Salivary Oxidant/Antioxidant Status in Chronic Temporomandibular Disorders Is Dependent on Source and Intensity of Pain - A Pilot Study.

Ema Vrbanović,Lea Vuletić,Tomislav Badel,Dubravka Knezović Zlatarić,Iva Z Alajbeg,Davor Illeš,Dunja Rogić,Ana Andabak Rogulj,Ivana Lapić,Ivan Alajbeg

doi:10.3389/fphys.2018.01405

Abstract

Temporomandibular disorders (TMD) have been associated with altered salivary oxidative status, but the relation with pain source and pain severity isn’t clarified. With the aim to assess their interaction with TMD, we compared levels of selected salivary oxidative stress (OS) markers (glutathione peroxidase, superoxide dismutase, total antioxidant capacity (TAC), uric acid, 8-hydroxydeoxyguanosine, malondialdehyde) and salivary cortisol (SC) as a stress indicator, between 20 TMD patients and 15 healthy control subjects. In order to record differences relating to pain source and severity, patients were respectively classified according to specific diagnoses (myofascial pain or disc displacement (DD)), and pain intensity (high or low). TAC was significantly higher in TMD patients than in controls (morning p = 0.015; afternoon p = 0.005). Significant differences were also observed when TAC levels between high-intensity pain patients and controls were compared, as well as between DD patients and controls. In logistic regression analysis, higher levels of TAC were related to DD (morning OR: 1.66, 95%CI: 1.05–2.64, p = 0.029; afternoon OR: 2.10, 95%CI: 1.11–3.98, p = 0.021) and to high-intensity pain (morning OR: 1.81, 95%CI: 1.04–3.15, p = 0.037; afternoon OR: 1.79, 95%CI: 1.02–3.14, p = 0.043). We also found that morning SC was positively correlated with antioxidant parameters in TMD patients. Our data suggest compensatory mechanism as response to higher level of stress. This stress could be extrinsic and lead toward TMD, or intrinsic, emerging from established TMD, or could be both. The intensity and the source of pain should be considered important factors in future investigations evaluating salivary OS markers in TMD patients.

Highlights

The role of Oxidative stress (OS) has been studied in temporomandibular disorders (TMD), the most common orofacial pain disorders of non-dental origin
Because pain-related TMD impact individual’s daily activities, psychosocial functioning, and quality of life, it is important to understand their pathophysiology and the mechanisms involved in provoking pain and determining its intensity in order to determine factors predictive for disease severity and enhance therapeutic strategies for these patients
The aim of our study was to compare the levels of selected salivary OS markers and salivary cortisol (SC) between patients with chronic pain-related TMD and healthy controls and to assess differences relating to the source and the intensity of pain

Summary

Introduction

Oxidative stress (OS) has been implicated in the pathophysiology of many diseases, including oral diseases (Agha-Hosseini et al, 2012; Lopez-Jornet et al, 2014; AlmerichSilla et al, 2015; Babaee et al, 2016; Ahmadi-Motamayel et al, 2017; Kumar et al, 2017).Oxidative Stress in Temporomanidbular DisordersDifferent biospecimen, including saliva (Nagler et al, 2002; Chiappin et al, 2007), are used to assess the (dis)balance in oxidative status for its potential role in the onset and/or the progression of a disease. The role of OS has been studied in temporomandibular disorders (TMD), the most common orofacial pain disorders of non-dental origin. Their etiopathophysiology is multifactorial, involving a combination of factors such as parafunctions, micro- and macro traumas, genetic influences, physiological and psychological stressors (Sharma et al, 2011). Because pain-related TMD impact individual’s daily activities, psychosocial functioning, and quality of life, it is important to understand their pathophysiology and the mechanisms involved in provoking pain and determining its intensity in order to determine factors predictive for disease severity and enhance therapeutic strategies for these patients. Advances in our understanding of the disorder and the mechanisms of pain allow the possibility of providing personalized care for TMD patients (Harper et al, 2016)

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