Academic journal article East Asian Archives of Psychiatry

Association of Temporomandibular Joint Osseous Changes with Anxiety, Depression, and Limitation of Mandibular Function in Elderly Vietnamese

Academic journal article East Asian Archives of Psychiatry

Association of Temporomandibular Joint Osseous Changes with Anxiety, Depression, and Limitation of Mandibular Function in Elderly Vietnamese

Article excerpt

Introduction

Temporomandibular joint (TMJ) osseous changes are a lowinflammatory arthritic degenerative disease. The prevalence of TMJ osseous changes varies among population-based studies, ranging from 11.6% to 68.1%.1-3 The rate of TMJ osseous changes is associated with the progression of degeneration: the early signs were erosion or flattening, whereas osteophytes and sclerosis were the last stage of degeneration.4 Radiographic studies of TMJ osseous changes among the general population have reported a prevalence of 6% to 70% for erosion, 21% to 80% for flattening, 3% to 50% for osteophytes, and 8.5% to 24% for sclerosis.1-3'5'6 TMJ osseous changes occur gradually after middle age and thus are known as an age-related disease.

The effect of ageing on mental health has been reported. The prevalence of psychological disorders among adult populations has been reported to be 16% to 40% in Europe, 11% to 39% in Asia, and 7% to 29% in the US.7-14 In Vietnam, >40% of older adults have psychological disorders, which are associated with demographic characteristics.15 Psychological disorders affect daily activities and quality of life and increase the risk of diseases and chronic pain in elderly people.15-18

TMJ osseous changes can progress to TMJ disorders (TMJD), which is a common cause of orofacial pain.19 It has been reported that 45% to 53% of patients with TMJD pain often have anxiety and depression.20

The two TMJs act simultaneously to perform rotational and translational movements of the mandible. TMJ osteoarthritis increases the risk of limited mouth opening by 1.5 to 7.5 times.21 TMJ osseous changes can cause disharmony among the masticatory structures and limitation of mandibular function.

The Diagnostic Criteria for Temporomandibular Disorders axis II has been used to evaluate the psychological aspects and mandibular function (such as mastication, motion, verbal and emotional expression) in patients with TMJD.22,23 This study aimed (1) to determine the prevalence of anxiety, depression, and TMJ osseous changes in elderly Vietnamese according to sex and residence, and (2) to investigate the association of TMJ osseous changes with anxiety, depression, and limitation of mandibular function.

Methods

This study was approved by the Human Research Ethics Committee of Danang University of Medical Technology and Pharmacy (No. 523/CN-DHKTYDDN) and was performed in accordance with the Helsinki Declaration. Written informed consent was obtained from each participant. This cross-sectional study examined the oral health status and clinical and psychological aspects of TMJD in elderly people living in Danang, Vietnam. Participants were randomly selected based on sex and residence.

Assuming a 50% prevalence of any TMJD among the population, 5% of acceptable error margin, and 10% of compensation for withdrawn participants, 300 participants were recruited to achieve a 90% confidence level. Of them, 55 were absent on the day of clinical and radiographic examinations and 66 had unreadable TMJ structures on orthopantomographs. The final sample included 179 participants.

Participants were screened for anxiety and depression using the self-reported 7-item Generalized Anxiety Disorder Scale (GAD-7)24 and 9-item Patient Health Questionnaire (PHQ-9),25 respectively. The GAD-7 measures the frequency of each anxious mood item from not at all (0) to nearly every day (3). Total score ranges from 0 to 21; scores of 5, 10, and 15 indicate mild, moderate, and severe anxiety, respectively. The PHQ-9 measures the frequency of each depressed mood item from not at all (0) to nearly every day (3). Total score ranges from 0 to 27; scores of 5-9, 10-14, 15-19, and >20 indicate mild, moderate, moderatesevere, and severe depression, respectively. Participants with GAD-7 score of >10 and PHD-9 score of >10 were defined as having anxiety and depression, respectively.

Participants then self-rated the limitation of their mandibular function using the 20-item Jaw Functional Limitation Scale (JFLS-20) questionnaire. …

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