Influence of the Covid-19 pandemic on temporo-mandibular joint disorders

OBJECTIVES The year 2020 went down in history due to the outbreak of the Covid-19 pandemic which radically changed global health. The Italian population carries with it the stigmata of this period full of fear. In correlation with the increase in stress, increases in tem poro-mandibular joint disorders (TMD) have also been found, particularly in those patients with a marked psycho-emotional component. The etiology of TMD is multifactorial, in fact temporo-mandibular joint disorders and bruxism are often associated with psycho-emotional stress, such as depression, anxiety, stress. The relationship between TMD and pain significantly affects daily activities and quality of life. The same problems can be seen in both night and daytime bruxism, this could be explained by greater muscle contraction as a defense reaction and by bruxism as an unconscious response to the period of greater stress. The main symptoms of TMD are: jaw pain, preauricular pain, toothache (without dental origin), joint pain, headache and mandibular functional limitation. The aim of this study is to determine what emerged from a series of patient visits, carried out at the Maxillo-Facial Surgery Department of the Ancona Hospital, suffering from TMD, bruxism and orofacial pain. MATERIALS AND METHODS The period analyzed goes from 03/09/2020 to 03/09/2022, taking into consideration maxilla-facial surgical visits for pain or disorders of the temporo-mandibular joint. In the department under study, at the Ancona Hospital, there has been an increase in pathologies and/or disorders of the temporo-mandibular joint in the post-lockdown period due to Covid-19. The inclusion criteria applied were: patients visited at the Maxillo-Facial Surgery Department of Ancona for TMD; patients diagnosed with TMD and evaluated with DC-TMD after the Covid period. All patients underwent a series of tests and questionnaires to evaluate, with numerical parameters, a series of aspects relating to temporomandibular joint (TMJ) disorders, sleep quality and psycho-social status. The assessment systems used are: The Depression, Anxiety, and Stress Scale (DASS-21), Pittsburgh Sleep Quality Index (PSQI) 24 and self-report to evaluate bruxism. The authors administered these tests to patients both during the first visit and after any pharmacological, rehabilitation and surgical therapies. In the patients examined, the diagnostic criteria for TMD (DC/TMD) were used to determine the extent of joint disorders. RESULTS The authors reported signs and symptoms, diagnosis and management of patients suffering from psychological stress crisis and evaluated the immediate risks for health and social isolation. TMJ pathology obviously includes occlusal, dental and degenerative processes factors among the etiological bases. Moreover, psycho-emotional disturbances are factors that can potentially have a relevant weight on the TMD. CONCLUSIONS The main goal of this study was to evaluate the psychological impact of the recent Covid-19 pandemic on subjects with TMD; the authors reported an increase in stress in the general population, and in diagnoses of anxiety-depressive related TMD in post-lockdown period.