Brazilian Journal of Pain
Brazilian Journal of Pain
Review Article

Post-traumatic stress disorder and temporomandibular dysfunction: a review and clinical implications

Transtorno de estresse pós-traumático e disfunção temporomandibular: uma revisão e implicações clínicas

Dyna Mara Araújo Oliveira Ferreira; Camila Cristine de Oliveira Vaz; Paulo César Rodrigues Conti

Downloads: 0
Views: 369


BACKGROUND AND OBJECTIVES: Post-traumatic stress disorder is a disabling disorder that can be developed after a person has experienced or exposed to a traumatic event. The evidence shows the coexistence between post-traumatic stress disorder and chronic painful conditions as the temporomandibular dysfunction. This study aimed to review the literature to describe the coexistence relation between post-traumatic stress disorder and temporomandibular dysfunction.

CONTENTS: A non-systematic search was carried on the Pubmed, BVS and LILACS databases on studies evaluating the relationship between post-traumatic stress disorder and temporomandibular dysfunction. Clinical studies published in the last 10 years that presented a diagnostic criterion validated for temporomandibular dysfunction and the post-traumatic stress disorder were selected. Six studies were included in the review. The results showed that the post-traumatic stress disorder often occurs in patients with temporomandibular dysfunction and, at the same time, a higher prevalence of temporomandibular dysfunction is found in individuals with post-traumatic stress disorder. There is a trend for a larger connection between post-traumatic stress disorder and muscular pain than pain in the temporomandibular joint. The presence of post-traumatic stress disorder modulates the level of physical, psychological and behavioral involvement in individuals with temporomandibular dysfunction, and can predict the onset of this painful conditions.

CONCLUSION: The review shows a complex coexistence between post-traumatic stress disorder and painful temporomandibular dysfunction.


Psychological trauma, Stress disorders, Temporomandibular joint dysfunction syndrome, Trauma


JUSTIFICATIVA E OBJETIVOS: Transtorno de estresse pós-traumático é um transtorno incapacitante que pode se desenvolver após exposição ou testemunho de um evento traumático. Evidências demonstram a coexistência entre transtorno de estresse pós-traumático e condições dolorosas crônicas como a disfunção temporomandibular. Este estudo teve como objetivo revisar a literatura para descrever a relação de coexistência entre transtorno de estresse pós-traumático e disfunção temporomandibular.

CONTEÚDO: Foi realizada uma busca não sistemática nas bases de dados Pubmed, BVS e LILACS para estudos avaliando a relação entre transtorno de estresse pós-traumático e disfunção temporomandibular. Foram selecionados estudos clínicos publicados nos últimos 10 anos e que apresentassem critério diagnóstico validado para a disfunção temporomandibular e transtorno de estresse pós-traumático. Seis trabalhos foram incluídos na revisão. Os resultados demonstraram que o transtorno de estresse pós-traumático ocorre frequentemente em pacientes com disfunção temporomandibular e ao mesmo tempo, uma maior prevalência de disfunção temporomandibular é encontrada em indivíduos com transtorno de estresse pós-traumático. Há uma tendência indicando uma associação maior entre transtorno de estresse pós-traumático e dor muscular que dor na articulação temporomandibular. Presença do transtorno de estresse pós-traumático modula o nível de comprometimento físico, psicológico e comportamental em indivíduos com disfunção temporomandibular e pode predizer início desta condição dolorosa.

CONCLUSÃO: A revisão demonstra uma relação de coexistência complexa entre transtorno de estresse pós-traumático e disfunção temporomandibular dolorosa.


Síndrome da disfunção da articulação temporomandibular, Transtornos de estresse pós-traumáticos, Trauma, Trauma psicológico


de Leeuw R, Klasser GD. Diagnosis and Management of TMDs. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. 2013.

Facial Pain. National Institute of Dental and Craniofacial Research. .

Durham J, Shen J, Breckons M, Steele JG, Araujo-Soares V, Exley C. Healthcare cost and impact of persistent orofacial pain: The DEEP Study Cohort. J Dent Res. 2016;95(10):1147-54.

Post-Traumatic Stress Disorder. Diagnostic and Statistical Manual of Mental Disorders(DSM). 2013.

Friedman MJ, Resick PA, Bryant RA, Brewin CR. Considering PTSD for DSM-5. Depress Anxiety. 2011;28(9):750-69.

Bertoli E, de Leeuw R, Schmidt JE, Okeson JP, Carlson CR. Prevalence and impact of post-traumatic stress disorder symptoms in patients with masticatory muscle or temporomandibular joint pain: differences and similarities. J Orofac Pain. 2007;21(2):107-19.

Porto F, de Leeuw R, Evans DR, Carlson CR, Yepes JF, Branscum A. Differences in psychosocial functioning and sleep quality between idiopathic continuous orofacial neuropathic pain patients and chronic masticatory muscle pain patients. J Orofac Pain. 2011;25(2):117-24.

Muhvic-Urek M, Uhac I, Vuksic-Mihaljevic Z, Leovic D, Blecic N, Kovac Z. Oral health status in war veterans with post-traumatic stress disorder. J Oral Rehabil. 2007;34(1):1-8.

Litt MD, Porto FB. Determinants of pain treatment response and nonresponse: identification of TMD patient subgroups. J Pain. 2013;14(11):1502-13.

Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: mutual maintenance?. Clin Psychol Rev. 2001;21(6):857-77.

Asmundson GJ, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: Research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry. 2002;47(10):930-7.

Scioli-Salter ER, Forman DE, Otis JD, Gregor K, Valovski I, Rasmusson AM. The shared neuroanatomy and neurobiology of comorbid chronic pain and PTSD: therapeutic implications. Clin J Pain. 2015;31(4):363-74.

Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6(4):301-55.

Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014;28(1):6-27.

de Leeuw R, Klasser GD. Orofacial Pain: Guidelines for Assessment, Diagnosis and Management. 2013.

Diagnostic and Statistical Manual of Mental Disorders (DSM). 2000.

Burris JL, Cyders MA, de Leeuw R, Smith GT, Carlson CR. Posttraumatic stress disorder symptoms and chronic orofacial pain: an empirical examination of the mutual maintenance model. J Orofac Pain. 2009;23(3):243-52.

Weber T, Boggero IA, Carlson CR, Bertoli E, Okeson JP, de Leeuw R. Smoking and posttraumatic stress disorder symptomatology in orofacial pain. J Dent Res. 2016;95(10):1161-8.

Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Diatchenko L, Dubner R. Psychological factors associated with development of TMD: the OPPERA prospective cohort study. J Pain. 2013;14(12 Suppl):T75-90.

Wiener RC. Oral health perception in veterans with self-identified disabilities: National Survey of Veterans, 2010. J Public Health Dent. 2015;75(3):245-52.

Schur EA, Afari N, Furberg H, Olarte M, Goldberg J, Sullivan PF, Buchwald D. Feeling bad in more ways than one: comorbidity patterns of medically unexplained and psychiatric conditions. J Gen Intern Med. 2007;22(6):818-21.

Uhac I, Tariba P, Kovac Z, Simonic-Kocijan S, Lajnert V, Mesic VF. Masticatory muscle and temporomandibular joint pain in Croatian war veterans with posttraumatic stress disorder. Coll Antropol. 2011;35(4):1161-6.

Mottaghi A, Zamani E. Temporomandibular joint health status in war veterans with post-traumatic stress disorder. J Educ Health Promot. 2014;23;3:60.

Ajanovic M, Tosum S, Kamber-Cesir A, Ðonlagic A, Kazazic L, Hamzic A. Prevalence of signs and symptoms of temporomandibular disorder in patients with posttraumatic stress disorder. Pesq Bras Odontoped Clin Integr. 2014;14(1):43-8.

Afari N, Wen Y, Buchwald D, Goldberg J, Plesh O. Are post-traumatic stress disorder symptoms and temporomandibular pain associated? Findings from a community-based twin registry. J Orofac Pain. 2008;22(1):41-9.

Weathers FW, Huska JA, Keane TM. PCL-C for DSM-IV. 1991.

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602.

Kilpatrick DG, Resnick HS, Milanak ME, Miller MW, Keyes KM, Friedman MJ. National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-V criteria. J Trauma Stress. 2013;26(5):537-47.

Fishbain DA, Pulikal A, Lewis JE, Gao J. Chronic pain types differ in their reported prevalence of post-traumatic stress disorder (PTSD) and there is consistent evidence that chronic pain is associated with PTSD: an evidence-based structured systematic review. Pain Med. 2017;18(4):711-35.

Siqveland J, Hussain A, Lindstrøm JC, Ruud T, Hauff E. Prevalence of posttraumatic stress disorder in persons with chronic pain: a meta-analysis. Front Psychiatry. 2017;14(8):164.

Lindroth JE, Schmidt JE, Carlson CR. A comparison between masticatory muscle pain patients and intracapsular pain patients on behavioral and psychosocial domains. J Orofac Pain. 2002;16(4):277-83.

De Leeuw R, Bertoli E, Schmidt JE, Carlson CR. Prevalence of traumatic stressors in patients with temporomandibular disorders. J Oral Maxillofac Surg. 2005;63(1):42-50.

Wahlström L, Michélsen H, Schulman A, Backheden M, Keskinen-Rosenqvist R. Longitudinal course of physical and psychological symptoms after a natural disaster. Eur J Psychotraumatol. 2013;27(4).

Afari N, Ahumada SM, Wright LJ, Mostoufi S, Golnari G, Reis V. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosom Med. 2014;76(1):2-11.

Moeller-Bertram T, Strigo IA, Simmons AN, Schilling JM, Patel P, Baker DG. Evidence for acute central sensitization to prolonged experimental pain in posttraumatic stress disorder. Pain Med. 2014;15(5):762-71.

Mostoufi S, Godfrey KM, Ahumada SM, Hossain N, Song T, Wright LJ. Pain sensitivity in posttraumatic stress disorder and other anxiety disorders: a preliminary case control study. Ann Gen Psychiatry. 2014;13(1):31.

Jones T, Moller MD. Implications of hypothalamic-pituitary-adrenal axis functioning in posttraumatic stress disorder. J Am Psychiatr Nurses Assoc. 2011;17(6):393-403.

Geuze E, Westenberg HG, Jochims A, de Kloet CS, Bohus M, Vermetten E. Altered pain processing in veterans with posttraumatic stress disorder. Arch Gen Psychiatry. 2007;64(1):76-85.

Rollman GB, Gillespie JM. The role of psychosocial factors in temporomandibular disorders. Curr Rev Pain. 2000;4(1):71-81.

Kronish IM, Edmondson D, Goldfinger JZ, Fei K, Horowitz CR. Posttraumatic stress disorder and adherence to medications in survivors of strokes and transient ischemic attacks. Stroke. 2012;43(8):2192-7.

Submitted date:

Accepted date:

5f160af50e8825044c9517e5 brjp Articles


Share this page
Page Sections