Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study.
OBJECTIVE
To describe the course of reported musculoskeletal pain in the temporomandibular region and other signs and symptoms of temporomandibular disorders (TMD) as well as psychological distress over the course of pregnancy and 1 year postpartum.


METHODS
Women with musculoskeletal orofacial pain (n = 19) and pain-free comparison subjects (n = 16) in the first trimester of pregnancy were selected through records review from the population of a large health maintenance organization. Subjects completed a self-administered questionnaire assessing pain, depression, and somatic symptoms; provided a sample of whole unstimulated saliva; and underwent a standardized clinical examination during the third, sixth, and ninth months of pregnancy and 1 year postpartum.


RESULTS
At baseline (third month of pregnancy), 16 of the 19 patients with musculoskeletal orofacial pain met criteria for an RDC/TMD diagnosis. Reported musculoskeletal orofacial pain diminished significantly during the second or third trimester of pregnancy and increased again postpartum. Measures of mandibular opening increased over pregnancy in both cases and comparison subjects and remained high postpartum. Depression and somatic symptoms changed little over the course of pregnancy but were substantially lowered at 1 year postpartum for both groups. As expected, subjects with pain had higher levels of palpation pain, diminished mandibular range of motion, and higher levels of psychological distress compared to subjects without orofacial pain.


CONCLUSIONS
Musculoskeletal orofacial pain and related symptoms appear to improve over the course of pregnancy. This improvement occurs in the presence of increased joint laxity and is not paralleled by improvements in psychological distress. Thus, it was concluded that the improvement in pain is most likely associated with the dramatic hormonal changes occurring during pregnancy.
LeResche
Linda
L
Department of Oral Medicine, University of Washington, Seattle, WA 98195-6370, USA. leresche@u.washington.edu
Sherman
Jeffrey J
JJ
Huggins
Kimberly
K
Saunders
Kathleen
K
Mancl
Lloyd A
LA
Lentz
Gretchen
G
Dworkin
Samuel F
SF
D000328:Adult; D003863:Depression / Q000150:complications; D004812:Epidemiologic Methods; D004958:Estradiol / Q000032:analysis; D005157:Facial Pain / Q000150:complications* / Q000378:metabolism; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000378:metabolism / Q000523:psychology; D011374:Progesterone / Q000032:analysis; D012463:Saliva / Q000737:chemistry; D013705:Temporomandibular Joint Disorders / Q000150:complications* / Q000378:metabolism / Q000523:psychology; D013997:Time Factors
D011374:Progesterone; D004958:Estradiol