THE RELATIONSHIP BETWEEN TEMPOROMANDIBULAR DISORDERS AND STRESS-ASSOCIATED SYNDROMES

Objectives, The purpose of this study was to determine the comorbidity of temporomandibular disorders and other stress-associated conditions in patients with chronic fatigue syndrome and fibromyalgia. Study Des ign. OF 92 patients who fulfilled the criteria for chronic fatigue syn drome or fibromyalgia (or both), 39 (42%) reported a prior diagnosis o f temporomandibular disorder. Further questionnaires were sent to the members of this group, and 30 patients responded. Results. Of the orig inal 92 patients, of whom 42% reported temporomandibular disorders, 46 % had histories of irritable bowel syndrome, 42% of premenstrual syndr ome, and 19% of interstitial cystitis. Of the patients with temporoman dibular disorders, the great majority reported an onset of generalized symptoms before the onset of facial pain. Despite this, 75% had been treated exclusively for temporomandibular disorders, usually with bite splints. Conclusions, Patients appearing for treatment with chronic f acial pain show a high comorbidity with other stress-associated syndro mes. The clinical overlap between these conditions may reflect a share d underlying pathophysiologic basis involving dysregulation of the hyp othalamic-pituitary-adrenal stress hormone axis in predisposed individ uals. A multidisciplinary clinical approach to temporomandibular disor ders would improve diagnosis and treatment outcomes for this group of patients.