University of Oulu

Knuutila, J., Kivipuro, J., Näpänkangas, R., Auvinen, J., Pesonen, P., Karppinen, J., Paananen, M., Pirttiniemi, P., Raustia, A., & Sipilä, K. (2022). Association of temporomandibular disorders with pain sensitivity: A cohort study. European Journal of Pain, 26, 143– 153.

Association of temporomandibular disorders with pain sensitivity : a cohort study

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Author: Knuutila, Jarno1; Kivipuro, Juhani1; Näpänkangas, Ritva1,2;
Organizations: 1Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
2Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
3Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
4Healthcare and Social Services of Oulunkaari, Oulunkaari Consortium of Municipalities, Oulu, Finland
5Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
6Finnish Institute of Occupational Health Oulu, Finnish Institute of Occupational Health, Oulu, Finland
7Kerava Health Care Center, Town of Kerava, Kerava, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2021-11-17


Background: Pain related to temporomandibular disorders (TMD) can be linked with multiple site pain (MSP), and may associate with increased pain sensitivity, more frequently among women than men. The aim of the study was to examine the associations of pressure pain threshold (PPT) and tolerance (PPTo) with TMD and associated MSP in the Northern Finland Birth Cohort 1966 (NFBC1966) study.

Methods: Altogether 1961 NFBC1966 subjects attended clinical medical and dental examination at the Institute of Dentistry, University of Oulu in 2012–2013. Clinical examinations were carried out using a modified Diagnostic Criteria for TMD protocol (DC/TMD). MSP was defined based on questions regarding body pain sites. Additionally, PPT and PPTo were assessed using algometer measurements. Mann–Whitney U-test and Tobit regression models were used to analyse associations between TMD sub-diagnoses, MSP, PPT and PPTo, stratified by sex. Further models were adjusted with anxiety and depressive symptoms, which were assessed using Hopkins Symptom Checklist-25 (HSCL-25) and two-way interaction terms.

Results: Among females, lower PPT and PPTo were associated with myalgia and arthralgia. Among males, lower PPT and PPTo were associated with MSP-linked TMD. Tobit regression analysis showed significantly lower PPT and PPTo values in the myalgia and arthralgia subgroups among female TMD subjects. Among females, disc displacement with reduction had an inverse association with PPT and PPTo. Among males, lower PPTo was associated with degenerative joint disease and MSP-linked TMD.

Conclusions: The pain regulatory mechanisms behind TMD act differently between the genders as local TMD among females and MSP-linked TMD among males were associated with pain sensitivity.

Significance: The study shows that there are differences in the associations of painful TMD with pressure pain tolerance, pressure pain sensitivity and MSP between male and female subjects.

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Series: European journal of pain
ISSN: 1090-3801
ISSN-E: 1532-2149
ISSN-L: 1090-3801
Volume: 26
Issue: 1
Pages: 143 - 153
DOI: 10.1002/ejp.1844
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: Jarno Knuutila was supported with a grant from the Finnish Association for the Study of Pain (FASP). The authors have no financial relationships relevant to this article to disclose.
Dataset Reference: Supporting information:
Copyright information: © 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.