Oral Health–Related Quality of Life in Patients with Temporomandibular Disorders

Aims: To characterize the level of impairment of oral health-related quality of life (OHRQoL) in a temporomandibular disorder (TMD) patient population. Methods: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G) in a consecutive sample of 416 patients seeking treatment for their complaints in the masticatory muscles and temporomandibular joints and with at least 1 diagnosis according to the German version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The level of impairment of OHRQoL was characterized by the OHIP summary score mean and its 95% confidence interval. OHRQoL was described for each of the 8 RDC/TMD diagnoses (Axis I) and the RDC/TMD Axis II measures (Graded Chronic Pain Scale [GCPS], jaw disability list, depression, and somatization). These findings were compared with the level of impairment of OHRQoL in the adult general population derived from a national sample (n = 2,026). Results: Among the RDC/TMD Axis I measures, all diagnoses were correlated with much higher impacts compared to the normal population (means for all diagnoses were 32.8 to 53.7 versus 15.8 in the general population). All diagnoses had a similar level of impact except for disc displacement with reduction (which had a lower impact). There were larger differences in mean OHIP-G scores among subgroups of RDC/TMD Axis II measures than among subgroups of RDC/TMD Axis I characteristics. The strongest association was with GCPS, with mean OHIP scores of 33.3 for grade I, 48.1 for grade II, 71.7 for grade III, and 88.5 for grade IV. Conclusion: OHRQoL was markedly impaired in TMD patients. The level of OHRQoL varied across diagnostic categories but more across Axis II, ie, the psychosocial axis; the variation was reflected especially in their level of graded chronic pain.

depression; Graded Chronic Pain Scale; jaw disability; Oral Health Impact Profile; oral health-related quality of life; Research Diagnostic Criteria for Temporomandibular Disorders; somatization; temporomandibular disorders

1. Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health 1994;11:3–11.

2. Murray H, Locker D, Mock D, Tenenbaum HC. Pain and the quality of life in patients referred to a craniofacial pain unit. J Orofac Pain 1996;10:316–323.

3. Segu M, Collesano V, Lobbia S, Rezzani C. Cross-cultural validation of a short form of the Oral Health Impact Profile for temporomandibular disorders. Community Dent Oral Epidemiol 2005;33:125–130.

4. John MT, Patrick DL, Slade GD. The German version of the Oral Health Impact Profile—Translation and psychometric properties. Eur J Oral Sciences 2002;110:425–433.

5. Larsson P, List T, Lundstrom I, Marcusson A, Ohrbach R. Reliability and validity of a Swedish version of the Oral Health Impact Profile (OHIP-S). Acta Odontol Scand 2004;62:147–152.

6. John MT, Miglioretti DL, LeResche L, Koepsell TD, Hujoel PP, Micheelis W. German short forms of the Oral Health Impact Profile. Community Dent Oral Epidemiol 2006;34:277–288.

7. John MT, Slade G, Szentpetery A, Setz J. Oral health-related quality of life in patients treated with fixed, removable and complete dentures 1 and 6-12 months after treatment. Int J Prosthodont 2004;17:503–511.

8. Dworkin SF, LeResche L (eds). Research Diagnostic Criteria for Temporomandibular Disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301–355.

9. International Consortium for RDC/TMD-based Research. Available at: http://www.rdc-tmdinternational.org

10. John MT, Hirsch C, Reiber T, Dworkin SF. Translating the Research Diagnostic Criteria for Temporomandibular Disorders into German: Evaluation of content and process. J Orofac Pain 2006;20:43–52.

11. John MT, LeResche L, Koepsell TD, Hujoel PP, Miglioretti DL, Micheelis W. Oral health-related quality of life in Germany. Eur J Oral Sci 2003;111:483–491.

12. Kröner-Herwig B, Denecke H, Glier B, et al. Qualitätssicherung in der Therapie chronischen Schmerzes -Ergebnisse einer Arbeitsgruppe der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS) zur psychologischen Diagnostik - IX. Multidimensionale Verfahren zur Erfassung schmerzrelevanter Aspekte und Empfehlungen zur Standarddiagnostik. Der Schmerz 1996;10:47–52.

13. Hautzinger M, Bailer M. Allgemeine Depressionsskala (ADS). Weinheim: Beltz, 1995.

14. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychological Meas 1977;1:385–401.

15. Von Zerssen D. Die Beschwerden-Liste. Weinheim: Beltz, 1976.

16. Beckmann D, Brähler E, Richter H-E. Der Giessen-Test (GT): Ein Test zur Individual- und Gruppendiagnostik. Bern: Huber, 1990.

17. John MT, Zwijnenburg AJ. Interobserver variability in assessment of signs of TMD. Int J Prosthodont 2001;14: 265–270.

18. Schmitter M, Ohlmann B, John MT, Hirsch C, Rammelsberg P. Research Diagnostic Criteria for Temporomandibular Disorders: A calibration and reliability study. Cranio 2005;23:212–218.

19. Bergner M, Bobbitt RA, Kressel S, Pollard WE, Gilson BS, Morris JR. The Sickness Impact Profile: Conceptual formulation and methodology for the development of a health status measure. Int J Health Serv 1976;6:393–415.

20. Reisine ST, Weber J. The effects of temporomandibular joint disorders on patients’ quality of life. Community Dent Health 1989;6:257-270.

21. Reisine ST, Fertig J, Weber J, Leder S. Impact of dental conditions on patients’ quality of life. Community Dent Oral Epidemiol 1989;17:7–10.

22. Rudy TE, Turk DC, Zaki HS, Curtin HD. An empirical taxometric alternative to traditional classification of temporomandibular disorders. Pain 1989;36:311–320.

23. Turk DC, Rudy TE. Toward an empirically derived taxonomy of chronic pain patients: Integration of psychological assessment data. J Consult Clin Psychol 1988;56:233–238.

24. Rudy TE, Turk DC, Kubinski JA, Zaki HS. Differential treatment responses of TMD patients as a function of psychological characteristics. Pain 1995;61:103–112.

25. Aggarwal VR, Lunt M, Zakrzewska JM, Macfarlane GJ, Macfarlane TV. Development and validation of the Manchester orofacial pain disability scale. Community Dent Oral Epidemiol 2005;33:141–149.

26. List T, Helkimo M. A scale for measuring the activities of daily living (ADL) of patients with craniomandibular disorders. Swed Dent J 1995;19:33–40.

27. Stegenga B, de Bont LG, de Leeuw R, Boering G. Assessment of mandibular function impairment associated with temporomandibular joint osteoarthrosis and internal derangement. J Orofac Pain 1993;7:183–195.

28. Sugisaki M, Kino K, Yoshida N, Ishikawa T, Amagasa T, Haketa T. Development of a new questionnaire to assess pain-related limitations of daily functions in Japanese patients with temporomandibular disorders. Community Dent Oral Epidemiol 2005;33:384–395.

29. List T, Paulin G, Lundström I, Ohrbach R. Orofacial disorders diagnosis: Relationship to the jaw limitation scale [abstract]. J Dent Res 2002;81(special issue A):1024.

30. Locker D. Measuring oral health: A conceptual framework. Community Dent Health 1988;5:3–18.

31. Nuttall NM, Slade GD, Sanders AE, Steele JG, Allen PF, Lahti S. An empirically derived population-response model of the short form of the Oral Health Impact Profile. Community Dent Oral Epidemiol 2006;34:18–24.

32. Szentpetery AG, John MT, Slade GD, Setz JM. Problems reported by patients before and after prosthodontic treatment. Int J Prosthodont 2005;18:124–131.

33. John MT, Hujoel P, Miglioretti DL, LeResche L, Koepsell TD, Micheelis W. Dimensions of oral-health-related quality of life. J Dent Res 2004;83:956–960.

34. Dworkin SF, Sherman J, Mancl L, Ohrbach R, LeResche L, Truelove E. Reliability, validity, and clinical utility of the Research Diagnostic Criteria for Temporomandibular Disorders Axis II Scales: Depression, non-specific physical symptoms, and graded chronic pain. J Orofac Pain 2002;16:207–220.

35. List T, Dworkin SF. Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using Research Diagnostic Criteria for Temporomandibular Disorders. J Orofac Pain 1996;10:240–253.

36. Yap AU, Dworkin SF, Chua EK, List T, Tan KB, Tan HH. Prevalence of temporomandibular disorder subtypes, psychologic distress, and psychosocial dysfunction in Asian patients. J Orofac Pain 2003;17:21–28.

37. Bush FM, Harkins SW. Pain-related limitation in activities of daily living in patients with chronic orofacial pain: Psychometric properties of a disability index. J Orofac Pain 1995;9:57–63.

38. Auerbach SM, Laskin DM, Frantsve LM, Orr T. Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients. J Oral Maxillofac Surg 2001;59:628–633.

39. Wong MC, Lo EC, McMillan AS. Validation of a Chinese version of the Oral Health Impact Profile (OHIP). Community Dent Oral Epidemiol 2002;30:423–430.

40. Lobbezoo F, van Selms MK, John MT, et al. Use of the Research Diagnostic Criteria for Temporomandibular Disorders for multinational research: Translation efforts and reliability assessments in The Netherlands. J Orofac Pain 2005;19:301–308.

41. Slade GD, Spencer AJ, Locker D, Hunt RJ, Strauss RP, Beck JD. Variations in the social impact of oral conditions among older adults in South Australia, Ontario, and North Carolina. J Dent Res 1996;75:1439–1450.

42. John MT, Dworkin SF, Mancl LA. Reliability of clinical temporomandibular disorder diagnoses. Pain 2005;118: 61–69.

43. Yap AU, Chua EK, Hoe JK. Clinical TMD, pain-related disability and psychological status of TMD patients. J Oral Rehabil 2002;29:374–380.

44. Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284–290.