Background/Aim: There is an abundance of data regarding temporomandibular disorders (TMD) and bruxism specific to patients with bipolar disorder (BD). This study aimed to investigate the prevalence of TMD signs in subjects with and without BD. Material and Methods: The case group included 242 adult patients (103 men and 139 women) with BD and and the control group included 187 subjects without BD (89 men and 98 women). The case and control groups were compared for the presence of bruxism and the signs of TMD including muscle and temporomandibular joint (TMJ) tenderness to palpation, limitation of maximum mouth opening, and TMJ sounds. Results: The frequency of at least one sign of TMD was significantly higher in patients with BD (191 ⁄242, 78.9%) than the control group (95 ⁄187, 50.8%) (p<0.001). Statistically significant differences were found between the case and control groups in terms of joint pain on palpation (p<0.05), masseter muscle pain on palpation (p<0.01), joint clicks (p<0.001) and limited mouth opening (p<0.001). Bruxism was significantly higher in patients with BD (49.6%) than the control group (19.8%) (p<0.001). Conclusions: Patients with BD appear to be more prone to having TMD signs and bruxism compared to the control group, but this comorbidity should be better understood by further studies.
1. De Leeuw R. Orofacial pain: guidelines for classification, assessment, and management. American Academy of Orofacial Pain. 4th ed. Quintessence Publ, Co. Chicago, 2008, pp:131.
2. Suvinen TI, Reade PC, Hanes KR, Könönen M, Kemppainen P. Temporomandibular disorder subtypes according to selfreported physical and psychosocial variables in female patients: a re-evaluation. J Oral Rehabil, 2005;32:166-173.
3. Aditya A, Lele S, Aditya P. Prevalence of symptoms associated with temporoman dibular disorders in patients with psychosocial disorders. J Int Dent Med Res, 2012;5:26-29.
4. Velasco-Ortega E, Monsalve-Guil L, Velasco-Ponferrada C, Medel-Soteras R, Segura-Egea JJ. Temporomandibular disorders among schizophrenic patients: A case-control study. Med Oral Patol Oral Cir Bucal, 2005;10:315-322.
5. Winocur E, Hermesh H, Littner D. Signs of bruxism and temporomandibular disorders among psychiatric patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007;103:60-63.
6. De Araújo AN, Do Nascimento MA, De Sena EP, Baptista AF. Temporo mandibular disorders in patients with schizophrenia using antipsychotic agents: a discussion paper. Drug Healthcare and Patient Safety, 2014;10:21-27.
7. Liao CH, Chang CS, Chang SN, Lane HY, Lyu SY, Morisky DE et al. The risk of temporomandibular disorder in patients with depression: a population-based cohort study. Community Dent Oral Epidemiol, 2011;39:525-531.
8. Gurbuz O, Alatas G, Kurt E. Prevalence of temporomandibular disorder signs in patients with schizophrenia. J Oral Rehabil, 2009;36:864-871.
9. Salmos-Brito JA, de Menezes RF, Teixeira CE, Gonzaga RK, Rodrigues BH, Braz R et al. Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders. Lasers Med Sci, 2013;28:57-64.
10. De Oliveira RH, Hallak JE, Siéssere S, de Sousa LG, Semprini M, de Sena MF et al. Electromyographic analysis of masseter and temporal muscles, bite force, masticatory efficiency in medicated individuals with schizophrenia and mood disorders compared with healthy controls. J Oral Rehabil, 2014;41:399-408.
11. Kampe T, Edman G, Bader G, Tagdae T, Karlsson S. Personality traits in a group of subjects with long standing bruxing behaviour. J Oral Rehabil, 1997;24:588-593.
12. Molina OF, dos Santos J. Hostility in TMD/bruxism patients and controls: a clinical comparison study and preliminary results. Cranio, 2002;20:282-288.
13. Piccoli L, Besharat LK, Cassetta M, Migliau G, Dicarlo S, Pompa G. Tooth wear among patients suffering from mental disorders. Annali di Stomatologia, 2014;2:52-60.
14. Ketter TA. Diagnostic features, prevalence and impact of bipolar disorder. J Clin Psychiatry, 2010;71(6):e14.
19. Craddock N, Davè S, Greening J. Association studies of bipolar disorder. Bipolar Disord, 2001;3:284-298.
20. American Psychiatric Association. Task Force on DSMIV. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, 5th edn. Washington, DC: American Psychiatric Association, 2000.
21. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960;23:56-62.
22. Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry, 1978;133:429-435.
23. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas, 1960;20:37-46.
24. Dworkin S, Le Resche L. Research diagnostic criteria for TMD: review, criteria, exami nations and specification, critique. J Craniomandib Disord, 1992;6:301-355.
25. American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual (ICSD-2), 2nd ed, American Academy of Sleep Medicine, Westchester, Ill, USA, 2005.
26. Johansson A, Haraldson T, Omar R, Kiliaridis S, Carlsson GE. A system for assessing the severity and progression of occlusal tooth wear. J Oral Rehabil, 1993;20:125-131.
27. Carlsson GE. Epidemiology and treatment needs for temporomandibular disorders. J Orofac Pain, 1999;13:232-237.
28. Carlson CR, Okeson JP, Falace DA, Nitz AJ, Curran SL, Anderson D. Comparison of psychologic and physiologic functioning between patients with masticatory muscle pain and matched controls. J Orofac Pain, 1993;7:15-22.
29. Manfredini D, Ciaparelli A, Dell Osso L, Bosco M. Mood disorders in subjects with bruxising behaviors. J Dent, 2005; 33:485-490.
30. Blasberg B, Greenberg MS. Temporomandibular disorders. In: Greenberg MS, Glick M, Ship JA, eds. Burket’s oral edicine. 11th edn. Ontorio, BC Decker Inc. Hamilton, 2008, pp:254.
31. Falisi G, Rastelli C, Panti F, Maglione H, Quezada Arcega R. Psychotropic drugs and bruxism. Expert Opin Drug Saf, 2014;13:1319-1326.
32. Kitsoulis P, Marini A, Iliou K, Galani V, Zimpis A, Kanavaros P, Paraskevas G. Signs and Symptoms of Temporomandibular Joint Disorders Related to the Degree of Mouth Opening and Hearing Loss. BMC Ear Nose Throat Disorders, 2011;11:1-8.
33. Carlsson GE, Magnusson T, Guimaraes AS. Tratamento das disfunco es temporomandi bulares na clınica odontologica. 1st edn. Sao Paulo: Quintessence Ed Ltda, Trad. Antonio Sergio Guimaraes, Liete Figueiredo Zwir, 2006, pp:9-23.
34. Sano T, Widmalm SE, Westesson PL, Takahashi K, Yoshida H, Michi K. Amplitude and frequency spectrum of temporomandibular joint sounds from subjects with and without other signs⁄symptoms of temporomandibular disorders J Oral Rehabil, 1999;26:145-150.
35. Carlson CR, Reid KI, Curran SL, Studts J, Okeson JP, Falace D, Nitz A, Bertrand PM. Psychological and physiological parameters of masticatory muscle pain. Pain, 1998;76:297-307.
36. Gatchel RJ, Garofalo JP, Ellis E, Holt M. Major psychological disorders in acute and chronic TMD: an initial examination. J Am Dent Assoc, 1996;127:1365-1374.
37. Blumensohn R, Ringler D, Eli I. Pain perception in patients with schizophrenia. J Nerv Ment Dis, 2002;190:481-483.
38. Lobbezoo F, Ahlberg J, Glaros A, Kato T, Koyano K et al. Bruxism defined and graded: an international consensus. J Oral Rehabil, 2013;40:2-4.