Clinical Factors Affecting Depression in Patients With Painful Temporomandibular Disorders During the COVID-19 Pandemic

Background: Temporomandibular disorders (TMD) are a multifactorial condition associated with both physical and psychological factors. Stress has been known to trigger or worsens TMD.  Aims: We aimed to investigate whether the novel coronavirus disease-2019 (COVID-19) pandemic aggravates depression in patients with painful TMD, and the factors that affect their level of depression. Method: We included 112 patients with painful TMD (74 females, 38 males; mean age: 35.90±17.60 years; myalgia [n=38], arthralgia [n=43], mixed joint–muscle TMD pain [n=31]). TMD was diagnosed based on the Diagnostic Criteria for TMD Axis I. Physical pain intensity was recorded using the visual analog scale (VAS); psycho-emotional status (depression: Beck Depression Inventory [BDI], anxiety: Beck Anxiety Inventory [BAI], and generalized stress related to COVID19: Global Assessment of Recent Stress [GARS]) was investigated twice (before [BC] and after COVID-19 [AC]). Additionally, factors affecting BDI-AC were investigated. Findings: BDI (p<0.001), BAI (p<0.001), GARS (p<0.001), and VAS (p<0.01) scores were significantly increased at AC than BC. The depression, anxiety, and stress levels were significantly positively correlated, and the AC and BC values of each factor showed a high correlation. In the mixed TMD group, BDI-AC was positively correlated with VAS-AC (p<0.001). In the multiple regression analysis, clenching habit was the strongest predictor of an increase in the BDI scores from moderate to severe, followed by psychological distress, muscle stiffness, female sex, BAI-AC, and TMJ sounds. Interpretation: COVID-19 has negatively affected the psycho-emotional state of patients with painful TMD, and several clinical factors, including female sex and clenching habits, have influenced depression. Funding Information: This research was supported by a National Research Foundation of Korea Grant (NRF/2020R1F1A1070072) that was obtained by Y.-H.L. and funded by the Korean government. This work was supported by the Korea Medical Device Development Fund grant funded by the Korean government (Ministry of Science and ICT, Ministry of Trade, Industry and Energy, Ministry of Health & Welfare, Republic of Korea, Ministry of Food and Drug Safety) (Project Number: KMDF_PR_20200901_0023, 9991006696). Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: All participants provided written consent for the study, which was approved by the Ethical Committee of Kyung Hee University Dental Hospital (KHD IRB no. KH-DT21023). This study was conducted in accordance with the principles of the Declaration of Helsinki.