title: Investigation of the relationship between psychosocial stress and temporomandibular disorder in adults by measuring salivary cortisol concentration: A case-control study.
abstract: OBJECTIVE
  Psychological factors, particularly psychosocial stress, have been implicated as risk indicators for temporomandibular disorder (TMD). The aim of this study was to assess any differences in salivary cortisol concentration, scores of perceived stress scale (PSS), and scores of depression and distress between TMD patients and matched controls.
  
  
  METHODS
  This case-control study comprised two groups; the patient group consisted of 60 patients attending the Department of Fixed Prosthodontics at the Faculty of Dentistry who met the inclusion criteria (42 females and 18 males aged 19-44), whereas the control group was selected to match the patient group in number, age and sex. Two questionnaires were used for stress assessment: The PSS 10 and the psychosocial measure of Research Diagnostic Criteria (RDC) for TMD axis II. Salivary cortisol levels were measured by a competitive immunoenzymatic colorimetric method. Data were analyzed using SPSS 17. Descriptive statistics, one-way ANOVA test, and independent t-test were used.
  
  
  RESULTS
  This study showed statistically significant differences between the patient group and the control group at the three measures of psychosocial stress (P < 0.05). Increased occurrence of this disorder in women has been observed.
  
  
  CONCLUSIONS
  Psychosocial stress plays an important role in the etiopathogenesis of TMD. Women are at increased risk of TMD when compared to men. Sub-types TMD patients approximately have the same level of stress. Muscle disorders were the most common.
authors.affiliation: Department of Prosthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria.
authors.forename: Ebtisam
authors.initials: E
authors.lastname: Salameh
authors.affiliation: Department of Prosthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria.
authors.forename: Fandi
authors.initials: F
authors.lastname: Alshaarani
authors.affiliation: Department of Face and Oral Biology, Faculty of Dentistry, Damascus University, Damascus, Syria.
authors.forename: Hussein Abou
authors.initials: HA
authors.lastname: Hamed
authors.affiliation: Department of Prosthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria.
authors.forename: Jihad Abou
authors.initials: JA
authors.lastname: Nassar
keywords: Hypothalamic-pituitary-adrenal axis and stress; salivary cortisol; temporomandibular disorder