Temporomandibular Disorders at The Crossroads: Investigating Vitamin D, Sleep, and Psychological Correlations
Abstract
Objectives: Vitamin D status and circadian rhythm disturbances have been implicated in chronic pain conditions. This study investigated the relationships between vitamin D levels, sleep chronotype, and psychological factors in temporomandibular disorders (TMD) patients compared to healthy controls.
Materials and Methods: This cross-sectional study assessed the relationship between vitamin D levels, sleep chronotype, and psychological distress in individuals with TMD, diagnosed according to RDC/TMD criteria. Participants were aged 18–45 and had undergone vitamin D testing within the last month. Vitamin D status was categorized as deficient (<20 ng/mL), insufficient (21–29 ng/mL), or normal (≥30 ng/mL). Chronotype was assessed using the Morningness-Eveningness Questionnaire, and psychological distress was measured using the Depression Anxiety Stress Scale-21 (DASS-21).
Results: The study included 51 participants (25 TMD patients, 26 controls). Vitamin D deficiency and insufficiency were more frequent in TMD patients, while normal levels were more common in controls (p=0.302). Mean serum vitamin D levels were also lower in the TMD group (19.77±11.53 vs 23.37±11.71 ng/mL), though this difference was not statistically significant (p=0.274). Chronotype distribution differed significantly (p=0.013), with evening types more common in TMD patients and morning types more frequent in controls. DASS-21 scores were higher in TMD patients but did not differ significantly between groups (p=0.267).
Conclusions: This study highlights a strong association between evening chronotype and TMD, suggesting a circadian influence in its pathogenesis. Although vitamin D levels were lower in TMD patients, no statistically significant association was found. These findings support the relevance of circadian patterns in TMD development and underscore the need for further research on the role of vitamin D in chronic pain conditions.
Ethical Statement
The study has been reviewed and approved by the Institutional Review Board of the Biruni University, Istanbul, Turkiye (approval date: 19.07.2023, IRB No. 2023/82-10). Informed written consent from each of the participants for this research was obtained.
Supporting Institution
2209 Program of the Scientific and Technological Research Council of Turkey (TÜBİTAK)
Project Number
1919B012221072
References
- 1. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. Journal of oral & facial pain and headache. 2014;28:6-27
- 2. Reis PHF, Laxe LAC, Lacerda‐Santos R, Münchow EA. Distribution of anxiety and depression among different subtypes of temporomandibular disorder: A systematic review and meta‐analysis. Journal of oral rehabilitation. 2022;49:754-67.
- 3. Straube S, Derry S, Straube C, Moore RA. Vitamin D for the treatment of chronic painful conditions in adults. Cochrane Database of Systematic Reviews. 2015:6;2015(5):CD007771
- 4. Nemati M, Tabrizi R, Rasooli F, Ghafari S. Is the prevalence of vitamin D deficiency in patients with temporomandibular disorder higher than healthy control group?. Journal of Maxillofacial and Oral Surgery. 2021:1-4;1205-1208
- 5. Im Y-G, Han M-Y, Baek H-S. Association of serum vitamin D level with temporomandibular disorder incidence: a retrospective, multi-center cohort study using six hospital databases. Nutrients. 2023;15:2860.
- 6. Rigon M, Obara K, Paixão L, Cardoso JR, Junior AJM. Relationship between temporomandibular and sleep disorders in adults: An overview of systematic reviews. Sleep medicine.2024:124:404-15.
- 7. Şener S, Guler Ö. Self-reported data on sleep quality and psychologic characteristics in patients with myofascial pain and disc displacement versus asymptomatic controls. International Journal of Prosthodontics. 2012;25;348-52
- 8. Rener-Sitar K, John MT, Bandyopadhyay D, Howell MJ, Schiffman EL. Exploration of dimensionality and psychometric properties of the Pittsburgh Sleep Quality Index in cases with temporomandibular disorders. Health and quality of life outcomes. 2014;12:1-9.
- 9. Ekici Ö. Relationship between chronic pain and sleep quality in patients with temporomandibular joint dysfunction. 2021;1:67-72
- 10. Díaz-Morales JF, Parra-Robledo Z. Day-of-week mood patterns in adolescents considering chronotype, sleep length and sex. Personality and Individual Differences. 2021;179:110951.
- 11. Merikanto I, Kortesoja L, Benedict C, Chung F, Cedernaes J, Espie CA, et al. Evening-types show highest increase of sleep and mental health problems during the COVID-19 pandemic—multinational study on 19 267 adults. Sleep. 2022;45:zsab216.
- 12. Jankowski KS, Linke M. Angry night birds: Emotionality, activity and sociability temperament in adolescent chronotypes. Chronobiology International. 2020;37:652-9.
- 13. Warzocha J, Gadomska-Krasny J, Mrowiec J. Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) from 2018 to 2022. Healthcare (Basel) MDPI; 2024:29;575
- 14. Wang Y, Xu J, Ding C, Deng T, Shen Z, Huang W, et al. The Link Between Temporomandibular Disorders and Jaw Functional Limitations Among Chinese Adolescents. International Dental Journal. 2025;75:554-563
- 15. Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Diatchenko L, Dubner R, et al. Psychological factors associated with development of TMD: the OPPERA prospective cohort study. The Journal of Pain. 2013;14:T75-T90.
- 16. Reiter S, Eli I, Mahameed M, Emodi-Perlman A, Friedman-Rubin P, Reiter MA, et al. Pain catastrophizing and pain persistence in temporomandibular disorder patients. J Oral Facial Pain Headache. 2018;32:309-20.
- 17. Zeng S, Tan Y, Cao Z, Zheng Y, Liu T, Deng Y, et al. Vitamin D Levels and Temporomandibular Disorders: A Bidirectional Two-Sample Mendelian Randomization Analysis. Journal of Pain Research. 2024:3487-500.
- 18. Staniszewski K, Lygre H, Berge T, Rosén A. Serum Analysis in Patients with Temporomandibular Disorders: A Controlled Cross‐Sectional Study in Norway. Pain Research and Management. 2019;2019:1360725.
- 19. Wei J, Zhang S, Chen Z, Tu S, Wang Y, Feng Y, et al. The prevalence of temporomandibular disorder and temporomandibular morphology among diverse chronotype profiles. Chronobiology International. 2023;40:1444-53.
- 20. Dan R, Li J, Zhao K, Yang Z, Dong Y, Fan P, et al. The association between chronotype profile and temporomandibular disorders among college students. Oral Diseases. 2024; 30(7):4573-4584.
- 21. Lei J, Fu J, Yap AU, Fu K-Y. Temporomandibular disorders symptoms in Asian adolescents and their association with sleep quality and psychological distress. CRANIO®. 2016;34:242-9.
- 22. Al-Khotani A, Meisha DE, Al Sayegh S, Hedenberg-Magnusson B, Ernberg M, Christidis N. The association between psychological symptoms and self-reported temporomandibular disorders pain symptoms in children and adolescents. Frontiers in Oral Health. 2021;2:675709.
- 23. Yap AU, Cao Y, Zhang M-J, Lei J, Fu K-Y. Number and type of temporomandibular disorder symptoms: their associations with psychological distress and oral health-related quality of life. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021;132:288-96.
- 24. Ahmed HS. Biochemical Changes Related with Temporomandibular Joint Disorders and Inflammatory Arthritis. Biomedical and Pharmacology Journal. 2017;10:2085-90.
- 25. Qin H, Guo S, Chen X, Liu Y, Lu L, Zhang M, et al. Clinical profile in relation to age and gender of patients with temporomandibular disorders: a retrospective study. BMC Oral Health. 2024;24:955.
- 26. Tabrizi R, Khanzadeh H, Jamasbi SSM, Rezaei F, Azadi A. Vitamin D Serum Levels and Temporomandibular Disorders: A Systematic Review and Meta-analysis. Archives of Oral Biology. 2024:106108.
- 27. Demir CY, Ersoz ME. Biochemical changes associated with temporomandibular disorders. Journal of International Medical Research. 2019;47:765-71.
- 28. Madani A, Shamsian SA, Layegh P, Abrisham SM, Ravaghi A, Najjaran NT. Are certain factors involved in calcium metabolism associated with temporomandibular disorders? CRANIO®. 2021;39:202-208
- 29. Khanna SS, Parulekar NR, Dhaimade PA. The Influence of Vitamin D on the Temporomandibular Joint and the Activities of Daily Living. Journal of Clinical & Diagnostic Research. 2017;11:ZC31-ZC34.
- 30. Gupta AK, Gupta R, Gill S. Effectiveness of Vitamin D along with Splint therapy in the Vit D deficient patients with Temporomandibular disorder-A Randomized, double-blind, placebo-controlled clinical trial. The Journal of Indian Prosthodontic Society. 2022;22:65-73.
- 31. Montaruli A, Castelli L, Mulè A, Scurati R, Esposito F, Galasso L, et al. Biological rhythm and chronotype: new perspectives in health. Biomolecules. 2021;11:487.
- 32. Taillard J, Sagaspe P, Philip P, Bioulac S. Sleep timing, chronotype and social jetlag: impact on cognitive abilities and psychiatric disorders. Biochemical pharmacology. 2021;191:114438.
- 33. Lee Y-H, Auh Q-S. Comparison of sleep quality deterioration by subgroup of painful temporomandibular disorder based on diagnostic criteria for temporomandibular disorders. Scientific Reports. 2022;12:9026.
- 34. Mourato PMN, Minghelli B. Association between temporomandibular disorders and sleep quality in higher education health students. BrJP. 2024;7:e20240046.
- 35. Gębska M, Dalewski B, Pałka Ł, Kołodziej Ł, Sobolewska E. Chronotype profile, stress, depression level, and temporomandibular symptoms in students with type D personality. Journal of clinical medicine. 2022;11:1886.
- 36. Özdinç S, Ata H, Selcuk H, Can HB, Sermenli N, Turan FN. Temporomandibular joint disorder determined by Fonseca anamnestic index and associated factors in 18-to 27-year-old university students. CRANIO®. 2020;38:327-32.
- 37. Patke A, Young MW, Axelrod S. Molecular mechanisms and physiological importance of circadian rhythms. Nature reviews Molecular cell biology. 2020;21:67-84.
- 38. Pfeffer M, Korf H-W, von Gall C. Chronotype and stability of spontaneous locomotor activity rhythm in BMAL1-deficient mice. Chronobiology International. 2015;32:81-91.
- 39. Zhou X, Yu R, Long Y, Zhao J, Yu S, Tang Q, et al. BMAL 1 deficiency promotes skeletal mandibular hypoplasia via OPG downregulation. Cell proliferation. 2018;51:e12470.
- 40. Gossan N, Boot-Handford R, Meng Q-J. Ageing and osteoarthritis: a circadian rhythm connection. Biogerontology. 2015;16:209-19.
- 41. Chen G, Zhao H, Ma S, Chen L, Wu G, Zhu Y, et al. Circadian rhythm protein bmal1 modulates cartilage gene expression in temporomandibular joint osteoarthritis via the MAPK/ERK pathway. Frontiers in pharmacology. 2020;11:527744.
- 42. Hand LE, Dickson SH, Freemont AJ, Ray DW, Gibbs JE. The circadian regulator Bmal1 in joint mesenchymal cells regulates both joint development and inflammatory arthritis. Arthritis Research & Therapy. 2019;21:1-12.
- 43. Li B, Liao G, Lee PMY, Huss A, Ma YTJ, Chan JW-Y, et al. Association between matched chronotype and poor mental health among shift workers: a systematic review and meta‐analysis. J Epidemiol Community Health. 2023;77:485-93.
- 44. Ryan J, Akhter R, Hassan N, Hilton G, Wickham J, Ibaragi S. Epidemiology of temporomandibular disorder in the general population: a systematic review. Advances in Dentistry & Oral Health. 2019;10:1-13.
Details
| Primary Language | English |
|---|---|
| Subjects | Oral and Maxillofacial Surgery |
| Journal Section | Research Article |
| Authors | |
| Project Number | 1919B012221072 |
| Submission Date | May 29, 2025 |
| Acceptance Date | September 26, 2025 |
| Publication Date | December 29, 2025 |
| DOI | https://doi.org/10.7126/cumudj.1707863 |
| IZ | https://izlik.org/JA86SZ48MA |
| Published in Issue | Year 2025 Volume: 28 Issue: 4 |
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