Analysing the psychosocial construct of temporomandibular disorders: Implications for orthodontics

Abstract

TMD pain and dysfunction were observed in up to 66 % and 41 % of patients seeking orthodontic treatment. Evidence-based knowledge of TMD etiology, detection, and management is thus paramount in contemporary orthodontic practice. This analytical review aims to introduce the biopsychosocial model, scrutinize the psychosocial construct, propose psychosocial screening tools, and clarify the effectiveness of psychological interventions for TMDs. The biopsychosocial model specifies that TMDs are the consequence of dynamic interactions between biological, psychological, and social factors across time. As the frequency of moderate-to-severe psychological distress and somatization/somatic symptoms burden is high in individuals with TMDs, prospective orthodontic patients should be screened for TMDs/psychosocial impairments to circumvent treatment and medico-legal complications. Among the available screening tools, an amalgamation of the quintessential 5 TMD symptoms (5Ts) of the DC/TMD, Physical Symptom Scale-8 (PSS-8), and Patient Health Questionnaire-4 (PHQ-4) provides an efficient way of identifying TMD, somatic, and psychological symptoms synchronously. For prospective orthodontic patients with considerable TMD pain/dysfunction and distress, tailored multimodal and multidisciplinary treatments incorporating psychosocial interventions, including counseling/self-management, cognitive-behavioral therapy, and behavior modification, may be warranted. Complementary positive psychological interventions could also be valuable in TMD management and the paradigm shift from “reactive” to “proactive” TMD care.