Evaluation of temporomandibular disorder symptoms and bruxism tendency in females with endometriosis: a cross-sectional case-control study

Serhat Can; Sinem Büşra Kıraç Can; Sultan Seren Karakuş

doi:10.32322/jhsm.2012220

Evaluation of temporomandibular disorder symptoms and bruxism tendency in females with endometriosis: a cross-sectional case-control study

Abstract

Aims: To compare temporomandibular disorder (TMD)-related clinical signs and symptoms, masticatory muscle tenderness, and self-reported bruxism in females with endometriosis and healthy controls with a comparable age distribution. Methods: This cross-sectional case-control study included 28 females aged 24-50 years with a confirmed diagnosis of endometriosis for at least 6 months and 28 healthy controls with a comparable age distribution. All participants underwent a standardized clinical examination of the temporomandibular joint (TMJ) and masticatory muscles. Pain intensity was assessed using the Visual Analog Scale (VAS). Maximum interincisal opening (MIO), TMJ sounds, laterotrusive movements, and mandibular deviation/deflection were also evaluated. Results: No significant differences were observed between the groups regarding MIO, maximum pain-free interincisal opening (MIO2), right and left laterotrusive movements, TMJ sounds, or mandibular deviation and deflection during mouth opening (all p>0.05). However, TMJ pain scores were significantly higher in females with endometriosis than in healthy controls (p<0.001). Tenderness scores for the temporalis, masseter, lateral pterygoid, and trapezius muscles were significantly higher in the endometriosis group than in the control group (all p<0.001). The prevalence of self-reported bruxism was also significantly higher in the endometriosis group than in the control group (82.1% vs. 14.3%, p<0.001). Conclusion: Females with endometriosis receiving combined oral contraceptive therapy exhibited significantly higher TMJ pain scores and greater masticatory muscle tenderness, as well as a higher prevalence of self-reported bruxism, than healthy controls not receiving hormonal therapy. These findings indicate a greater burden of TMD-related clinical signs and symptoms in this group; however, the independent effects of endometriosis and combined oral contraceptive use cannot be distinguished.

Keywords

Supporting Institution

none.

Ethical Statement

This study was approved by the Marmara University Medical Faculty Ethics Committee (No: 09.2024.195 Date: 25/09/2024). Written informed consent was obtained from all participants before enrollment. The study was conducted in accordance with the Declaration of Helsinki.

References

Bueno CH, Pereira DD, Pattussi MP, Grossi PK, Grossi ML. Gender differences in temporomandibular disorders in adult populational studies: a systematic review and meta-analysis. J Oral Rehabil. 2018;45(9):720-729. doi:10.1111/JOOR.12661
Dubner R, Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. J Dent Res. 2016;95(10):1093-1101. doi:10.1177/0022034516653922
Can S, Can SBK, Karakuş SS, Berkel G. Does the use of the levonorgestrel intrauterine system increase the prevalence of masticatory muscles tenderness? Oral Surg Oral Med Oral Pathol Oral Radiol. 2025;140(4):384-390. doi:10.1016/J.OOOO.2025.03.001
Berger M, Szalewski L, Bakalczuk M, Bakalczuk G, Bakalczuk S, Szkutnik J. Association between estrogen levels and temporomandibular disorders: a systematic literature review. Prz Menopauzalny. 2015;14(4):260-270. doi:10.5114/PM.2015.56538
Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839-852. doi:10.1016/S0140-6736(21)00389-5
Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268-279. doi:10.1056/NEJMRA0804690
Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis. Nat Rev Dis Primers. 2018;4(1):9. doi:10.1038/S41572-018-0008-5
Moradi Y, Shams-Beyranvand M, Khateri S, et al. A systematic review on the prevalence of endometriosis in women. Indian J Med Res. 2021;154(3):446-454. doi:10.4103/IJMR.IJMR_817_18

Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. doi:10.1093/HROPEN/HOAC009
Brown J, Crawford TJ, Datta S, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2018;2018(5):CD001019. doi:10.1002/14651858.CD001019.pub3
Tulandi T, Vercellini P. Growing evidence that endometriosis is a systemic disease. Reprod Biomed Online. 2024;49(3):104292. doi:10.1016/J.RBMO.2024.104292
Griffiths MJ, Horne AW, Gibson DA, Roberts N, Saunders PTK. Endometriosis: recent advances that could accelerate diagnosis and improve care. Trends Mol Med. 2024;30(9):875-889. doi:10.1016/J.MOLMED.2024.06.008
Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod. 2002;17(10):2715-2724. doi:10.1093/HUMREP/17.10.2715
Van Barneveld E, Manders J, Van Osch FHM, et al. Depression, anxiety, and correlating factors in endometriosis: a systematic review and meta-analysis. J Womens Health (Larchmt). 2022;31(2):219-230. doi:10.1089/JWH.2021.0021
Colombo GE, Makieva S, Somigliana E, et al. The association between endometriosis and migraine: a systematic review and meta-analysis of observational studies. J Headache Pain. 2025;26:1. doi:10.1186/S10194-025-02020-4
Wójcik M, Goździewicz T, Hudáková Z, Siatkowski I. Endometriosis and the temporomandibular joint-preliminary observations. J Clin Med. 2023;12(8):2862. doi:10.3390/jcm12082862
Okeson JP. Management of Temporomandibular Disorders and Occlusion. Vol 8. 2020.
McNamara HC, Frawley HC, Donoghue JF, et al. Peripheral, central, and cross sensitization in endometriosis-associated pain and comorbid pain syndromes. Front Reprod Health. 2021;3:729642. doi:10.3389/FRPH.2021.729642
Raimondo D, Raffone A, Renzulli F, et al. Prevalence and risk factors of central sensitization in women with endometriosis. J Minim Invasive Gynecol. 2023;30(1):73-80.e1. doi:10.1016/J.JMIG.2022.10.007
Gardella B, Dominoni M, Gritti A, et al. Endometriosis pain and epithelial neutrophil activating peptide-78 levels. Sci Rep. 2022;12(1):3227. doi:10.1038/S41598-022-07349-3
Lara-Ramos A, Álvarez-Salvago F, Fernández-Lao C, et al. Widespread pain hypersensitivity and lumbopelvic impairments in women diagnosed with endometriosis. Pain Med. 2021;22(9):1970-1981. doi:10.1093/PM/PNAA463
La Touche R, Paris-Alemany A, Hidalgo-Pérez A, López-de-Uralde-Villanueva I, Angulo-Diaz-Parreño S, Muñoz-García D. Evidence for central sensitization in patients with temporomandibular disorders: a systematic review and meta-analysis of observational studies. Pain Pract. 2018;18(3):388-409. doi:10.1111/PAPR.12604
Till SR, Nakamura R, Schrepf A, As-Sanie S. Approach to diagnosis and management of chronic pelvic pain in women: incorporating chronic overlapping pain conditions in assessment and management. Obstet Gynecol Clin North Am. 2022;49(2):219-239. doi:10.1016/J.OGC.2022.02.006
Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD. Overlapping chronic pain conditions: implications for diagnosis and classification. J Pain. 2016;17(9 Suppl):T93-T107. doi:10.1016/J.JPAIN.2016.06.002
Lövgren A, Visscher CM, Lobbezoo F, et al. The association between myofascial orofacial pain with and without referral and widespread pain. Acta Odontol Scand. 2022;80(7):481-486. doi:10.1080/00016357.2022.2036363
Phan VT, Stratton P, Tandon HK, et al. Widespread myofascial dysfunction and sensitisation in women with endometriosis-associated chronic pelvic pain: a cross-sectional study. Eur J Pain. 2021;25(4):831-840. doi:10.1002/EJP.1713
Marciniak T, Walewska N, Skoworodko A, Bobowik P, Kruk-Majtyka W. Prevalence of temporomandibular disorders in adult women with endometriosis. J Clin Med. 2024;13(24). doi:10.3390/jcm13247615
Jensen JT, Schlaff W, Gordon K. Use of combined hormonal contraceptives for the treatment of endometriosis-related pain: a systematic review of the evidence. Fertil Steril. 2018;110(1):137-152.e1. doi:10.1016/J.FERTNSTERT.2018.03.012
Yazici H, Taskin MI, Guney G, Hismiogullari AA, Arslan E, Tulaci KG. The novel relationship between polycystic ovary syndrome and temporomandibular joint disorders. J Stomatol Oral Maxillofac Surg. 2021;122(6):544-548. doi:10.1016/J.JORMAS.2020.10.008

Details

Primary Language

English

Subjects

Oral and Maxillofacial Surgery, Oral Medicine and Pathology, Pain, Obstetrics and Gynaecology

Journal Section

Research Article

Authors

Serhat Can ^*
0000-0002-6767-0442
Türkiye

Sinem Büşra Kıraç Can
0000-0002-2052-4106
Türkiye

Sultan Seren Karakuş
0000-0003-4032-9604
Türkiye

Publication Date

October 25, 2026

Submission Date

August 6, 2026

Acceptance Date

October 4, 2026

Published in Issue

Year 2026 Volume: 9 Number: 6

DOI

https://doi.org/10.32322/jhsm.2012220

IZ

https://izlik.org/JA78FX57TP

Cite

RIS / Bibtex

APA

Can, S., Kıraç Can, S. B., & Karakuş, S. S. (2026). Evaluation of temporomandibular disorder symptoms and bruxism tendency in females with endometriosis: a cross-sectional case-control study. Journal of Health Sciences and Medicine, 9(6), 1786-1790. https://doi.org/10.32322/jhsm.2012220

AMA

1.Can S, Kıraç Can SB, Karakuş SS. Evaluation of temporomandibular disorder symptoms and bruxism tendency in females with endometriosis: a cross-sectional case-control study. J Health Sci Med / JHSM. 2026;9(6):1786-1790. doi:10.32322/jhsm.2012220

Chicago

Can, Serhat, Sinem Büşra Kıraç Can, and Sultan Seren Karakuş. 2026. “Evaluation of Temporomandibular Disorder Symptoms and Bruxism Tendency in Females With Endometriosis: A Cross-Sectional Case-Control Study”. Journal of Health Sciences and Medicine 9 (6): 1786-90. https://doi.org/10.32322/jhsm.2012220.

EndNote

Can S, Kıraç Can SB, Karakuş SS (October 1, 2026) Evaluation of temporomandibular disorder symptoms and bruxism tendency in females with endometriosis: a cross-sectional case-control study. Journal of Health Sciences and Medicine 9 6 1786–1790.

IEEE

[1]S. Can, S. B. Kıraç Can, and S. S. Karakuş, “Evaluation of temporomandibular disorder symptoms and bruxism tendency in females with endometriosis: a cross-sectional case-control study”, J Health Sci Med / JHSM, vol. 9, no. 6, pp. 1786–1790, Oct. 2026, doi: 10.32322/jhsm.2012220.

ISNAD

Can, Serhat - Kıraç Can, Sinem Büşra - Karakuş, Sultan Seren. “Evaluation of Temporomandibular Disorder Symptoms and Bruxism Tendency in Females With Endometriosis: A Cross-Sectional Case-Control Study”. Journal of Health Sciences and Medicine 9/6 (October 1, 2026): 1786-1790. https://doi.org/10.32322/jhsm.2012220.

JAMA

1.Can S, Kıraç Can SB, Karakuş SS. Evaluation of temporomandibular disorder symptoms and bruxism tendency in females with endometriosis: a cross-sectional case-control study. J Health Sci Med / JHSM. 2026;9:1786–1790.

MLA

Can, Serhat, et al. “Evaluation of Temporomandibular Disorder Symptoms and Bruxism Tendency in Females With Endometriosis: A Cross-Sectional Case-Control Study”. Journal of Health Sciences and Medicine, vol. 9, no. 6, Oct. 2026, pp. 1786-90, doi:10.32322/jhsm.2012220.

Vancouver

1.Serhat Can, Sinem Büşra Kıraç Can, Sultan Seren Karakuş. Evaluation of temporomandibular disorder symptoms and bruxism tendency in females with endometriosis: a cross-sectional case-control study. J Health Sci Med / JHSM. 2026 Oct. 1;9(6):1786-90. doi:10.32322/jhsm.2012220