University of Oulu

Aisha Banafa, Kirsi Sipilä, Jaana Suvisaari & Anna Liisa Suominen (2021) Low-grade inflammation as a potential mediator between depressive symptoms and temporomandibular pain: an 11-year follow-up study on Finnish adults, Acta Odontologica Scandinavica, DOI: 10.1080/00016357.2021.1909746

Low-grade inflammation as a potential mediator between depressive symptoms and temporomandibular pain : an 11-year follow-up study on Finnish adults

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Author: Banafa, Aisha1; Sipilä, Kirsi2,3; Suvisaari, Jaana4;
Organizations: 1Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
2Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
3Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
4Department of Public Health Solutions, Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
5Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
6Health Evaluation and Projection Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.4 MB)
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Language: English
Published: Informa, 2021
Publish Date: 2021-04-22


Background: Low-grade inflammation and depressiveness have been associated with chronic pain conditions.

Objective: To examine whether low-grade inflammation mediates the association between depressive symptoms and temporomandibular (TM) pain in Finnish adults based on the Health 2000/2011 Surveys (BRIF8901).

Methods: The sample comprised subjects who underwent clinical TM pain examination (pain on palpation of the masticatory muscles and temporomandibular joints) in 2000 and 2011 and responded to questions on TM pain symptoms in 2011. The serum level of hs-CRP was obtained in both years, and depressiveness was assessed using the Beck Depression Inventory-21 (BDI-21) in 2000 and BDI-13 in 2011. Four subgroups were formed based on the presence of TM pain: No pain, pain in 2000-only, pain in the 2011-only, and pain in both-years. Analyses included Rao Scott’s chi-square test cross-sectionally, and multinomial logistic regression longitudinally with the level of hs-CRP and BDI-21 score in 2000 as predictors. Mediation was tested using Hayes A. Processv3.5.

Results: Higher BDI-21/-13 and hs-CRP levels corresponded to higher prevalences of TM pain in both years. Longitudinally, in men, higher hs-CRP level predicted TM pain in 2000-only and TM pain in both-years. Higher BDI-21 score predicted having TM pain in 2011-only. In women, higher BDI-21 score predicted TM pain in 2000-only and having TM pain in both-years. Both BDI-21 and hs-CRP had a direct effect on TM pain outcome with no mediation detected.

Conclusions: While depressiveness may increase the risk of chronic TM pain in women, the risk in men is increased by low-grade inflammation.

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Series: Acta odontologica Scandinavica
ISSN: 0001-6357
ISSN-E: 1502-3850
ISSN-L: 0001-6357
Volume: Latest articles
DOI: 10.1080/00016357.2021.1909746
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: This study was based on data from the Health 2000 and the Health 2011 Surveys, which were organized by the National Institute for Health and Welfare of Finland, the former National Public Health Institute.
Copyright information: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Acta Odontologica Scandinavica Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.