Temporomandibular Disorders Among Smokers and Nonsmokers: A Longitudinal Cohort Study

Aims: To evaluate whether smoking influences the presence and/or development of signs and symptoms of temporomandibular disor-ders (TMD) among adults. Methods: A random sample of subjects 35, 50, and 65 years of age was drawn from the general popula-tion and examined with the aid of a questionnaire and a clinical examination. Within the sample, smokers were identified based on reported current smoking and nonsmokers were matched to the smokers based on age, gender, educational level, area of residence, and number of teeth. In total, 268 subjects were matched (134 pairs). Six years after the baseline examination, 122 matched pairs were re-examined. Results: Mild symptoms of TMD were reported by approximately 30% of the sample both at baseline and at the follow-up examination 6 years later. Pain in the jaws and/or more severe symptoms of TMD were reported by approximately 15%on both occasions. No significant differences between smokers and nonsmokers were found regarding symptoms of TMD. In both examinations, mild signs (dysfunction index I) were found in approximately 40% of the sample and moderate to severe signs (dysfunction index II to III) in approximately 20%; no statisti-cally significant differences were found between smokers and non-smokers. No significant differences were found between smokers and nonsmokers regarding the course of symptoms or signs of TMD during the study period. Conclusion: Smoking is not a fac-tor related to the presence or development of signs and symptoms of TMD.

bruxism; epidemiology; headaches; orofacial pain; smoking; tobacco

1. Marshall JA, Mahanna GK. Cancer in the differential diagnosis of orofacial pain. Dent Clin North Am 1997;41:355–365.

2. Jay SJ. Tobacco use and chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder [letter]. Arch Intern Med 2000;160:2398, 2401.

3. Aaron LA, Burke MM, Buchwald D. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorders. Arch Intern Med 2000;160:221–227.

4. Molina OF, dos Santos J, Mazzetto M, Nelson S, Nowlin T, Mainieri ET. Oral jaw behaviors in TMD and bruxism: A comparison study by severity of bruxism. Cranio 2001;19:114–122.

5. Altschuler E. Smoke and TMJ? [letter]. J Otolaryngol 1999;28:180.

6. Hill C. Trends in tobacco use in Europe. J Natl Cancer Inst Monogr 1992;12:21–24.

7. Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: Combination of national statistics with two case-control studies. BMJ 2000;5:323–329.

8. Colombo P, Scarpino V, Zuccaro P, Apolone G, Gallus S, La Vecchia C. Smoking in Italian women and men, 2001. Tumori 2002;88:10–12.

9. Weintraub JM, Hamilton WL. Trends in prevalence of current smoking, Massachusetts and states without tobacco control programmes, 1990 to 1999. Tob Control 2002;11(suppl 2):8–13.

10. Persson J, Sjöberg I, Johansson S-E. Health-Related Habits of Life 1980–2002. Living Conditions. Report no. 105. Stockholm, Sweden: Statistics Sweden, 2004.

11. Valanis BG. Epidemiology of lung cancer: A worldwide epidemic. Semin Oncol Nurs 1996;12:251–259.

12. Pirastu R, Iavarone I, Comba P. Bladder cancer: A selected review of the epidemiological literature. Ann 1st Super Sanita 1996;32:3–20.

13. Tredaniel J, Boffetta P, Buiatti E, Saracci R, Hirsch A. Tobacco smoking and gastric cancer: Review and meta-analysis. Int J Cancer 1997;72:565–573.

14. Ellis JL, Campos-Outcalt D. Cardiovascular disease risk factors in native Americans: A literature review. Am J Prev Med 1994;10:295–307.

15. Everhart JE, Byrd-Holt D, Sonnenberg A. Incidence and risk factors for self-reported peptic ulcer disease in United States. Am J Epidemiol 1998;147:529–536.

16. Lanier DC, Stockton P. Clinical predictors of outcome of acute episodes of low back pain. J Fam Pract 1988;27:483–489.

17. Jamison RN, Stetson BA, Parris WC. The relationship between cigarette smoking and chronic low back pain. Addict Behav 1991;16:103–110.

18. Ernst E. Smoking, a cause of back trouble? Br J Rheumatol 1993;32:239–242.

19. Líndal E, Stefánsson JG. Connection between smoking and back pain—Findings from an Icelandic general population study. Scand J Rehab Med 1996;28:33–38.

20. Holm S, Nachemson A. Nutrition of the intervertebral disc: Acute effects of cigarette smoking. An experimental animal study. Ups J Med Sci 1988;93:91–99.

21. Battié MC, Videman T, Gill K, Moneta GB, Nyman R, Kaprio J, Koskenvuo M. 1991 Volvo Award in clinical sciences. Smoking and lumbar intervertebral disc degener-ation: An MRI study of identical twins. Spine 1991;16:1015–1021.

22. An HS, Silveri CP, Simpson JM, et al. Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls. J Spinal Disord 1994;7:369–373.

23. Turnbull B. Smoking and periodontal disease. A review. J N Z Soc Periodontol 1995;79:10–15.

24. Bouclin R, Landry RG, Noreau G. The effects of smoking on periodontal structures: A literature review. J Can Dent Assoc 1997;63:356, 360–363.

25. Qandil R, Sandhu HS, Matthews DC. Tobacco smoking and periodontal diseases. J Can Dent Assoc 1997;63:187–195.

26. Ernster VL, Grady D, Miike R, Black D, Selby J, Kerlikowske K. Facial wrinkling in men and women, by smoking status. Am J Public Health 1995;85:78–82.

27. Yin L, Morita A, Tsuji T. Alterations of extracellular matrix induced by tobacco smoke extract. Arch Dermatol Res 2000;292:188–194.

28. Manson JE, Ajani UA, Liu S, Nathan DM, Hennekens CH. A prospective study of cigarette smoking and the incidence of diabetes mellitus among US male physicians. Am J Med 2000;109:538–542.

29. Lavigne GL, Lobbezoo F, Rompre PH, Nielsen TA, Montplaisir J. Cigarette smoking as a risk factor for restless legs syndrome and sleep bruxism. Sleep 1997;20:290–293.

30. Riley JL 3rd, Tomar SL, Gilbert GH. Smoking and smoke-less tobacco: Increased risk for oral pain. J Pain 2004;5:218–225.

31. Rasmussen SR, Sogaard J. Socioeconomic costs due to tobacco smoking [in Danish]. Ugeskr Laeger 2000;162:3329–3333.

32. Costs of smoking among active duty U.S. Air Force per-sonnel—United States, 1997. MMWR 2000;49:441–445.

33. Barendregt JJ, Bonneux L, van der Maas PJ. The health care costs of smoking. N Engl J Med 1997;337: 1052–1057.

34. Wänman A, Agerberg G. The etiology of craniomandibular disorders: Evaluation of some occlusal and psychosocial factors in 19-year-olds. J Craniomandib Disord 1991;5:35–44.

35. Parker MW. A dynamic model of etiology in temporo-mandibular disorders. J Am Dent Assoc 1990; 120:283–290.

36. Wänman A, Wigren L. Need and demand for dental treatment. A comparison between an evaluation based on an epidemiologic study of 35-, 50-, and 65-year olds and performed dental treatment of matched age groups. Acta Odontol Scand 1995;53:318–324.

37. Agerberg G. Maximal mandibular movements in young men and women. Sven Tandlak Tidskr 1974;67:81–100.

38. Wänman A. The relationship between muscle tenderness and craniomandibular disorders: A study of 35-year-olds from the general population. J Orofac Pain 1995;9:235–243.

39. Oilo G, Dahl BL, Hatle G, Gad A-L. An index for evaluating wear of teeth. Acta Odontol Scand 1987;45:361–365.

40. Helkimo M. Studies on function and dysfunction of the masticatory system. II. Index for anamnestic and clinical dysfunction and occlusal state. Sven Tandlak Tidskr 1974;26:101–121.

41. Andersson H, Ejlertsson G, Leden I. Widespread muscu-loskeletal chronic pain associated with smoking. An epidemiological study in a general rural population. Scand J Rehabil Med 1998;30:185–191.

42. Ciancaglini R, Gherlone EF, Radaelli G. Association between loss of occlusal support and symptoms of functional disturbances of the masticatory system. J Oral Rehabil 1999;26:248–253.

43. Locker D. Smoking and oral health in older adults. Can J Public Health 1992;83:429–432.

44. Carlsson GE. Epidemiology and treatment need for temporomandibular disorders. J Orofac Pain 1999;13:232–237.

45. Wänman A. Craniomandibular disorders in adolescents. A longitudinal study in an urban Swedish population. Swed Dent J 1987;44(suppl):1–61.

46. Magnusson T. Five-year longitudinal study of signs and symptoms of mandibular dysfunction in adolescents. Cranio 1986;4:338–344.

47. Könönen M, Nyström M. A longitudinal study of craniomandibular disorders in Finnish adolescents. J Orofac Pain 1993;7:329–336.

48. Kamisaka M, Yatani H, Kuboki T, Matsuka Y, Minakuchi H. Four-year longitudinal course of TMD symptoms in an adult population and the estimation of risk factors in relation to symptoms. J Orofac Pain 2000;14:224–232.

49. Wänman A. Longitudinal course of symptoms of craniomandibular disorders in men and women. A 10-year follow-up study of an epidemiological sample. Acta Odontol Scand 1996;54:337–342.

50. Velly AM, Gornitsky M, Philippe P. Contributing factors to chronic myofascial pain: A case-control study. Pain 2003;104:491-499.

51. Zarb GA, Carlsson GE, Sessle BJ, Mohl ND (eds).Temporomandibular Joint and Masticatory Muscle Disorders. Copenhagen: Munksgaard, 1994.

52. Jensen JA, Goodson WH, Hopf HW, Hunt TK. Cigarette smoking decreases tissue oxygen. Arch Surg 1991;126:1131–1134.

53. Vikat A, Rimpela M, Salminen JJ, Rimpela A, Savolainen A, Virtanen SM. Neck or shoulder pain and low back pain in Finnish adolescents. Scand J Public Health 2000;28:164–173.

54. McCreary CP, Clark GT, Merril RL, Flack V, Oakley ME. Psychological distress and diagnostic subgroups of temporomandibular disorder patients. Pain 1991;44:29–34.

55. Yap AU, Chua EK, Tan KB, Chan YH. Relationships between depression/somatization and self-reports of pain and disability. J Orofac Pain 2004;18:220–225.

56. Parchman ML. Recognition of depression in patients who smoke. J Fam Pract 1991;33:255–258.

57. Parrott AC. Stress modulation over the day in cigarette smokers. Addiction 1995;90:233–244.

58. Jorm AF, Rodgers B, Jacomb PA, Christensen H, Henderson S, Korten AE. Smoking and mental health: Results from a community survey. Med J Aust 1999;170:74–77.

59. Martini S, Wagner FA, Anthony JC. The association of tobacco smoking and depression in adolescence: Evidence from the United States. Subst Use Misuse 2002; 37:1853–1867.

60. Tsoh JY, Lam JN, Delucchi KL, Hall SM. Smoking and depression in Chinese Americans. Am J Med Sci 2003;326:187–191.