Document Type : Original Article


Department of Oral Medicine, School of Dentistry, Islamic Azad University, Khorasgan Branch, Isfahan, Iran


Background and Aim: The objective of this study was to determine the prevalence of signs
and symptoms of temporomandibular joint dysfunction (TMJD) in the Iran/Iraq war veterans
suffering from post-traumatic stress disorder. Materials and Methods: A total of 120 subjects
in the age range of 27 to 55 years were included; it included case group (30 war veterans
with PTSD) and three control groups (30 patients with PTSD who had not participated in the
War, 30 healthy war veterans, and 30 healthy subjects who had not participated in the War).
All subjects underwent a clinical TMJ examination that involved the clinical assessment of the
TMJ signs and symptoms. Results: The groups of veterans had high prevalence of TMJD
signs and symptoms vs. other groups; history of Trauma to joint was significantly higher in
subjects who had participated in the war compare with subjects who had not participated in
the war (P = 0.0006). Furthermore, pain in palpation of masseter, temporal, pterygoideus,
digastric, and sternocleidomastoid muscles in the groups of veterans was significantly greater
than other groups (P < 0.0001). Clicking noise during mouth chewing was significantly different
between groups (P = 0.01). And, there was significant difference in the frequencies of maximum
opening of the mouth between groups (P = 0.001). Conclusion: The results of this study
showed that subjects’ war veterans with PTSD have significantly poorer TMJ functional status
than the control subjects.


1. American Psychiatric Association. Diagnostic and statistical manual
of mental disorders, 4th ed, Washington (DC): American Psychiatric
Association; 1994.
2. American Psychiatric Association. Diagnostic and Statistical Manual
of Mental Disorders, 3rd ed. Washington, DC: American Psychiatric
Association Press; 1980.
3. Schnurr PP, Green BL. Trauma and Health: Physical Health
Consequences of Exposure to Extreme Stress. Washington, DC:
American Psychological Association; 2004.
4. Beckham JC, Moore SD, Feldman ME, Hertzberg JR, Kirby AC,
Fairbank JA. Health status, somatiziation and symptom severity of
posttraumatic stress disorder in combat veterans with posttraumatic
stress disorder. Am J Psychiatry 1998;155:1565‑9.
5. Schnurr PP, Spiro A. Combat disorder, posttraumatic stress disorder
symptoms and health behaviors as predictors of self‑reported
physical health in older veterans. J Nerv Ment Dis 1999;187:353‑9.
6. Wagner AW, Wolfe J, Rotnitsky A, Proctor SP, Erickson DJ. An
investigation of the impact of posttraumatic stress disorder on
physical health. J Trauma Stress 2000;13:41‑55.
7. Jakupcak M, Luterek J, HuntS, Conybeare D, McFall M. Posttraumatic
stress and its relationship to physical health functioning in a sample
of Iraq and Afghanistan War Veterans seeking post deployment VA
health care. J Nerv Ment Dis 2008;196:425‑8.
8. Hoge CW, Terhakopian A, Castro CA, Messer SC, Engel CC.
Association of posttraumatic stress disorder with somatic
symptoms, health care visits and absenteeism among Iraq War
veterans. Am J Psychiatry 2007;164:150‑3.
9. Stretch RH. Psychosocial readjustment of Canadian Vietnam
veterans. J Consult Clin Psychol 1991;59:188‑9.
10. Orner RJ. Post‑traumatic stress syndrome among British veterans
of the Falkland war. In: Wilson JP, Raphael B, editors. International
handbook of traumatic stress syndromes. New York: Plenum Press;
1993. p. 305‑11.
11. Kulka RA, Schlenger WE, Fairbank JA, Jordan BK, Hough RL,
Marmar CR, et al. Assessment of PTSD in the community – prospects
and pitfalls from recent studies of Vietnam veterans. Psychological
assessment. J Consult Clin Psychol 1991;3:547‑60.
12. Gregurek R, Vukuši H, Bareti V, Potrebica S, Krbot V, DZidi I, et al.
Anxiety and post traumatic stress disorder in disabled war veterans.
Croat Med J 1996;37:38‑41.
13. Okeson JP. Management of temporomandibular disorder and
occlusion. 5th ed. St. Louis: Mosby; 2003. p. 1‑24.
14. Sipilä K, VeijolaJ, JokelainenJ, Järvelin MR, OikarinenKS, RaustiaAM,
et al. Association between symptoms of temporomandibular
disorders and depression: An epidemiological study of the Northern
Finland 1966 Birth Cohort. Cranio 2001;19:183‑7.
15. Suvinen TI, Hanes KR, Gerscham JA, Reade PC. Psychophisical
subtypes of temporomandibular disorders. J Orofac Pain
16. Uhac I, Kovac Z, Muhvić‑Urek M, Kovacević D, Francisković T,
Simunović‑Soskić M. The prevalence of temporomandibular
disorders in war veterans with post‑traumatic stress disorder. Mil
Med 2006;171:1147‑9.
17. Muhvić‑Urek M, Uhac I, Vuksić‑Mihaljević Z, Leović D, Blecić N,
Kovac Z. Oral health status in war veterans with post‑traumatic
stress disorder. J Oral Rehabil 2007;34:1‑8.
18. Uhac I, Kovac Z, Valentic‑Peruzovic M, Juretic M, Moro LJ,
Grzic R. The influence of war stress on the prevalence of signs
and symptoms of temporomandibular disorders. J Oral Rehabil
19. Weathers FW, Ruscio AM, Keane TM. Psychometricproperties of
nine scoring rules for the Clinician‑Administered Posttraumatic
Stress Disorder Scale. Psychol Assess 1999;11:124‑33.
20. Greenberg M, Glick M. Burkets Oral Mediceni Diagnosis and
Treatment. 12th ed. England: BC Decker Inc.; 2010. p. 271‑307.
21. Rugh JD, Wood BJ, Dahlstrom L. Temporomandibular disorders:
Assessment of psychological factors. Adv Dent Res 1993;7:127‑36.
22. Rollman GB, Gillespie JM. The roll of psychosocial factor in temporo
mandibular disorders. J Curr Rev Pain 2003;4:71‑81.
23. Stock still JW, Callahan CD. Personality hardiness anxiety and
depression as contructs of interest in the study of temporomandibular
disorders. J Craniomandibular Disord 2007;15:129‑34.
24. Deleeuw R, Bertoli E. Prevalence of traumatic stressor in patient
with temporomandibular disorders. J Oral Maxillofac Surg
25. Manfredino D, Bandethini AB, Cantini E. Mood and anxiety
Psychopathology and temporomandibular disorder. J Oral Rehabil
26. Matsuka Y, Yatan H, Kuboki T. Temporomandibular disorders in
the adult population. J Am Dent Assoc 2008;24:158‑62. 27. Bonjardim LR, Gaviao MB, Pereira LJ. Anxiety and depression in
adolescent and their relationship with mandibular disorders. Int J
Prosthodont 2008;38:347‑52.
28. Afari N, Wen Y. Are post traumatic stress disorder symptoms
and temporomandibular pain associated? Finding from a
community‑based twin rwgistry. J Orofac Pain 2008;22:41‑9.
29. Deleeuw R, Bertoli E. Prevalence of post traumatic stress disorder
symptoms in orofacial pain patients. Oral Surg Oral Med Oral Pathol
Oral Radiol 2005;99:558‑68.