The impact of stress on psychological and physiological aspects of health of patients with TMD: A literature review from 2015–2020
More details
Hide details
Interdisciplinary Scientific Group of Sports Medicine, Department of Sports Medicine, Medical University of Lublin, Poland
Department of Sports Medicine, Medical University of Lublin, Poland
Submission date: 2020-04-07
Final revision date: 2020-06-05
Acceptance date: 2020-06-06
Online publication date: 2020-09-05
Corresponding author
Aleksandra Byś   

Department of Sports Medicine, Medical University of Lublin, Chodźki 7, 20-093 Lublin, Poland
Pol. Ann. Med. 2021;28(1):82-87
Studies suggest that temporomandibular disorders (TMD) are a complex disorder with many causes consistent with the biopsychosocial disease model. One of the important areas of TMD etiology are psychological factors, including stress, but its role in the mechanism of TMD formation is ambiguous.

The aim of this literature review was to summarize the latest study about the impact of stress in relation to temporomandibular joint disorders.

Material and methods:
Articles from PubMed and PEDro online databases were identified using the keywords ‘stress,’ ‘distress,’ ‘TMD.’ The review included works published in the period from October 1, 2015 to March 6, 2020. Finally, 10 articles were qualified for the review.

Results and discussion:
The most frequently used research tool was the questionnaire. Other methods used to evaluate a level of stress in TMD patients were measurement of cortisol level and surface electromyography of masticatory muscles.

Stress is one of the psychological factors involved in TMD pathophysiology. Increased levels of stress in patients with TMD are associated with elevated levels of cortisol, hyperactivity of the HPA axis and increased bioelectric activity of the masticatory muscles. There is a need to extend research on the effects of stress on TMD by more objective methods.

No financial support was received for this study.
The authors have no conflicts of interest to declare.
Osiewicz MA, Lobbezoo F, Loster BW, Wilkosz M, Naeije M, Ohrbach R. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): The Polish version of a dual-axis system for the diagnosis of TMD.* RDC/TMD form. Czas Stomatol. 2013;66(5):576–649.
Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent Clin North Am. 2013;57(3):465–479.
Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015;91(6):378–386.
Yap A-U, Qiu L-Y, Natu V-P, Wong M-C. Functional, physical and psychosocial impact of temporomandibular disorders in adolescents and young adults. Med Oral Patol Oral Cirugia Bucal. 2020;25(2):e188-e194.
Slade GD, Fillingim RB, Sanders AE, et al. Summary of findings from the OPPERA prospective cohort study of incidence of first-onset temporomandibular disorder: implications and future directions. J Pain. 2013;14(12):T116–124.
Atsü SS, Güner S, Palulu N, Bulut AC, Kürkçüoğlu I. Oral parafunctions, personality traits, anxiety and their association with signs and symptoms of temporomandibular disorders in the adolescents. Afr Health Sci. 2019;19(1):1801–1810.
Urbani G, Cozendey-Silva EN, de Jesus LF. Temporomandibular joint dysfunction syndrome and police work stress: an integrative review. Cienc Saude Coletiva. 2019;24(5):1753–1765.
Zhukava T. Studying the level of anxiety and depression in patients with chronic somatic pathologies. Pol Ann Med. 2011;18(1):7–11.
Ohrbach R, Michelotti A. The role of stress in the etiology of oral parafunction and myofascial pain. Oral Maxillofac Surg Clin N Am. 2018;30(3):369–379.
Radat F. [Stress et migraine]. Rev Neurol (Paris). 2013;169(5):406–412. 11.008 [in French].
Ciavarella D, Tepedino M, Laurenziello M, et al. Swallowing and temporomandibular disorders in adults. J Craniofac Surg. 2018;29(3):e262–e267.
Magalhães BG, de Melo Freitas JL, da Silva Barbosa AC, et al. Temporomandibular disorder: otologic implications and its relationship to sleep bruxism. Braz J Otorhinolaryngol. 2018;84(5):614-619.
Da Silva Andrade A, Gamero GH, Pereira LJ, Junqueira Zanin IC, Gavião MB. Salivary cortisol levels in young adults with temporomandibular disorders. Minerva Stomatol. 2008;57(3):109–116.
Ahuja V, Ranjan V, Passi D, Jaiswal R. Study of stress-induced temporomandibular disorders among dental students: An institutional study. Natl J Maxillofac Surg. 2018;9(2):147–154.
Stocka A, Kuc J, Sierpinska T, Golebiewska M, Wieczorek A. The influence of emotional state on the masticatory muscles function in the group of young healthy adults. BioMed Res Int. 2015;2015.
Staniszewski K, Lygre H, Bifulco E, et al. Temporomandibular disorders related to stress and HPA-axis regulation. Pain Res Manag. 2018;2018:1–7.
Augusto VG, Perina KCB, Penha DSG, Dos Santos DCA, Oliveira VAS. Temporomandibular dysfunction, stress and common mental disorder in university students. Acta Ortop Bras. 2016;24(6):330–333.
Salameh E, Alshaarani F, Hamed HA, Nassar JA. Investigation of the relationship between psychosocial stress and temporomandibular disorder in adults by measuring salivary cortisol concentration: A case-control study. J Indian Prosthodont Soc. 2015;15(2):148–152.
Sójka A, Stelcer B, Roy M, Mojs E, Pryliński M. Is there a relationship between psychological factors and TMD? Brain Behav. 2019;9(9):e01360.
Paulino MR, Moreira VG, Lemos GA, da Silva PLP, Bonan PRF, Batista AUD. Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life. Cienc Saude Coletiva. 2018;23(1):173–186.
Natu VP, Yap AU-J, Su MH, Irfan Ali NM, Ansari A. Temporomandibular disorder symptoms and their association with quality of life, emotional states and sleep quality in South-East Asian youths. J Oral Rehabil. 2018;45(10):756–763.
Chisnoiu A, Lascu L, Pascu L, Georgiu C, Chisnoiu R. Emotional stress evaluation in patients with temporomandibular joint disorder. Hum Vet Med. 2015;7(2):104–107.
de Paiva Tosato J, Ferreira Caria PH, de Paula Gomes CAF, et al. Correlation of stress and muscle activity of patients with different degrees of temporomandibular disorder. J Phys Ther Sci. 2015;27(4):1227–1231.
Chisnoiu AM, Picos AM, Popa S, et al. Factors involved in the etiology of temporomandibular disorders – a literature review. Clujul Med. 2015;88(4):473–478.
Slade GD, Ohrbach R, Greenspan JD, et al. Painful temporomandibular disorder: Decade of discovery from OPPERA studies. J Dent Res. 2016;95(10):1084–1092.
Stubbs B, Koyanagi A, Thompson T, et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen Hosp Psychiatry. 2016;43:63–70.
Houle TT, Butschek RA, Turner DP, Smitherman TA, Rains JC, Penzien DB. Stress and sleep duration predict headache severity in chronic headache sufferers. Pain. 2012;153(12):2432–2440.
Maurel S, Calvo N, Sáez-Francàs N, Alegre J, Castro-Marrero J. Association between psychological constructs and physical and emotional distress in individuals with fibromyalgia. Clin Exp Rheumatol. 2020 [published online ahead of print].
Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017;16:1057–1072.
Lee DY, Kim E, Choi MH. Technical and clinical aspects of cortisol as a biochemical marker of chronic stress. BMB Rep. 2015;48(4):209–216.
Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: A psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014;94(12):1816–1825.
Gameiro GH, da Silva Andrade A, Nouer DF, Ferraz de Arruda Veiga MC. How may stressful experiences contribute to the development of temporomandibular disorders? Clin Oral Investig. 2006;10(4):261–268.
Zhu L-J, Liu M-Y, Li H, et al. The different roles of glucocorticoids in the hippocampus and hypothalamus in chronic stress induced HPA axis hyperactivity. Homberg J, ed. PLoS One. 2014;9(5):e97689.
Glaros AG, Marszalek JM, Williams KB. Longitudinal multilevel modeling of facial pain, muscle tension, and stress. J Dent Res. 2016;95(4):416–422.
Kobs G, Bernhardt O, Kocher T, Meyer G. Oral parafunctions and positive clinical examination findings. Stomatologija. 2005;7(3):81–83.
Saczuk K, Lapinska B, Wilmont P, Pawlak L, Lukomska-Szymanska M. Relationship between sleep bruxism, perceived stress, and coping strategies. Int J Environ Res Public Health. 2019;16(17):3193.
Zorina-Lichtenwalter K, Meloto CB, Khoury S, Diatchenko L. Genetic predictors of human chronic pain conditions. Neuroscience. 2016;338:36–62.
Smith SB, Maixner DW, Greenspan JD, et al. Potential genetic risk factors for chronic TMD: Genetic associations from the OPPERA case control study. J Pain. 2011;12(11 Suppl):T92–T101.
Nascimento TD, Yang N, Salman D, et al. µ-Opioid activity in chronic TMD pain is associated with COMT polymorphism. J Dent Res. 2019;98(12):1324–1331.
Journals System - logo
Scroll to top