Temporomandibular disorders: Prevalence of psychosocial impairment


Temporomandibular disorders (TMD) are relatively common with between 12-65% of the population being affected. There is increasing recognition of the importance of psychosocial factors in the aetiology and treatment of TMD, with high levels of psycho-social impairment and psychological disorders have been reported in TMD populations.  In 1992 The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were developed following the introduction of a biopsychosocial model for TMD. This is based on the evaluation of physical (Axis I) and psychosocial findings (Axis II) which has been updated as the Diagnostic Criteria for TMD (DC/TMD)

The aim of this review was to assess the level of psychosocial impairment in TMD patients using the RDC/TMD or DC/TMD Axis II.


Searches were conducted in the Medline and Scopus databases and the journals, Journal of Dental Research, Journal of Oral Rehabilitation, Journal of Orofacial Pain, Clinical Oral Investigations and Journal of Dentistry.  Observational studies with sample sizes of more than 100 assessing DC/TMD Axis II findings in TMD patient population using RDC/TMD to assess depression (DEP) and somatisation (SOM), by the Symptoms Checklist 90R (SCL-90R), and pain-related disability, by the Graded Chronic Pain Scale (GCPS) were considered. Only studies published in English after the original RDC/TMD publication in 1992 were included.

Two reviewers independently screened and selected studies and assessed for quality using the methodological evaluation of observational research (MORE) checklist. A narrative summary was provided.


  • 14 papers were included.
  • Data from arrange of countries (Brazil, Finland, Germany, Iran, Israel, Italy, Korea, Netherlands, Poland, Singapore, USA) and ethnic groups was included.
  • Sample sizes ranged from 117 – 1643 with age ranges between 18-81 years.
  • Female patient predominated in all the included papers.
  • 11 papers presented information on somatisation (SOM)
  • A broad range in the prevalence of moderate-to-severe SOM in patients with TMD was observed, which ranged from 28.5% to 76.6% with or without pain items. The prevalence of moderate-to-severe SOM in non-patient population was around 30%.
  • 12 papers presented information on depression (DEP), with 8 showing a moderate-to-severe DEP in 21.4% to 60.1% of the patients.  Two papers comparing non-patient with patient population showed higher scores for DEP in patients with TMD.
  • Most patients were rated as grade I or II of the Graded Chronic Pain Scale, while high pain-related impairment was present in 2.6% to 24% of the individuals.


The authors concluded: –

In spite of the limitations of this review, it can be concluded that psychological disorders and psychosocial impairment are highly prevalent in TMD patients. Severe-to-moderate SOM and DEP are commonly reported by TMD patients, while most patients presented low disability/low-intensity pain or low disability/high- intensity pain.


This review searched 2 large databases however the included studies were restricted to those published in English which may have resulted in relevant studies being excluded. The authors highlight a major problem with the included studies in that they are all drawn from health care (patient?) populations. If these patients are from a university or secondary care population, they are likely to represent patients with more severe problems so are unlikely to be representative.  It is also interesting to note that the range of moderate-to-severe SOM in patients with TMD includes the percentage of moderate to severe SOM seen in non-TMD patients.


Primary Paper

De La Torre Canales G, Câmara-Souza MB, Muñoz Lora VRM, Guarda-Nardini L, Conti PCR, Rodrigues Garcia RM, Del Bel Cury AA, Manfredini D. Prevalence of psychosocial impairment in temporomandibular disorder patients: A systematic review. J Oral Rehabil. 2018 Jul 4. doi: 10.1111/joor.12685. [Epub ahead of print] Review. PubMed PMID: 29972707.

Other references

 Dental Elf  TMD Blogs


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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