Investigation of the Relationship Between Temporomandibular Joint Dysfunction and Forward Head Posture, Cervical Mobility and Psychological Status in Adult Individuals

Yıl 2025, Cilt: 12 Sayı: 2, 428 - 442, 31.08.2025

Arife Akbulut Bayrak , Bihter Akınoğlu , Ayfer Ezgi Yılmaz , Bayram Bilgi , Şeyda Toprak Çelenay

https://doi.org/10.21020/husbfd.1608495

Öz

Objectives: The aim of the study was to investigate the relationship between temporomandibular joint dysfunction (TJD) and forward head posture, cervical mobility and psychological status in adult individuals.
Materials and Methods: 190 individuals (70.5% female, 29.5% male) were included in the study. The physical and demographic information of the participants were recorded. TJD symptoms and signs were evaluated with the Helkimo Clinical Craniomandibular Dysfunction Index (HCCDI), and forward head posture was assessed by measuring the craniovertebral angle with a universal modified goniometer. Cervical mobility was assessed using the Clinometer phone application. Psychological status was assessed using the Hospital Anxiety and Depression Scale.
Results: The average HCCDI scores of individuals was found to be 4.45±4.02. It was determined that there was a negative correlation between cervical flexion (p=0.037, r=-0.160), extension (p=0.028, r=-0.168) and craniovertebral angle (p=0.010, r=-0.186) and HCCDI score, and a positive correlation between anxiety (p<0.001, r=0.312) and HCCDI score. It was determined that there was no relationship between right-left cervical rotations, right-left cervical lateral flexion, and depression and HCCDI scores (p>0.05).
Conclusion: According to the results of this study, TJD severity increases as forward head posture increases and cervical flexion and extension joint range of motion decreases. It was also observed that the severity of TJD increased in individuals with high anxiety scores. It may be beneficial to include forward head posture, cervical mobility, and anxiety in the evaluation and treatment of individuals diagnosed with TJD.

Anahtar Kelimeler

anxiety , depression , posture , temporomandibular joint disorders

Yetişkin Bireylerde Temporomandibular Eklem Disfonksiyonu ile İleri Baş Postürü, Servikal Mobilite ve Psikolojik Durum Arasındaki İlişkinin İncelenmesi

Öz

Amaç: Çalışmanın amacı yetişkin bireylerde temporomandibular eklem disfonksiyonu (TMED) ile ileri baş postürü, servikal mobilite ve psikolojik durum ilişkisini araştırmaktı.
Gereç ve Yöntem: Çalışmaya 190 (%70,5’i kadın, %29,5’i erkek) birey dahil edildi. Fiziksel ve demografik bilgiler kaydedildi. TMED semptom ve bulguları Helkimo Klinik Kraniomandibular Disfonksiyon İndeksi (HKKDİ) ile, ileri baş postürü universal modifiye gonyometre ile kraniovertebral açı ölçülerek değerlendirildi. Servikal mobiliteyi değerlendirmek için Clinometer telefon uygulaması kullanıldı. Psikolojik durum Hastane Anksiyete ve Depresyon Ölçeği ile değerlendirildi.
Bulgular: Bireylerin HKKDİ skorları ortalaması 4,45±4,02 bulundu. Servikal fleksiyon (p=0,037, r=-0,160), ekstansiyon (p=0,028, r=-0,168) ve kraniovertebral açı (p=0,010, r=-0,186) ile HKKDİ skoru arasında negatif yönlü, anksiyete (p<0,001, r=0,312) ile HKKDİ skoru arasında ise pozitif yönlü korelasyon olduğu belirlendi. Sağ-sol servikal rotasyonlar, sağ-sol servikal lateral fleksiyonlar ve depresyon ile HKKDİ skoru arasında ilişki olmadığı belirlendi (p>0,05).
Sonuç: Bu çalışmanın sonuçlarına göre, ileri baş postürü arttıkça ve servikal fleksiyon ve ekstansiyon eklem hareket açıklığı azaldıkça TMED şiddeti artmaktadır. Anksiyete skorları yüksek olan bireylerde de TMED şiddeti artmaktadır. TMED tanılı bireylerde ileri baş postürü, servikal mobilite ve anksiyetenin de değerlendirme ve tedaviye dahil edilmesi yararlı olabilir.

Anahtar Kelimeler

anksiyete , depresyon , postür , temporomandibular eklem bozuklukları

Kaynakça

• Aydemir, O. (1997). Hastane anksiyete ve depresyon olcegi Turkce formunun gecerlilik ve guvenilirligi. Turk Psikiyatri Derg., 8,187-280.
• Bair, M.J., Wu, J., Damush, T.M., Sutherland, J.M. & Kroenke, K. (2008). Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med.,70(8),890- 897. Doi: https://doi.org/10.1097/PSY.0b013e318185c510
• Câmara-Souza, M. B., Figueredo, O. M. C., Maia, P. R. L., Dantas, I. D. S.& Barbosa, G. A. S. (2018). Cervical posture analysis in dental students and its correlation with temporomandibular disorder. Cranıo®, 36(2), 85-90. Doi: https://doi.org/10.1080/08869634.2017.1298226
• Chisnoiu, A.M., Picos, A.M., Popa, S., Chisnoiu, P.D., Lascu, L., Picos, A. & Chisnoiu, R. (2015). Factors involved in the etiology of temporomandibular disorders a literature review. Clujul Med, 88(4),473-8.
• De, Laat., A., Meuleman, H., Stevens, A., & Verbeke, G. (1998). Correlation between cervical spine and temporomandibular disorders. Clinical Oral İnvestigations, 2, 54-57.Doi: https://doi.org/10.1007/s007840050045
• Diab, A. A. & Moustafa, I. M. (2012). The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clinical Rehabilitation, 26(4), 351-361. Doi: https://doi.org/10.1177/0269215511419536.
• Ferreira, M.P., Waisberg, C.B., Conti, P.C.R. & Bevilaqua‐Grossi, D. (2019). Mobility of the upper cervical spine and muscle performance of the deep flexors in women with temporomandibular disorders. J Oral Rehabil, 46,1177-1184. Doi: https://doi.org/10.1111/joor.12858
• Gameiro, G.H., da Silva Andrade, A., Nouer, D.F. & de Arruda Veiga, M.C.F. (2006). How may stressful experiences contribute to the development of temporomandibular disorders?. Clin Oral Investig. 10,261-268. Doi: https://doi.org/10.1007/s00784-006-0064-1
• Greenbaum, T., Dvir, Z., Reiter, S. & Winocur, E. (2017). Cervical flexion‐rotation test and physiological range of motion—a comparative study of patients with myogenic temporomandibular disorder versus healthy subjects. Musculoskelet Sci Pract, 27,7‐13. Doi: https://doi.org/10.1016/j.msksp.2016.11.010.
• Haughie, L.J., Fiebert, I.M. & Roach, K.E. (1995). Relationship of forward head posture and cervical backward bending to neck pain. Man Ther, 3(3),91-7. Doi: https://doi.org/10.1179/jmt.1995.3.3.91.
• Hayran M. Sağlık araştırmaları için temel istatistik. 1st ed. Ankara: Omega Yayınları; 2011.
• Helkimo, M. (1974). Studies on functional and dysfunction of the masticatory system II. Index for anamnestic and clinical dysfunction and occlusal state. Swed. Dent. J., 67, 101-121.
• Karan, A. & Aksoy, C. (2004). Temporomandibular Eklem Rehabilitasyonu. In: Oguz H, Dursun E, Dursun N, editors. Tibbi Rehabilitasyon. Istanbul: Nobel Kitapevi. p.1061-79.
• Keleş, E., Şimşek, E., Salmanı, M., Tarsuslu Şimşek, T., Angın, S. & Yakut, Y. (2016). Eklem hareket açıklığı ölçümünde kullanılan iki akıllı telefon uygulamasının uygulayıcı içi ve uygulayıcılar arası güvenirliğinin incelenmesi. Journal of Exercise Therapy and Rehabilitation, 3(1), 21-29.
• Kmeid, E., Nacouzi, M., Hallit, S. & Rohayem, Z. (2020). Prevalence of temporomandibular joint disorder in the Lebanese population, and its association with depression, anxiety, and stress. Head Face Med, 16,19. Doi: https://doi.org/ 0.1186/s13005-020-00234-2.
• Laflamme, Y.T., Boutin, N., Dion, A.M., et al. (2013). Reliability and criterion validity of two applications of the iphone to measure cervical range of motion in healthy participants. J Neuroeng Rehabil, 10,69-78. Doi: https://doi.org/10.1186/1743-0003-10-69.
• Laskin, D.M. (1969). Etiology of the pain-dysfunction syndrome. J Am Dent Assoc, 79(1), 147-53. Doi: https://doi.org/10.14219/jada.archive.1969.0234.
• Matheus, R.A., Ramos-Perez, F.M., Menezes, A.V., Ambrosano, G.M., Haiter-Neto, F., Bóscolo, F.N., et al. (2009). The relationship between temporomandibular dysfunction and head and cervical posture. J Appl Oral Sci, 17(3),204-8. Doi: https://doi.org/10.1590/s1678-77572009000300014.
• McNeill, C., Mohl, N.D., Rugh, J.D. & Tanaka, T.T. (1990). Temporomandibular disorders: diagnosis, management, education, and research. J Am Dent Assoc, 120(3),253-63.
• Michelotti, A., de Wijer, A., Steenks, M. & Farella, M. (2005). Home‐exercise regimes for the management of non‐specific temporomandibular disorders. J Oral Rehabil, 32(11),779-85. Doi: https://doi.org/10.1111/j.1365-2842.2005.01513.x.
• Motta, L.J., Fernandes, K.P.S., Mesquıta-Ferrarı, R.A., Bıasotto-Gonzalez, D.A. & Bussadorı, S.K. (2012) Temporomandibular dysfunction and cervical posture and occlusion in adolescents. Braz J Oral Sci, 11 (3), 401-405. Doi: https://doi.org/10.20396/bjos.v11i3.8641392
• Okeson, J.P. (2005). Bell’s Orofacial Pains, 6th ed., Chicago, Quintessence Publishing Co.,13-45.
• Okeson, J. P. & De Leeuw, R. (2011). ‘Differential diagnosis of temporomandibular disorders and other orofacial pain disorders’, Dental Clinics of North America, 55(1), 105-120. Doi: https://doi.org/10.1016/j.cden.2010.08.007
• Ries, L.G.K., Alves, M.C. & Bérzin, F. (2008). Asymmetric activa tion of temporalis, masseter, and sternocleidomas toid muscles in temporomandibular disorder patients. Cranio, 26(1),59-64. Doi: https://doi.org/10.1179/crn.2008.008
• Rocha, C. P., Croci, C. S. & Caria, P. H. F. (2013). Is there relationship between temporomandibular disorders and head and cervical posture? A systematic review. Journal Of Oral Rehabilitation, 40(11), 875-881. Doi: https://doi.org/10.1111/joor.12104.
• Simoen, L., van den Berghe, L., Jacquet, W.& Marks, L. (2020). Depression and anxiety levels in patients with temporomandibular disorders: comparison with the general population. Clin Oral Investig. 24,3939-45. Doi: https://doi.org/10.1007/s00784-020-03260-1.
• Sonnesen, L., Bakke, M. & Solow B. (2001).Temporomandibular disorders in relation to craniofacial dimensions, head posture and bite force in children selected for orthodontic treatment. Eur J Orthod, 23(2),179-92. Doi: https://doi.org/10.1093/ejo/23.2.179.
• Suvinen, T.I., Reade, P.C., Kemppainen, P., Könönen, M. & Dworkin, S.F. (2005). Review of aetiological concepts of temporomandibular pain disorders: towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors. Eur J Pain, 9(6),613-33. Doi: https://doi.org/10.1016/j.ejpain.2005.01.012
• Tanhan, A., Yıldız, A., Demirbüken, İ. & Polat, M. (2019). Sağlık Bilimleri Öğrencilerinde Temporomandibular Eklem Disfonksiyonu ile Disfonksiyonu Tetikleyen Faktörler Arasındaki İlişkinin Araştırılması. Sakarya University Journal of Science, 9 (2), 258-265. Doi: https://doi.org/10.31832/smj.490740
• Winocur, E., Littner, D., Adams, I. & Gavish, A. (2006). Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescents: a gender comparison. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 102(4), 482-487. Doi: https://doi.org/10.1016/j.tripleo.2005.11.007
• Yıldız, N. T., Kocaman, H., Yıldırım, H., & Canlı, M. (2024). An investigation of machine learning algorithms for prediction of temporomandibular disorders by using clinical parameters. Medicine, 103(41), :p e39912, DOI: https://doi.org/10.1097/MD.0000000000039912.
• Yip, C.H.T., Chiu, T.T.W. & Poon, A.T.K. (2008). The relationship between head posture and severity and disability of patients with neck pain. Man Ther, 13(2),148- 54. Doi: https://doi.org/10.1016/j.math.2006.11.002.