Changes in salivary oxidative status, salivary cortisol, and clinical symptoms in female patients with temporomandibular disorders during occlusal splint therapy: a 3-month follow up

E Vrbanović, I Lapić, D Rogić, I Z Alajbeg, E Vrbanović, I Lapić, D Rogić, I Z Alajbeg

Abstract

Background: Differences in the expression of oxidative stress (OS) markers between female patients with temporomandibular disorders (TMD) and healthy individuals indicate that OS plays a role in the pathogenesis of TMD. Because chronic exposure to stress generates oxidative damage during continuous stimulation of the hypothalamic-pituitary-adrenal axis, we expected that higher levels of cortisol might be associated with higher oxidative damage. Our aim was to test the association between OS markers, stress perception, and salivary cortisol (SC) in chronic, female TMD patients. We tracked changes in OS markers and SC during occlusal splint therapy in order to evaluate the influence of treatment on oxidative status. We hypothesized that the effects of TMD therapy would differ among individuals depending on the source and intensity of pain.

Methods: Sixteen female patients were recruited, and 12 finished the study. Clinical assessment and saliva sampling were performed at the baseline and follow-up appointments. Repeated measures analysis of variance and Pearson's correlation were used for analyzing the data.

Results: After 3 months, a significant reduction in afternoon total antioxidant capacity (TAC) was observed (p < 0.05). A significant reduction in afternoon malondialdehyde (MDA) (p = 0.021) and a decrease in afternoon MDA to superoxide dismutase ratios (p = 0.017) were present in high-intensity pain patients. At baseline, higher levels of perceived stress were significantly associated with higher morning cortisol (ρ = 0.67). At the end of the therapy, reduced perceived stress was positively correlated with morning SC changes when considering all TMD patients, but the association between perceived stress with OS markers was present only in myofascial pain (MP) group. The effect of treatment on the self-perceived quality of life was more pronounced in female MP patients while the reduction of spontaneous pain was significantly greater in high-intensity pain patients.

Conclusion: Our data indicate that occlusal splint therapy in female TMD patients contributes to increasing their capacity to remove free radicals. The question remains whether or not TAC decreases in this process as a result of avoiding unnecessary processes, once the increase in antioxidants effectively compensates for OS. The intensity and the source of pain should be considered important factors in future investigations evaluating salivary OS markers and their association with perceived stress and SC in TMD patients.

Trial registration: ClinicalTrials.gov NCT03029494 . Registered on 2017-01-19.

Keywords: Occlusal splint; Oxidative stress; Salivary cortisol; Salivary diagnostics; Temporomandibular disorders.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the progress through the phases of the study
Fig. 2
Fig. 2
ab Visual analogue scale scores (means and standard deviations) during the 3-month interval of occlusal splint therapy. Asterisk indicates a post-hoc significant difference (within group comparisons, compared to baseline). *p < 0.05 **p < 0.001. VAS, Visual Analogue Scale; MP, myofascial pain; DD, disc displacement; HIP, high-intensity pain; LIP, low-intensity pain
Fig. 3
Fig. 3
ab Oral Health Impact Profile scores (means and standard deviations) during the 3-month interval of occlusal splint therapy. Asterisk indicates a post-hoc significant difference (within group comparisons, compared to baseline). *p < 0.05 **p < 0.001. OHIP-14, Oral Health Impact Profile; MP, myofascial pain; DD, disc displacement; HIP, high-intensity pain; LIP, low-intensity pain
Fig. 4
Fig. 4
ab Maximal comfortable mouth opening (means and standard deviations) during the 3-month interval of occlusal splint therapy. MCO, maximal comfortable mouth opening; MP, myofascial pain; DD, disc displacement; HIP, high-intensity pain; LIP, low-intensity pain
Fig. 5
Fig. 5
ab Change in perceived stress level (means and standard deviations) during the 3-month interval of occlusal splint therapy. PSS, Perceived Stress Scale; MP, myofascial pain; DD, disc displacement; HIP, high-intensity pain; LIP, low-intensity pain

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