The Associations of Injury and Stress with Temporomandibular Disorders
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Temporomandibular disorders (TMDs) are complex musculoskeletal pain conditions that affect the orofacial region. Injury, compared to other known risk factors, is closely related to pain through a nociceptive pathway that starts with detection of real or potential tissue damage and may progress to pain. The association between injury and TMD is largely based on cross-sectional studies which limit causal inference about the role of jaw injury in TMD. The few prospective studies assessed jaw injuries from different settings and have a narrow focus regarding type of jaw injury, potentially limiting counts of injury and affecting internal validity; thus, no prospective study has comprehensively assessed injury to the jaw from various traumatic events in order to investigate the association between incident injury and TMD. In addition, psychological states and pain sensitivity are well-known risk factors for TMD, of which psychological stress has well-established putative mechanisms for affecting pain and TMD. Specifically, stress associated with TMD may potentially exacerbate nociceptive pain episodes once an individual is injured. However, no prospective study has assessed whether injury can modify the association between stress and TMD, and the mechanism underlying the interplay between stress and injury on increased TMD incidence remains unclear.