Thakur, Preetanjali2019-05-132019-05-132019-03https://hdl.handle.net/11299/202896University of Minnesota M.S. thesis. March 2019. Major: Dentistry. Advisor: Eric Schiffman. 1 computer file (PDF); vii, 30 pages.Aims: Oral behaviors, anxiety and stress are believed to be related to temporomandibular disorders (TMD) pain. The aims of the study were to investigate the association of TMD pain intensity with oral behaviors, anxiety and stress, and the association of oral behaviors with anxiety and stress. Methods: From among the clinical and community-based participants in the multi-site Validation Project, 721 subjects were included in this study who had completed self-report questionnaires that reported pain intensity (Characteristic Pain Intensity [CPI]), oral behaviors (Oral Behavior Checklist [OBC]), anxiety (Symptom Checklist - 90 revised [SCL-ANX]) and stress (Perceived Stress Scale [PSS]) experienced during the previous month; and anxiety experienced during the previous week. Participants were divided into four groups based on the CPI report: no pain, mild, moderate and severe pain, and were compared using analysis of variance (ANOVA). Statistical differences between groups were evaluated using an F-test for continuous variables and Chi-square test for categorical variables. Spearman correlation coefficients were computed to examine the association of (1) CPI with OBC, SCL-ANX and PSS and (2) OBC with SCL-ANX and PSS. Simple linear regression analysis was used to investigate the bivariate relationships for outcomes CPI and OBC. The multivariate regression analysis with age and sex adjustment was conducted to examine relationship between CPI and dependent variables, and OBC and dependent variables. Results: Using CPI as a categorical variable, pain intensity was associated by a dose-response curve relationship for each of the independent variables: OBC, SCL-ANX, and PSS (ANOVA; p<0.0001). Positive correlations were found between CPI versus OBC (r=0.44, n=721), SCL-ANX (r=0.30, n=720), and PSS (r=0.21, n=721) with p<0.0001 for all correlations. Positive correlations between OBC with SCL-ANX (r=0.38, n=720) and PSS (r=0.32, n=721) with p<0.0001 were found. Using simple linear regression, OBC accounted for 18% of the variance of CPI versus SCL-ANX and PSS that explained 10% and 5% of CPI, respectively. SCL-ANX and PSS accounted for 12% and 11% of the variance of OBC, respectively. The multivariate regression model estimated that with 1SD increase of OBC, CPI will increase by 9 after adjusting for SCL-ANX, PSS, age and gender. For 1 SD increase in SCL-ANX, CPI will increase by 5 after adjusting for OBC, PSS, age and gender. For 1 SD increase in SCL-ANX, OBC will increase by 2.27 and for 1 SD increase in PSS, OBC will increase by 1.63 after adjusting for age, sex and each other. These statistically significant associations are positive and range from weak-moderate with correlation coefficients of 0.21 to 0.44. Together, these variables with age and sex adjustment explain 22% of the TMD pain intensity variability. Together, anxiety and stress with age and sex adjustment explain 19% of the variability of oral behaviors. Conclusion: Participants with severe TMD pain intensity reported significantly higher frequency of oral behaviors and higher levels of anxiety and stress compared to participants with no and mild pain. Participants with higher frequency of oral behaviors reported significantly higher anxiety and stress compared to participants with lower frequency of oral behaviors. Participants with the highest frequency of oral behaviors (tercile III of OBC) had clinically significantly more TMD pain than those with the lowest frequency of oral behaviors (tercile I of OBC). As predicted by the biopsychosocial model, TMD pain is associated with many factors beyond those assessed in the present study.enanxietyoral behaviorspain assessmentstressTemporomandibular disordersTMD pain intensityThesis or Dissertation