| 摘要: | INTRODUCTION: The most frequent cause of non-dental stemmed orofacial pain is Temporomandibular disorder (TMD) and it is currently understood in terms of musculoskeletal disorders involving Temporomandibular joint, masseter muscle and surrounding tissues. According to previous studies, TMD has a high lifetime prevalence of up to 93%, with most cases affecting women. Minor psychiatric illnesses, such as depression and anxiety, could influence TMD severity; literature review shows that there is co-existence between TMD and depression and/or anxiety. Moreover, depressive and anxiety symptoms may make degenerations to different anatomical structures of Temporomandibular joint, where depressive signs are particularly influence to joint pain and anxiety signs are specifically influence to muscle pain. The aim of this study is to determine the incidence of TMD in cohorts with and without psychiatric illness and their health services utilization, using a population based retrospective cohort design.
METHODS: From Taiwan Universal National Health Insurance Research Database, using the ninth revision of the International Classification of Diseases codes (ICD-9), we identified 17,962 subjects who were diagnosed with depression and anxiety for the first time in 2005 and 2006. A total of 71,848 control group patients, matched by age and sex, were randomly selected from the same dataset. Both groups were followed until December 2013 to evaluate the incidence of TMD and patient’s health services utilization.
RESULTS: Total of 3,838 patients were diagnosed by TMD from whole study sample, where 69.73% (n=2,676) of them were diagnosed from control and 30.27% (n=1,162) of them were diagnosed from case cohorts. The mean age of patients diagnosed with TMD was 63.3±14.6 involving predominance of female 72.41% (n=2,772) gender. Relative risk for TMD incidence was calculated using logistic regression analysis between cohorts. Individuals with psychiatric illness had 1.81 (p=<0.0001) times higher risk of getting TMD than without psychiatric illness patients, and female subjects had 1.58 (p=<0.0001) times higher risk of getting TMD than man. In our study total health expenditure of TMD patients was 263,415, whereas expenditure of TMD patients who had psychiatric illness was 209,710 having significant (p=<0.0001) differences from their comparison groups respectively. We observed that mean health services visit was 269.3 in TMD illness group and 212.6 in TMD patients with psychiatric illness group, both showing higher number with statistical significance (p=<0.0001) in comparison to their individual groups.
CONCLUSIONS: This study result shows that minor psychiatric illnesses, such as depression and anxiety, could be considered as potential risk factors for TMD pain. Elder and female population is more involved in incidence of TMD. There were statistical significances in mean amount of total health expenditure and health services utilization in patients diagnosed by Temporomandibular disorder in comparison to its control groups, as their total health expenditure showed higher cost and health services utilization showed higher times of visit. |
