Evaluation of familial and behavioral factors in the etiology of temporomandibular disorder in children and adolescents

Objective: The first step in the treatment of temporomandibular disorder (TMD) in children and adolescents is to determine and control the etiological factors, as in adults. Today, the biopsychosocial approach is accepted in the etiology of TMD. According to this approach, psychosocial factors such as anxiety, somatization and environmental factors must be carefully evaluated in the treatment of the disease. The aim of this study is to evaluate whether behavioral and familial factors play a role in the etiology of the disease in children and adolescents with TMD. Materials and Methods: The study included 70 children and adolesants with TMD between the ages of 9-18, and 69 healthy volunteers and their accompanying parents. TMD diagnosis was made with the combined use of clinical examination and imaging methods when necessary. Demographic data, pain and jaw functions of all individuals included in the study were evaluated. In clinical examination findings, pain, maximum mouth opening and joint sounds were evaluated. The graded chronic pain scale (GCPS), patient health questionnaire-4 (PHQ-4) and oral habits checklist in DC/TMD Axis II and TMD pain questionnaire in Axis I were applied to all individuals. In addition, the child behavior assessment scale was applied to all individuals and the family assessment scale was applied to their parents. Survey results were compared statistically. Results: A statistically significant difference was found between the patient health questionnaire and oral habits checklist scores according to the groups (p=0.001). Oral habits were more common in the TMD group than in healthy individuals. When the family rating scale score was evaluated, no statistically significant difference was found between the two groups (p=0.315). When the overall score of the child behavior list was compared, a statistically significant difference was found between the groups (p=0.001). Compared to the groups, it was found that the median values of social withdrawal, somatic problems, introversion problems such as anxiety/depression, as well as extraversion scores such as criminal behaviors and aggressive behaviors, and diligent control scores were higher in the TMD group. A statistically significant positive and very weak correlation was found between age and communication scores (p=0.038). Conclusion: The higher prevalence of behavioral disorders and oral habits in children and adolescents with TMD suggests that these factors may play a role in the etiology of TMD. If the existence of these factors is suspected, it would be beneficial to include behavioral therapies in our treatment plan.