruxism (oral behaviours checklist) pre-, post-treatment and at the 6-month follow-up. Hypotheses were tested using the Friedman test, followed by a post hoc Wilcoxon signed-rank test. Effect sizes (Cohen's r) are reported. Barely any pain interference was reported, therefore these outcomes were not analysed.ResultsIn individuals with chronic painful TMD (n = 98), pain intensity, awake bruxism and sleep bruxism decreased across the three time points. Post hoc tests showed that chronic painful TMD (r = 0.59), pain intensity (r = 0.28), awake bruxism (r = 0.51) and sleep bruxism (r = 0.35) decreased between pre- and post-treatment. Between pre-treatment and the 6-month follow-up, chronic painful TMD (r = 0.58), awake bruxism (r = 0.30) and sleep bruxism (r = 0.39) decreased as well.ConclusionThe results provide preliminary support for a trauma-sensitive approach for patients with chronic painful TMD and PTSD and suggest that trauma-focused treatment may be beneficial for chronic painful TMD, awake bruxism and sleep bruxism in patients with PTSD and chronic painful TMD. In this study, including participants with post-traumatic stress disorder (PTSD) and chronic painful temporomandibular disorders (TMD), we found that painful TMD, awake bruxism, and sleep bruxism decreased after treatment of PTSD. These results were maintained at 6-month follow-up. This represents a first step in exploring the implications of the comorbidity between chronic painful TMD and PTSD. The results are the first indication that treating PTSD might be beneficial for patients with chronic painful TMD who also suffer from PTSD.image