Clinical study of the patients with intractable temporomandibular disorders intervened with psychologic problems

Abstract

This study was carried out to evaluate the clinical treatment and prognosis of patients with the refractory temporomandibular disorder (TMD) with mental problems. The study included 27 patients with the TMD with mental problems from the Seoul National University Bundang Hospital, South Korea, between June 2003 and December 2016 (8 males, 19 females, mean age 40.9 years). Diagnosis of TMD disorder was made based on history, clinical examination, RDC/TMD chart, and radiologic examination (panorama, T-M panorama, CT, scintigraphy, MRI). RDC/TMD Axis II was used to discriminate between the presence and absence of a mental problem. The age, sex, chief complaint, diagnosis, treatment method, duration and prognosis of the patients were analyzed and the progress of treatment was analyzed using RDC/TMD Axis II. The number of female patients was higher than that of male patients (19 females, 8 males) and the majorities (51.9%) of them were middle-aged patients (over 40 years). Treatment methods selectively included taking medications such as analgesics and antidepressants, splint devices, physical therapy, TMJ injection, botulinum injection, trigger point anesthesia injection, arthrocentesis, and arthroscopy. Co-treatment was done in departments of neuropsychiatry, rehabilitation medicine, neurology, and anesthesiology, if necessary. The mean duration of treatment was 38.8 months. Improvement in prognosis was observed in 17 cases, no difference was noted in 7 cases and the worse prognosis was observed in 3 cases. When active psychosocial support and psychiatric treatment in addition to TMJ treatment were performed, patients with refractory TMJ disorders and mental problems exhibited favorable prognosis.