Subtypes of acute and chronic temporomandibular disorders: Their relation to psychological and sleep impairments

Objectives To determine the differences in psychological states and sleep quality in patients with various temporomandibular disorder (TMD) subtypes, and to ascertain the relationships between TMD duration with psychological and sleep impairments. Methods A total of 830 TMD patients were recruited categorized into pain-related (PT), intra-articular (IT), and combined (CT) TMD groups. Each group was further divided into acute and chronic subtypes. The Depression, Anxiety, and Stress Scales-21 (DASS-21), and Pittsburgh Sleep Quality Index (PSQI) were used to assess emotional states and sleep problems. Results Although chronic TMDs generally had higher levels of anxiety, depression, stress, and sleep impairments than acute TMDs, significant differences were only observed for the PT group. Ranking of the mean depression, anxiety, and stress scores was as follows: acute TMDs: CT > PT > IT; chronic TMDs: PT > CT > IT. For both acute and chronic TMDs, the ranking of mean PSQI global and component scores was PT >= CT >= IT. Logistic regression analyses indicated that stress (ORs = 4.40) and depression (ORs = 2.82) increased the risks of chronic pain-related TMDs (p < .05). Conclusions Chronic pain-related TMDs are associated with high levels of psychological distress and poorer sleep, while chronic intra-articular TMDs are not. Stress and depression increased the probability of chronic pain-related TMDs.