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Risk Factors of the Masticatory Function in Patients with Temporomandibular Disorders: A Cross-Sectional Cohort Study
J Oral Med Pain 2019;44:92-102
Published online September 30, 2019;
© 2019 Korean Academy of Orofacial Pain and Oral Medicine

Keon-Hyung Kim, Jo-Eun Park, Mee-Eun Kim, Hye-Kyoung Kim

Department of Oral Medicine, Collage of Dentistry, Dankook University, Cheonan, Korea
Correspondence to: Hye-Kyoung Kim
Department of Oral Medicine, Collage of Dentistry, Dankook University, 119 Dandaero, Dongnam-gu, Cheonan 31116, Korea
Tel: +82-41-550-1913 Fax: +82-505-434-7951 E-mail:
Received August 9, 2019; Revised August 21, 2019; Accepted August 21, 2019.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: To investigate the masticatory function of patients with different temporomandibular disorders (TMD) phenotypes, and to explore the risk factors for the masticatory function of TMD patients among multiple biopsychosocial variables using patient-reported outcomes (PROs).
Methods: Clinical features and TMD diagnoses of 250 cases were investigated by reviewing medical records. Psychosocial factors were evaluated using four questionnaires representing pain severity and pain interference (Brief Pain Inventory), pain catastrophizing (Pain Catastrophizing Scale, PCS), psychological distress (Symptom Check List-90-Revised, SCL-90R) and kinesiophobia (Tampa Scale for Kinesiophobia for Temporomandibular Disorders, TSKTMD). Masticatory function, as a dependent variable, was determined using the Jaw Functional Limitation Scale (JFLS). Kruskal-Wallis test and Spearman’s rank correlation were used for analyses.
Results: A total of 145 cases were included and classified into four subgroups including group 1: TMD with internal derangement without pain (n=14), group 2: TMD with muscle pain (n=32), group 3: TMD with joint pain (n=60) and group 4: TMD with muscle-joint combined pain (n=39). Pain severity (p=0.001) and interference (p=0.022) were the highest in group 2, but the mean global score of JFLS was the highest in group 3, followed by group 4, group 2, and group 1 (p=0.013). Pain severity, pain interference, the mean global score of PCS and the mean global score of TSK-TMD showed significant and moderate correlation with the mean global score of JFLS. All subdimensions and the global severity index of SCL-90R had significant, but weak correlations with all scores of JFLS.
Conclusions: The results suggest that masticatory functional limitation depends on the TMD phenotypes. Among the various PROs, pain perception, pain catastrophizing and kinesiophobia seem to be more influential risk factors on jaw function than psychological distress, such as depression and anxiety.
Keywords : Biopsychosocial; Catastrophization; Kinesiophobia; Masticatory function; Temporomandibular disorder

September 2019, 44 (3)