Araştırma Makalesi
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The Relationship among Pain Perception, Severity of Temporomandibular Disorders, and Spinal Health in Older Adults: Cross-sectional Study

Yıl 2024, Cilt: 11 Sayı: 4, 656 - 662, 29.12.2024
https://doi.org/10.34087/cbusbed.1519013

Öz

Aim; It was aimed to determine pain perception, temporomandibular disorders (TMD) severity, and spine functionality and the relationship between them in older adults.
Method; A total of 301 individuals (177 women and 124 men) with an average age of 71.57±6.30 years (range 65-95) participated in the study. Musculoskeletal pain (MP), neck pain (NP), and low back pain (LBP) were each assessed separately, along with pain perception, tolerance to discomfort, spinal functional status, and temporomandibular disorders severity. These were measured using the Numeric Rating Scale (NRS), Centrality of Pain Scale (COPS), Discomfort Intolerance Test (DIT), Spine Functional Index (SFI), and Fonseca Anamnestic Index (FAI), respectively. Relationships between parameters were analyzed with Pearson correlation analysis, and gender differences were examined using Multivariate Analysis of Covariance.
Results; The relationship between MP with NP (0.518) and LBP (0.520) and between SFI with COPS (-0.593) was moderate to good. The relationship between MP with COPS (0.485), SFI (-0.372), FAI (0.332); and between NP with LBP (0.495) and FAI (0.453); between LBP with COPS (0.412), SFI (-0.409) and FAI (0.366); and between FAI with COPS (0.377) and SFI (-0.352) was low to fair. Differences were observed between female and male individuals in terms of Mini Mental Test, MP, NP, LBP, COPS, DIT, SFI, and FAI scores (p< 0.05).
Conclusion; It should be taken into consideration that MP may increase with the increase in NP and LBP, and spinal functionality may decrease with the increase in pain perception.

Etik Beyan

This study was approved by Tokat Gaziosmanpaşa University, Social and Human Sciences Research Ethics Committee (Decision No: 13.27, Date: August 15, 2023).

Destekleyen Kurum

None.

Teşekkür

The authors are grateful to the individuals who participated in the study.

Kaynakça

  • Dahlhamer, J, Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016, MMWR Morbidity and Mortality Weekly Report 2018, 67(36), 1001-1006.
  • 2. Rundell, S.D., Patel, K.V., Krook, M.A., Heagerty, P.J., Suri, P, Friedly, J.L., Turner, J.A., Deyo, R.A., Bauer, Z, Nerenz, D.R., Avins, A.L., Nedeljkovic, S.S., Jarvik, J.G., Multi-site pain is associated with long-term patient-reported outcomes in older adults with persistent back pain. Pain Medicine, 2019, 20(10), 1898-1906.
  • 3. Welsh, T.P., Yang, A.E., Makris, U.E., Musculoskeletal pain in older adults: a clinical review, Medical Clinics of North America, 2020, 104(5), 855-872.
  • 4. Meucci, R.D., Fassa, A.G., Faria, N.M.X., Prevalence of chronic low back pain: systematic review, Revista de Saúde Pública, 2015, 49, 73.
  • 5. Karp, J.F., DiNapoli, E.A., Wetherell, J., Bolon, C., Rodriguez, E., Shega, J., Weiner, D.K., Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment: Part IX: Anxiety, Pain Medicine, 2016, 17(8), 1423-1435.
  • 6. Wong, C.K., Mak, R.Y., Kwok, T.S., Tsang, J.S., Leung, M.Y., Funabashi, M., Macedo, L.G., Dennett, L., Wong, A.Y. Prevalence, incidence, and factors associated with non-specific chronic low back pain in community-dwelling older adults aged 60 years and older: a systematic review and meta-analysis, The Journal of Pain, 2022, 23(4), 509-534.
  • 7. Shahidi, B., Curran-Everett, D., Maluf, K.S., Psychosocial, physical, and neurophysiological risk factors for chronic neck pain: a prospective inception cohort study, The Journal of Pain, 2015, 16(12), 1288-1299.
  • 8. Ünlüer, N.Ö., Ateş, Y., An investigation of neck pain in older adults, and its relation with shoulder position sense and upper extremity function, Somatosensory & Motor Research, 2021, 38(4), 333-338.
  • 9. Lucena, L.O., Nascimento, C.M.M., Asano, N.M.J., Coriolano, M.G.W.S., Lins, C.C.S.A., Manual therapy for temporomandibular disorder in older adults: an integrative literature review, Revista CEFAC, 2022, 24, e9721.
  • 10. Quinto, C.A., Classification and Treatment of Temporomandibular Disorder: What is the Role of Speech Therapy in the Treatment of These Disorders?, Revista CEFAC, 2000, 2(2), 15-22.
  • 11. Nguyen, M.S., Jagomägi, T., Nguyen, T., Saag, M., Voog-Oras, Ü., Symptoms and signs of temporomandibular disorders among elderly Vietnamese, Proceedings of Singapore Healthcare, 2017;26(4):211-216.
  • 12. Macedo,J., Doi, M., Oltramari-Navarro, P.V., Gorres, V., Mendes, M.S., Silva, I.M., Navarro, R., Marchiori L.L., Association between ear fullness, earache, and temporomandibular joint disorders in the elderly. International Archives of Otorhinolaryngology, 2014, 18(4), 383-386.
  • 13. Murrieta, J.F., Alvarado, E.L., Valdez, Orozco, L., Meza, J., Juárez, M.L., Prevalence of temporomandibular joint disorders in a Mexican elderly group, Journal of Oral Research, 2016, 5(1), 13-18.
  • 14. Hong, S.W., Lee, J.K., Kang, J.H., Relationship among cervical spine degeneration, head and neck postures, and myofascial pain in masticatory and cervical muscles in elderly with temporomandibular disorder, Archives of Gerontology and Geriatrics, 2019, 81, 119-128.
  • 15. Campbell, R., Ju, A., King, M.T., Rutherford, C., Perceived benefits and limitations of using patient-reported outcome measures in clinical practice with individual patients: a systematic review of qualitative studies, Quality of Life Research, 2022, 31(6), 1597-1620.
  • 16. Folstein, M.F., Folstein, S.E., McHugh, P.R., “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician, Journal of Psychiatric Research, 1975, 12(3), 189-198.
  • 17. Güngen, C., Ertan, T., Eker, E., Yaşar, R., Engin, F., Reliability and Validity of The Standardized Mini Mental State Examination in The Diagnosis of Mild Dementia in Turkish Population, Türk Psikiyatri Dergisi, 2002, 13(4), 273-281.
  • 18. Flaherty, S.A., Pain measurement tools for clinical practice and research, The AANA Journal, 1996, 64(2), 133-140.
  • 19. Nicolaidis, C., Chianello, T., Gerrity, M., Development and preliminary psychometric testing of the centrality of pain scale, Pain Medicine, 2011, 12(4), 612-617.
  • 20. Ozsoy‐Unubol, T., Unal‐Ulutatar, C., Cross‐cultural adaptation and validation of the Turkish version of Centrality of Pain Scale in patients with fibromyalgia syndrome, International Journal of Rheumatic Diseases, 2020, 23(6), 772-777.
  • 21. Schmidt, N.B., Richey, J.A., Fitzpatrick, K.K., Discomfort intolerance: Development of a construct and measure relevant to panic disorder, Journal of Anxiety Disorders, 2006, 20(3), 263-280.
  • 22. Özdel, K., Yalçınkaya-Alkar, Ö., Taymur, İ., Türkçapar, M.H., Zamkı, E., Sargın, A.E., Discomfort Intolerance Scale: A Study of Reliability and Validity, Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi, 2012, 1(1), 52-58. 23. Gabel, C.P., Melloh, M., Burkett, B., Michener, L.A., The Spine Functional Index: development and clinimetric validation of a new whole-spine functional outcome measure, The Spine Journal, 2019, 19(2), e19-e27.
  • 24. Tonga, E., Gabel, C.P., Karayazgan, S., Cuesta-Vargas, A.I., Cross-cultural adaptation, reliability and validity of the Turkish version of the spine functional index, Health and Quality of Life Outcomes, 2015, 13, 1-9.
  • 25. Fonseca, D.M., Bonfante, G., Valle, A.L., Freitas, S.F.T., Diagnosis of the craniomandibular disfunction through anamnesis, Revista Gaúcha de Odontologia (Porto Alegre), 1994, 42(1), 23-28.
  • 26. Arikan, H., Citaker, S., Ucok, C., Psychometric properties of the Fonseca Anamnestic Index (FAI) for temporomandibular disorders: Turkish version, responsiveness, reliability, and validity study, Disability and Rehabilitation, 2023, 46(7), 1408-1415.
  • 27. Portney, L.G., Watkins, M.P., Correlation. In: Portney LG, Watkins MP, ed. Foundations of clinical research: application to practice. 3rd ed. Philadelphia FA Davis Co. 2015:525.
  • 28. Portney, L.G., Correlation. In: Portney LG, ed. Foundations of clinical research: applications to evidence-based practice. 4th ed. Philadelphia FA Davis Co. 2020:430.
  • 29. Molton, I.R., Terrill, A.L., Overview of persistent pain in older adults, American Psychologist, 2014, (2), 197-207.
  • 30. Erzurumlu, Z.Ü., Çelenk, P., Effects of Aging on Temporomandibular Joint, Türk Diş Hekimliği Araştırma Dergisi, 2022, 1(2), 75-78.
  • 31. Kalladka, M., Quek, S., Heir, G., Eliav, E., Mupparapu, M., Viswanath, A., Temporomandibular joint osteoarthritis: diagnosis and long-term conservative management: a topic review, The Journal of Indian Prosthodontic Society, 2014, 14(1), 6-15.
  • 32. Dagnino, A., Campos, M.M., Chronic pain in the elderly: Mechanisms and perspectives, Frontiers in Human Neuroscience, 2022, 16, 736688.
  • 33. Erol, E., Yildiz, A., Yildiz, R., Apaydin, U., Gokmen, D., Elbasan, B. Reliability and validity of the turkish version of the Fremantle back awareness questionnaire. Spine, 2019, 44(9), E549-E554.
  • 34. Onan, D., Gokmen, D., Ulger, O. The Fremantle Neck Awareness Questionnaire in chronic neck pain patients: Turkish version, validity and reliability study. Spine, 2020, 45(3), E163-E169.
  • 35. Yağcı, N., Cavlak, U., Baskan, E., Öztop, M., Low back pain risk among older adults, Cukurova Medical Journal, 2020, 45(2), 421-427.

Yaşlı Erişkinlerde Ağrı Algısı, Temporomandibular Bozuklukların Şiddeti ve Omurga Sağlığı Arasındaki İlişki: Kesitsel Çalışma

Yıl 2024, Cilt: 11 Sayı: 4, 656 - 662, 29.12.2024
https://doi.org/10.34087/cbusbed.1519013

Öz

Giriş ve Amaç: Bu çalışmada, yaşlı bireylerde ağrı algısı, temporomandibular bozuklukların şiddeti ve omurga fonksiyonelliği ile bunlar arasındaki ilişkiyi belirlemek amaçlanmıştır.
Gereç ve Yöntemler: Çalışmaya ortalama yaşı 71,57±6,30 yıl (65-95 arası) olan toplam 301 birey (177 kadın ve 124 erkek) katıldı. Kas-iskelet ağrısı (KİA), boyun ağrısı (BA) ve bel ağrısı (BeA) ayrı ayrı değerlendirilirken, ağrı algısı, rahatsızlığa tolerans, omurga fonksiyonel durumu ve temporomandibular bozuklukların şiddeti de değerlendirildi. Bu değerlendirmeler sırasıyla Sayısal Derecelendirme Ölçeği (SDÖ), Ağrıyı Merkezleştirme Ölçeği (AMÖ), Rahatsızlığa İntolerans Testi (RİT), Omurga Fonksiyon İndeksi (OFİ) ve Fonseca Anamnestik İndeks (FAİ) kullanılarak yapıldı. Parametreler arasındaki ilişkiler Pearson korelasyon analizi ile incelendi ve cinsiyetler arasındaki farklar Çok Değişkenli Kovaryans Analizi kullanılarak değerlendirildi.
Bulgular: KİA ile BA (0.518) ve BeA (0.520) arasındaki ilişki ve OFİ ile AMÖ (-0.593) arasındaki ilişki orta ila iyi düzeydeydi. KİA ile AMÖ (0.485), OFİ (-0.372) ve FAİ (0.332) arasındaki ilişki; BA ile BeA (0.495) ve FAİ (0.453) arasındaki ilişki; BeA ile AMÖ (0.412), OFİ (-0.409) ve FAİ (0.366) arasındaki ilişki ve FAİ ile AMÖ (0.377) ve OFİ (-0.352) arasındaki ilişki düşük ila zayıf düzeydeydi. Kadın ve erkek bireyler arasında Mini Mental Test, KİA, BA, BeA, AMÖ, RİT, OFİ ve FAİ skorları açısından farklılıklar gözlendi (p< 0.05).
Sonuç: KİA'nın, BA ve BeA artışıyla birlikte artabileceği ve ağrı algısının artmasıyla omurga fonksiyonelliğinin azalabileceği dikkate alınmalıdır.

Kaynakça

  • Dahlhamer, J, Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016, MMWR Morbidity and Mortality Weekly Report 2018, 67(36), 1001-1006.
  • 2. Rundell, S.D., Patel, K.V., Krook, M.A., Heagerty, P.J., Suri, P, Friedly, J.L., Turner, J.A., Deyo, R.A., Bauer, Z, Nerenz, D.R., Avins, A.L., Nedeljkovic, S.S., Jarvik, J.G., Multi-site pain is associated with long-term patient-reported outcomes in older adults with persistent back pain. Pain Medicine, 2019, 20(10), 1898-1906.
  • 3. Welsh, T.P., Yang, A.E., Makris, U.E., Musculoskeletal pain in older adults: a clinical review, Medical Clinics of North America, 2020, 104(5), 855-872.
  • 4. Meucci, R.D., Fassa, A.G., Faria, N.M.X., Prevalence of chronic low back pain: systematic review, Revista de Saúde Pública, 2015, 49, 73.
  • 5. Karp, J.F., DiNapoli, E.A., Wetherell, J., Bolon, C., Rodriguez, E., Shega, J., Weiner, D.K., Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment: Part IX: Anxiety, Pain Medicine, 2016, 17(8), 1423-1435.
  • 6. Wong, C.K., Mak, R.Y., Kwok, T.S., Tsang, J.S., Leung, M.Y., Funabashi, M., Macedo, L.G., Dennett, L., Wong, A.Y. Prevalence, incidence, and factors associated with non-specific chronic low back pain in community-dwelling older adults aged 60 years and older: a systematic review and meta-analysis, The Journal of Pain, 2022, 23(4), 509-534.
  • 7. Shahidi, B., Curran-Everett, D., Maluf, K.S., Psychosocial, physical, and neurophysiological risk factors for chronic neck pain: a prospective inception cohort study, The Journal of Pain, 2015, 16(12), 1288-1299.
  • 8. Ünlüer, N.Ö., Ateş, Y., An investigation of neck pain in older adults, and its relation with shoulder position sense and upper extremity function, Somatosensory & Motor Research, 2021, 38(4), 333-338.
  • 9. Lucena, L.O., Nascimento, C.M.M., Asano, N.M.J., Coriolano, M.G.W.S., Lins, C.C.S.A., Manual therapy for temporomandibular disorder in older adults: an integrative literature review, Revista CEFAC, 2022, 24, e9721.
  • 10. Quinto, C.A., Classification and Treatment of Temporomandibular Disorder: What is the Role of Speech Therapy in the Treatment of These Disorders?, Revista CEFAC, 2000, 2(2), 15-22.
  • 11. Nguyen, M.S., Jagomägi, T., Nguyen, T., Saag, M., Voog-Oras, Ü., Symptoms and signs of temporomandibular disorders among elderly Vietnamese, Proceedings of Singapore Healthcare, 2017;26(4):211-216.
  • 12. Macedo,J., Doi, M., Oltramari-Navarro, P.V., Gorres, V., Mendes, M.S., Silva, I.M., Navarro, R., Marchiori L.L., Association between ear fullness, earache, and temporomandibular joint disorders in the elderly. International Archives of Otorhinolaryngology, 2014, 18(4), 383-386.
  • 13. Murrieta, J.F., Alvarado, E.L., Valdez, Orozco, L., Meza, J., Juárez, M.L., Prevalence of temporomandibular joint disorders in a Mexican elderly group, Journal of Oral Research, 2016, 5(1), 13-18.
  • 14. Hong, S.W., Lee, J.K., Kang, J.H., Relationship among cervical spine degeneration, head and neck postures, and myofascial pain in masticatory and cervical muscles in elderly with temporomandibular disorder, Archives of Gerontology and Geriatrics, 2019, 81, 119-128.
  • 15. Campbell, R., Ju, A., King, M.T., Rutherford, C., Perceived benefits and limitations of using patient-reported outcome measures in clinical practice with individual patients: a systematic review of qualitative studies, Quality of Life Research, 2022, 31(6), 1597-1620.
  • 16. Folstein, M.F., Folstein, S.E., McHugh, P.R., “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician, Journal of Psychiatric Research, 1975, 12(3), 189-198.
  • 17. Güngen, C., Ertan, T., Eker, E., Yaşar, R., Engin, F., Reliability and Validity of The Standardized Mini Mental State Examination in The Diagnosis of Mild Dementia in Turkish Population, Türk Psikiyatri Dergisi, 2002, 13(4), 273-281.
  • 18. Flaherty, S.A., Pain measurement tools for clinical practice and research, The AANA Journal, 1996, 64(2), 133-140.
  • 19. Nicolaidis, C., Chianello, T., Gerrity, M., Development and preliminary psychometric testing of the centrality of pain scale, Pain Medicine, 2011, 12(4), 612-617.
  • 20. Ozsoy‐Unubol, T., Unal‐Ulutatar, C., Cross‐cultural adaptation and validation of the Turkish version of Centrality of Pain Scale in patients with fibromyalgia syndrome, International Journal of Rheumatic Diseases, 2020, 23(6), 772-777.
  • 21. Schmidt, N.B., Richey, J.A., Fitzpatrick, K.K., Discomfort intolerance: Development of a construct and measure relevant to panic disorder, Journal of Anxiety Disorders, 2006, 20(3), 263-280.
  • 22. Özdel, K., Yalçınkaya-Alkar, Ö., Taymur, İ., Türkçapar, M.H., Zamkı, E., Sargın, A.E., Discomfort Intolerance Scale: A Study of Reliability and Validity, Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi, 2012, 1(1), 52-58. 23. Gabel, C.P., Melloh, M., Burkett, B., Michener, L.A., The Spine Functional Index: development and clinimetric validation of a new whole-spine functional outcome measure, The Spine Journal, 2019, 19(2), e19-e27.
  • 24. Tonga, E., Gabel, C.P., Karayazgan, S., Cuesta-Vargas, A.I., Cross-cultural adaptation, reliability and validity of the Turkish version of the spine functional index, Health and Quality of Life Outcomes, 2015, 13, 1-9.
  • 25. Fonseca, D.M., Bonfante, G., Valle, A.L., Freitas, S.F.T., Diagnosis of the craniomandibular disfunction through anamnesis, Revista Gaúcha de Odontologia (Porto Alegre), 1994, 42(1), 23-28.
  • 26. Arikan, H., Citaker, S., Ucok, C., Psychometric properties of the Fonseca Anamnestic Index (FAI) for temporomandibular disorders: Turkish version, responsiveness, reliability, and validity study, Disability and Rehabilitation, 2023, 46(7), 1408-1415.
  • 27. Portney, L.G., Watkins, M.P., Correlation. In: Portney LG, Watkins MP, ed. Foundations of clinical research: application to practice. 3rd ed. Philadelphia FA Davis Co. 2015:525.
  • 28. Portney, L.G., Correlation. In: Portney LG, ed. Foundations of clinical research: applications to evidence-based practice. 4th ed. Philadelphia FA Davis Co. 2020:430.
  • 29. Molton, I.R., Terrill, A.L., Overview of persistent pain in older adults, American Psychologist, 2014, (2), 197-207.
  • 30. Erzurumlu, Z.Ü., Çelenk, P., Effects of Aging on Temporomandibular Joint, Türk Diş Hekimliği Araştırma Dergisi, 2022, 1(2), 75-78.
  • 31. Kalladka, M., Quek, S., Heir, G., Eliav, E., Mupparapu, M., Viswanath, A., Temporomandibular joint osteoarthritis: diagnosis and long-term conservative management: a topic review, The Journal of Indian Prosthodontic Society, 2014, 14(1), 6-15.
  • 32. Dagnino, A., Campos, M.M., Chronic pain in the elderly: Mechanisms and perspectives, Frontiers in Human Neuroscience, 2022, 16, 736688.
  • 33. Erol, E., Yildiz, A., Yildiz, R., Apaydin, U., Gokmen, D., Elbasan, B. Reliability and validity of the turkish version of the Fremantle back awareness questionnaire. Spine, 2019, 44(9), E549-E554.
  • 34. Onan, D., Gokmen, D., Ulger, O. The Fremantle Neck Awareness Questionnaire in chronic neck pain patients: Turkish version, validity and reliability study. Spine, 2020, 45(3), E163-E169.
  • 35. Yağcı, N., Cavlak, U., Baskan, E., Öztop, M., Low back pain risk among older adults, Cukurova Medical Journal, 2020, 45(2), 421-427.
Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Araştırma Makalesi
Yazarlar

Halime Arıkan 0000-0003-2381-9978

Meral Sertel 0000-0002-7575-9762

Zuhal Şevval Gökdere 0000-0003-0216-5688

Yayımlanma Tarihi 29 Aralık 2024
Gönderilme Tarihi 19 Temmuz 2024
Kabul Tarihi 10 Eylül 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 11 Sayı: 4

Kaynak Göster

APA Arıkan, H., Sertel, M., & Gökdere, Z. Ş. (2024). The Relationship among Pain Perception, Severity of Temporomandibular Disorders, and Spinal Health in Older Adults: Cross-sectional Study. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 11(4), 656-662. https://doi.org/10.34087/cbusbed.1519013
AMA Arıkan H, Sertel M, Gökdere ZŞ. The Relationship among Pain Perception, Severity of Temporomandibular Disorders, and Spinal Health in Older Adults: Cross-sectional Study. CBU-SBED. Aralık 2024;11(4):656-662. doi:10.34087/cbusbed.1519013
Chicago Arıkan, Halime, Meral Sertel, ve Zuhal Şevval Gökdere. “The Relationship Among Pain Perception, Severity of Temporomandibular Disorders, and Spinal Health in Older Adults: Cross-Sectional Study”. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 11, sy. 4 (Aralık 2024): 656-62. https://doi.org/10.34087/cbusbed.1519013.
EndNote Arıkan H, Sertel M, Gökdere ZŞ (01 Aralık 2024) The Relationship among Pain Perception, Severity of Temporomandibular Disorders, and Spinal Health in Older Adults: Cross-sectional Study. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 11 4 656–662.
IEEE H. Arıkan, M. Sertel, ve Z. Ş. Gökdere, “The Relationship among Pain Perception, Severity of Temporomandibular Disorders, and Spinal Health in Older Adults: Cross-sectional Study”, CBU-SBED, c. 11, sy. 4, ss. 656–662, 2024, doi: 10.34087/cbusbed.1519013.
ISNAD Arıkan, Halime vd. “The Relationship Among Pain Perception, Severity of Temporomandibular Disorders, and Spinal Health in Older Adults: Cross-Sectional Study”. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 11/4 (Aralık 2024), 656-662. https://doi.org/10.34087/cbusbed.1519013.
JAMA Arıkan H, Sertel M, Gökdere ZŞ. The Relationship among Pain Perception, Severity of Temporomandibular Disorders, and Spinal Health in Older Adults: Cross-sectional Study. CBU-SBED. 2024;11:656–662.
MLA Arıkan, Halime vd. “The Relationship Among Pain Perception, Severity of Temporomandibular Disorders, and Spinal Health in Older Adults: Cross-Sectional Study”. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, c. 11, sy. 4, 2024, ss. 656-62, doi:10.34087/cbusbed.1519013.
Vancouver Arıkan H, Sertel M, Gökdere ZŞ. The Relationship among Pain Perception, Severity of Temporomandibular Disorders, and Spinal Health in Older Adults: Cross-sectional Study. CBU-SBED. 2024;11(4):656-62.