One in 3 adults developed temporomandibular disorder symptoms over 2.3 years. Comorbid pain was common and recurrence was rapid, yet many did not seek health care or use analgesics.
The course of preclinical pain symptoms sheds light on the etiology and prognosis of chronic pain. We aimed to quantify rates of developing initial and recurrent symptoms of painful temporomandibular disorder (TMD) and to evaluate associations with health behaviors. In the OPPERA prospective cohort study, 2,719 individuals aged 18 to 44 years with lifetime absence of TMD when enrolled completed 25,103 quarterly (3-monthly) questionnaires during a median 2.3-year follow-up period. Questionnaires documented TMD symptom episodes, headache, other body pain, health care attendance, and analgesic use, and. Kaplan-Meier methods for clustered data estimated symptom-free survival time. Multivariable models assessed demographic variation in TMD symptom rates and evaluated associations with health care and analgesic use. One-third of the study subjects developed TMD symptoms and for a quarter of symptomatic episodes, pain intensity was severe. Initial TMD symptoms developed at an annual rate of 18.8 episodes per 100 persons. The annual rate more than doubled for first-recurrence and doubled again for second or subsequent recurrence such that, 1 year after first recurrence, 71% of study subjects experienced a second recurrence. The overall rate increased with age and was greater in African Americans and lower in Asians relative to those of white race/ethnicity. The probability of TMD symptoms was strongly associated with concurrent episodes of headache and body pain and with past episodes of TMD symptoms. Episodes of TMD symptoms, headache, and body pain were associated with increases of ∼10% in probability of analgesic use and health care attendance. Yet, even when TMD, headache, and body pain occurred concurrently, 27% of study subjects neither attended health care nor used analgesics.
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
aRegional Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
bDepartment of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
cDepartment of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
dDepartment of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
eDepartment of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
fBattelle Memorial Institute, Durham, North Carolina, USA
gDepartment of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
hBrotman Facial Pain Center, University of Maryland–Baltimore, Baltimore, Maryland, USA
iDepartment of Neural and Pain Sciences, University of Maryland–Baltimore, Baltimore, Maryland, USA
jDepartment of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA
*Corresponding author. Address: University of North Carolina at Chapel Hill, Department of Dental Ecology, Koury Oral Health Sciences, Room 4501E, UNC School of Dentistry, 385 South Columbia Street, CB#7455, Chapel Hill, NC 7455, USA. Tel.: +1 919 537 3273.
Article history: Received 28 June 2012; Received in revised form 3 December 2012; Accepted 30 January 2013.