Abstract
Background
Multiple risk factors predict temporomandibular disorders (TMD) onset, but temporal changes in risk factors and their contribution to risk of TMD have not been evaluated. The study aims were to (1) describe changes occurring in premorbid TMD risk factors when re‐measured at TMD onset and six months later; and (2) determine if measures of change improve accuracy in predicting TMD incidence compared to premorbid measures alone.
Methods
In this observational prospective cohort study at 4 university research clinics, 3258 community‐based, 18‐44 year‐olds without TMD were enrolled. During the 3‐year median follow‐up, 260 incident cases of first‐onset TMD were identified, and 196 TMD‐free subjects were selected as matched controls. Six‐months later, 147/260 incident cases (56.6%) were re‐examined revealing 72 (49%) with “persistent TMD” and 75 (51%) whose condition had resolved (“transient TMD”). Virtually all (126) of the 127 re‐examined controls remained without TMD. Questionnaires and clinical measurements evaluated risk factors from clinical, health, psychological and behavioral, and neurosensory domains.
Results
Most risk factors across all 4 domains increased with TMD onset, remained elevated in the persistent group, and declined in the transient group (i.e., significant ANOVA interactions, p<0.05). Accuracy in predicting first‐onset TMD, quantified as area under the receiver operating characteristic curve was 0.71 (95%CL 0.68, 0.73) using only premorbid measures of risk factors, which increased to 0.91 (95%CL 0.89, 0.94) after addition of change measures.
Conclusions
TMD pain onset and persistence appear to be determined by enduring characteristics of the person as well as mutually interactive with temporally evolving variables.
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