Is there association between temporomandibular dysfunctions, sleep quality, parafunctional habits, anxiety and depressive symptoms in patients with chronic kidney disease undergoing hemodialysis? - Pilot study

Abstract

Abstract: There is a high prevalence of anxiety, depression, and stress in patients with chronic kidney disease (CKD) and these factors associated with psychotropic medications can lead to temporomandibular disorders (TMD). However, the association between these variables and TMD is still unclear. Objective: To associate TMD with anxiety, depression, stress, sleep quality, use of psychotropic drugs and parafunctional habits (PH) in patients with CKD undergoing hemodialysis (HD). Methods: Cross-sectional study, approved by CEP (CAAE: 63054822.5.0000.5350) carried out with 28 patients. Patients with scores greater than 19 points on the Mini Mental State Examination questionnaire and at least one positive response on the American Academy of Orofacial Pain TMD screening questionnaire and who underwent hemodialysis for more than 3 months were included. Those who were in isolation or hospitalized at the time of data collection were excluded. After analyzing the screening results, the patients were submitted to the research protocol, which consisted of the following instruments: application of the questionnaire to collect clinical and sociodemographic data; Fonseca anamnestic index;  Parafunctional Habits (PFH) assessment questionnaire; Hamilton Anxiety Scale – HAM and Pittsburgh Sleep Quality Index – PSQI. Results: It was found that 60.71% of the patients had some degree of TMD and 92.86% had PH, the most cited being the habit of chewing gum/candy and sleeping on one side. Still, 82.17% of the patients slept more than 6 hours a day, even though they did not have a good quality of sleep. 42.8% of patients reported the presence of depression and 42.85% used psychotropic medications. TMD had a statistically significant association with the PFH of waking bruxism, resting the hand on the jaw, chewing on one side only and biting the nails and with the use of antidepressant medication. Conclusion: Most patients with CKD on hemodialysis have TMD and there is a statistically significant association of TMD degrees with the PFH of grinding teeth awake, clenching teeth awake, resting the hand on the jaw, biting nails and chewing on one side alone and with the use of antidepressant medication. This is an indication that TMD should be evaluated and treated in these patients with the potential to improve their quality of life.