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      Comparison of temporomandibular disorders between menopausal and non-menopausal women

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          Abstract

          Objectives

          Hormonal changes during menopause alter a woman's susceptibility to some disorders. Information regarding the prevalence of temporomandibular disorder (TMD) in menopausal women is limited in the literature. In this study, the prevalence and severity of TMDs were compared between menopausal and non-menopausal women.

          Materials and Methods

          The study included 140 women (69 premenopausal and 71 postmenopausal) 45 to 55 years of age that were examined in Shiraz Dental School, Shiraz in Iran. The Helkimo clinical dysfunction index (Di) was used to evaluate temporomandibular joint (TMJ) dysfunction. The data were analyzed using chi-square and Fisher's exact tests.

          Results

          Occurrence of TMD was significantly higher in menopausal than non-menopausal women ( P<0.001). All the TMD criteria based on Helkimo Di except range of mandibular movement were significantly more common in menopausal women. The range of mandibular movement was not significantly different between menopausal and non-menopausal women ( P=0.178).

          Conclusion

          The results from this study show that TMD can be considered more common and severe in menopausal than non-menopausal women. This finding indicates that, similar to other conditions in menopausal women such as arthritis and osteoporosis, TMD should be taken into consideration by dental and medical professionals.

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          Most cited references29

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          Modulation of pain by estrogens.

          T Craft (2007)
          It has become increasingly apparent that women suffer a disproportionate amount of pain during their lifetime compared to men. Over the past 15 years, a growing number of studies have suggested a variety of causes for this sex difference, from cellular to psychosocial levels of analysis. From a biological perspective, sexual differentiation of pain appears to occur similarly to sexual differentiation of other phenomena: it results in large part from organizational and activational effects of gonadal steroid hormones. The focus of this review is the activational effects of a single group of ovarian hormones, the estrogens, on pain in humans and animals. The effects of estrogens (estradiol being the most commonly examined) on experimentally induced acute pain vs. clinical pain are summarized. For clinical pain, the review is limited to a few syndromes for which there is considerable evidence for estrogenic involvement: migraine, temporomandibular disorder (TMD) and arthritis. Because estrogens can modulate the function of the nervous, immune, skeletal, and cardiovascular systems, estrogenic modulation of pain is an exceedingly complex, multi-faceted phenomenon, with estrogens producing both pro- and antinociceptive effects that depend on the extent to which each of these systems of the body is involved in a particular type of pain. Forging a more complete understanding of the myriad ways that estrogens can ameliorate vs. facilitate pain will enable us to better prevent and treat pain in both women and men.
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            Pronociceptive and antinociceptive effects of estradiol through endogenous opioid neurotransmission in women.

            Prominent interindividual and sex-dependent differences have been described in responses to sustained pain and other stressful stimuli. Variations in mu-opioid receptor-mediated endogenous opioid neurotransmission may underlie some of these processes. We examined both baseline mu-opioid receptor levels and the activation of this neurotransmitter system during sustained pain using positron emission tomography in a sample of young healthy men and women. Women were studied twice, during low and high estrogen states. The high-estrogen state was associated with regional increases in baseline mu-opioid receptor availability in vivo and a greater activation of endogenous opioid neurotransmission during the pain stressor. The latter did not differ from that obtained in males. During the low estrogen condition, however, significant reductions in endogenous opioid tone were observed at the level of thalamus, nucleus accumbens, and amygdala, which were associated with hyperalgesic responses. Estrogen-associated variations in the activity of mu-opioid neurotransmission correlated with individual ratings of the sensory and affective perceptions of the pain and the subsequent recall of that experience. These data demonstrate a significant role of estrogen in modulating endogenous opioid neurotransmission and associated psychophysical responses to a pain stressor in humans.
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              Changes in temporomandibular pain and other symptoms across the menstrual cycle.

              The objective of this study was to assess changes in levels of clinical temporomandibular (TMD) pain in relation to phases of the menstrual cycle. TMD cases were 35 women not using oral contraceptives (OCs); 35 women using OCs; and 21 men. Controls were 35 normally cycling women without TMD or other chronic pains. Subjects kept daily diaries over three menstrual cycles, reporting average and worst pain, general and premenstrual symptoms. Data were subject-centered and de-trended using the residuals from a random-effects linear regression model. To test for cyclic variation, cycles were standardized to 28 days and data were grouped into 9 periods/cycle (Days 1-3, 4-6, em leader, 22-24, 25-28). Overall levels of average pain, worst pain and symptoms did not differ across TMD subject groups. For worst pain, multivariate analysis of variance revealed a statistically significant difference across 3-day periods for normally cycling women with TMD (P=0.011) and for women using OCs (P=0.017). In both groups, TMD pain levels rose toward the end of the cycle and peaked during menstruation. In women not using OCs, there was a secondary pain peak at Days 13-15, around the time of ovulation. This peak was not seen in women using OCs. There was no statistically significant difference over time periods for men (P=0.94). Similar patterns were found for average pain, as well as PMS symptoms and general somatic symptoms. These results suggest that TMD pain in women is highest at times of lowest estrogen, but rapid estrogen change may also be associated with increased pain.

                Author and article information

                Journal
                J Korean Assoc Oral Maxillofac Surg
                J Korean Assoc Oral Maxillofac Surg
                JKAOMS
                Journal of the Korean Association of Oral and Maxillofacial Surgeons
                The Korean Association of Oral and Maxillofacial Surgeons
                2234-7550
                2234-5930
                October 2018
                26 October 2018
                : 44
                : 5
                : 232-236
                Affiliations
                [1 ]Department of Prosthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
                [2 ]Postgraduate Student of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
                Author notes
                Corresponding author: Masumeh Taghva. Department of Prosthodontics, Shiraz Dental School, School of Dentistry, Shiraz University of Medical Sciences, Ghasrodasht Street, Ghomabad, Shiraz 71868-93798, Iran. TEL: +98-9171883704, FAX: +98-71-36270325, taghvam@ 123456yahoo.com
                Author information
                https://orcid.org/0000-0003-2352-7211
                https://orcid.org/0000-0001-6662-2257
                https://orcid.org/0000-0002-6206-9973
                Article
                10.5125/jkaoms.2018.44.5.232
                6209692
                9608fd72-24d0-4c88-81aa-57bee777a70e
                Copyright © 2018 The Korean Association of Oral and Maxillofacial Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 November 2017
                : 27 December 2017
                : 27 December 2017
                Categories
                Original Article

                temporomandibular joint disorders,menopause,prevalence

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