title: The associations between psychosocial aspects and TMD-pain related aspects in children and adolescents.
abstract: BACKGROUND
  Temporomandibular disorders (TMD) in children and adolescents is prevalent with pain as a common component, and has a comorbidity with psychosocial problems such as stress, depression, anxiety as well as somatic complaints. Therefore, the aim of the study was to investigate if psychosocial problems in children and adolescents are associated with TMD with pain (TMD-pain) and TMD without pain (TMD-painfree) when compared to children and adolescents without TMD.
  
  
  METHODS
  This cross-sectional study consisted of 456 randomly selected children and adolescents, enrolled from 10 boy's- and 10 girl's- schools in Jeddah, between 10 and 18 years of age. On the examination day, prior to the clinical examination according to Research Diagnostic Criteria for TMD Axis I and II, the participants first answered two validated questions about TMD pain, and after that the Arabic version of the Youth Self Report scale. According to their clinical examination and diagnosis the participants were divided into three groups; non-TMD group, TMD-pain group, and TMD-painfree group.
  
  
  RESULTS
  The TMD-pain group presents a higher frequency of the internalizing problems anxiety, depression and somatic complaints than non-TMD group (p < 0.05). Regarding externalizing problems the only significant association found was for aggressive behavior in the TMD-pain group (p < 0.05). The TMD-pain group also shows a higher frequency of social problems than the non-TMD group. However, no such difference was found when compared to the TMD-painfree group. There was also a significant association with a higher frequency of thought problems in the TMD-pain group (p < 0.05). The children's and adolescents' physical activities were within border line clinical range for all three groups, whereas the social competence was within the normal range. There were no significant associations between any of the groups in this respect.
  
  
  CONCLUSIONS
  TMD-pain in children and adolescents does not seem to affect the social activities. However, TMD-pain seem to have a strong association to emotional, behavior and somatic functioning, with higher frequencies of anxiety, depression, somatic problems, aggressive behavior and thought problems, than children and adolescents without TMD-pain. With respect to the biopsychosocial model the present study indicates that there are significant associations to psychosocial, somatic and behavioral comorbidities and TMD-pain in children and adolescents in the Middle East region.
authors.affiliation: Orofacial Pain and Jaw Function, Department of Dental Medicine, Karolinska Institutet, SE-141 04, Huddinge, Sweden. aalkhotani@yahoo.com.|Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden. aalkhotani@yahoo.com.
authors.forename: Amal
authors.initials: A
authors.lastname: Al-Khotani
authors.affiliation: Cariology, Department of Dental Medicine, Karolinska Institutet, SE-141 04, Huddinge, Sweden.
authors.forename: Aron
authors.initials: A
authors.lastname: Naimi-Akbar
authors.affiliation: Orofacial Pain and Jaw Function, Department of Dental Medicine, Karolinska Institutet, SE-141 04, Huddinge, Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Gjelset
authors.affiliation: Dental Speciality Center, Ministry of Health, Jeddah, Saudi Arabia.
authors.forename: Emad
authors.initials: E
authors.lastname: Albadawi
authors.affiliation: Pediatric Dentistry and Orthodontics Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Lanre
authors.initials: L
authors.lastname: Bello
authors.affiliation: Orofacial Pain and Jaw Function, Department of Dental Medicine, Karolinska Institutet, SE-141 04, Huddinge, Sweden.|Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.|Department of Clinical Oral Physiology at the Eastman Institute, Stockholm Public Dental Health (Folktandvården SLL AB), SE-113 24, Stockholm, Sweden.
authors.forename: Britt
authors.initials: B
authors.lastname: Hedenberg-Magnusson
authors.affiliation: Orofacial Pain and Jaw Function, Department of Dental Medicine, Karolinska Institutet, SE-141 04, Huddinge, Sweden.|Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Christidis
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000523:psychology*; D001007:Anxiety / Q000523:psychology*; D002648:Child; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000523:psychology*; D057566:Self Report; D013705:Temporomandibular Joint Disorders / Q000523:psychology*
keywords: Adolescents; Children; Pain; Psychosocial; Temporomandibular disorders