Sex Hormones associated with Temporomandibular Pain on Palpation in Male Adolescents - Results of the Epidemiologic LIFE Child Study.

Abstract

This study aimed to investigate whether the sex steroid precursor hormone dehydroepiandrosterone sulfate (DHEA-S), sex hormone-binding globulin (SHBG), and testosterone (TT) are associated with temporomandibular (TM) pain on palpation in male adolescents. Out of the LIFE Child study dataset containing 1,022 children and adolescents aged 10 to 18 years (496 males, 48.5%), we used a subsample of 273 male adolescents (mean age: 13.8 ± 2.3 years) in advanced pubertal development (PD) to analyze the association between hormones and TM pain. The Tanner scale was applied to describe the stage of PD. Pain on palpation of the temporalis and masseter muscles and the TM joints (palpation pain) was assessed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Serum levels of sex hormones (DHEA-S, SHBG, TT) were determined using standardized laboratory analyses. Free TT was estimated from the ratio between TT and SHBG (free androgen index = FAI). We calculated the risk of perceived positive palpation pain for male participants as a function of hormone levels (DHEA-S, FAI) taking into account age and body mass index (BMI). Among more developed (Tanner stage 4-5) male adolescents, 22.7% (n=62) reported palpation pain in the TM region. In these participants, FAI levels were approximately half that of individuals without such pain (p<0.01). DHEA-S levels were about 30% lower in the pain group (p<0.01). In multivariable regression analyses, the odds ratio (OR) for pain on palpation decreased to 0.75 (95% confidence interval [CI]: 0.57-0.98) per 10 units of FAI level compared to those without pain, after controlling for the effects of age and adjusted BMI. We observed the same effect for this subgroup per unit of DHEA-S serum level (OR=0.71; 95% CI: 0.53-0.94). At subclinical lower levels of serum free TT and DHEA-S, male adolescents are more likely to report pain on standardized palpation of the masticatory muscles and/or TM joints. This finding supports the hypothesis that sex hormones may influence pain reporting.