IADR Abstract Archives
Jaw Injury Predicts TMD Onset: Predictive Models from OPPERA Study
Objectives: Prospectively evaluate the contribution of jaw injury to first–onset incidence of painful temporomandibular disorder (TMD).
Methods: Data were from the nested case-control study of TMD incidence, part of the OPPERA study (Orofacial Pain: Prospective Evaluation and Risk Assessment). Between 2006-2008, 2,737 community-based adults were enrolled at four U.S. study sites; participants had no history of TMD symptoms and examiners confirmed TMD absence. At enrollment, participants reported prior injury history and current non-specific oral symptoms; examiners also measured hyperalgesia, a potential marker for pain up-regulation and somatic symptom focus. During a median 3-year follow-up period, participants completed quarterly (3-monthly) follow-up questionnaires assessing jaw injury and TMD symptoms. Symptomatic participants were re-examined, yielding 249 incident cases of first-onset TMD; for this nested study, 192 controls who developed neither TMD symptoms nor clinical TMD during follow-up were also re-examined. Binary logistic regression models computed incidence odds ratios (IOR) and associated 95% confidence limits (95%CL) as estimates of association between jaw injury and clinical TMD incidence. Effect modification was assessed with demographics of age (<30yrs, 62%), gender (female, 65%), and race (white, 52%).
Results: Prior to their follow-up visit, 90 TMD cases and 23 controls experienced injury due to external trauma or excessive jaw function. Effect modification by each demographic variable was not significant (Breslow-Day Test, p>0.28). In the univariate model (controlling for study site), injury during follow-up was associated with five-fold greater incidence of TMD (IOR=4.7, 95%CL=2.8,8.0). After controlling for demographics, the association remained unchanged (IOR=4.8, 95%CL=2.9,8.2). Likewise, the IOR for injury during follow-up was not appreciably confounded by injury prior to enrollment (IOR=5.3, 95%CL=3.0,9.4), hyperalgesia at enrollment (IOR=4.9, 95%CL=2.9,8.3), and non-specific oral symptoms at enrollment (IOR=5.3, 95%CL=3.0,9.1).
Conclusions: Jaw injury was strongly associated with elevated TMD risk; the relationship was not explained by characteristics such as hyperalgesia that might contribute to injury over-reporting.
Methods: Data were from the nested case-control study of TMD incidence, part of the OPPERA study (Orofacial Pain: Prospective Evaluation and Risk Assessment). Between 2006-2008, 2,737 community-based adults were enrolled at four U.S. study sites; participants had no history of TMD symptoms and examiners confirmed TMD absence. At enrollment, participants reported prior injury history and current non-specific oral symptoms; examiners also measured hyperalgesia, a potential marker for pain up-regulation and somatic symptom focus. During a median 3-year follow-up period, participants completed quarterly (3-monthly) follow-up questionnaires assessing jaw injury and TMD symptoms. Symptomatic participants were re-examined, yielding 249 incident cases of first-onset TMD; for this nested study, 192 controls who developed neither TMD symptoms nor clinical TMD during follow-up were also re-examined. Binary logistic regression models computed incidence odds ratios (IOR) and associated 95% confidence limits (95%CL) as estimates of association between jaw injury and clinical TMD incidence. Effect modification was assessed with demographics of age (<30yrs, 62%), gender (female, 65%), and race (white, 52%).
Results: Prior to their follow-up visit, 90 TMD cases and 23 controls experienced injury due to external trauma or excessive jaw function. Effect modification by each demographic variable was not significant (Breslow-Day Test, p>0.28). In the univariate model (controlling for study site), injury during follow-up was associated with five-fold greater incidence of TMD (IOR=4.7, 95%CL=2.8,8.0). After controlling for demographics, the association remained unchanged (IOR=4.8, 95%CL=2.9,8.2). Likewise, the IOR for injury during follow-up was not appreciably confounded by injury prior to enrollment (IOR=5.3, 95%CL=3.0,9.4), hyperalgesia at enrollment (IOR=4.9, 95%CL=2.9,8.3), and non-specific oral symptoms at enrollment (IOR=5.3, 95%CL=3.0,9.1).
Conclusions: Jaw injury was strongly associated with elevated TMD risk; the relationship was not explained by characteristics such as hyperalgesia that might contribute to injury over-reporting.