Clinical orofacial characteristics associated with risk of first-onset TMD: The OPPERA prospective cohort study

Richard Ohrbach, Eric Bair, Roger B. Fillingim, Yoly Gonzalez, Sharon M. Gordon, Pei Feng Lim, Margarete Ribeiro-Dasilva, Luda Diatchenko, Ronald Dubner, Joel D. Greenspan, Charles Knott, William Maixner, Shad B. Smith, Gary D. Slade

Research output: Contribution to journalArticlepeer-review

76 Scopus citations


Case-control studies have documented clinical manifestations of chronic temporomandibular disorder (TMD), whereas clinical predictors of TMD development are largely unknown. We evaluated 41 clinical orofacial characteristics thought to predict first-onset TMD in a prospective cohort study of U.S. adults aged 18 to 44 years. During the median 2.8-year follow-up period, 2,737 people completed quarterly screening questionnaires. Those reporting symptoms were examined and 260 people were identified with first-onset TMD. Univariate and multivariable Cox regression models quantified associations between baseline clinical orofacial measures and TMD incidence. Significant predictors from baseline self-report instruments included oral parafunctions, prior facial pain and its life-impact, temporomandibular joint noises and jaw locking, and nonspecific orofacial symptoms. Significant predictors from the baseline clinical examination were pain on jaw opening and pain from palpation of masticatory, neck, and body muscles. Examiner assessments of temporomandibular joint noise and tooth wear facets did not predict incidence. In multivariable analysis, nonspecific orofacial symptoms, pain from jaw opening, and oral parafunctions predicted TMD incidence. The results indicate that only a few orofacial examination findings influenced TMD incidence, and only to a modest degree. More pronounced influences were found for self-reported symptoms, particularly those that appeared to reflect alterations to systems beyond the masticatory tissues. Perspective: OPPERA's prospective cohort study identifies predictors of first-onset TMD comprising self-reported orofacial symptoms and examination findings. The results suggest a complex pattern of TMD etiology that is influenced by disorders locally, in masticatory tissues, and systemically, in painregulatory systems.

Original languageEnglish (US)
Pages (from-to)T33-T50
JournalJournal of Pain
Issue number12 SUPPL.
StatePublished - Dec 2013
Externally publishedYes


  • Cohort studies
  • Pain
  • Parafunction
  • Temporomandibular disorder
  • Trauma

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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