Association between Salivary Cortisol Levels and Temporomandibular Joint Disorders: A prospective Clinical Cohort Study
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Abstract
Background: Temporomandibular disorders (TMD) represent a spectrum of conditions affecting the jaw joint and associated musculature, often manifesting as chronic pain and functional impairment. Recent investigations have implicated stress-related physiological markers, particularly salivary cortisol, as potential contributors to TMD development and progression.
Objective: This study sought to examine the correlation between heightened salivary cortisol concentrations and TMD presentation, while concurrently evaluating demographic patterns and treatment outcomes among affected individuals.
Methods: The investigation employed a prospective clinical design at Al-Awlaki Laboratory in Sana'a, Yemen, enrolling 20 patients with confirmed myofascial TMD diagnoses. Standardized morning saliva collections (8:30-10:00 AM) facilitated cortisol quantification via electrochemiluminescence immunoassay, complemented by comprehensive clinical evaluations to exclude confounding conditions. A multimodal therapeutic approach incorporating behavioral interventions, physical therapy, and dental appliances was implemented, with specialist referrals as clinically indicated.
Results: Analysis revealed consistently elevated cortisol levels across all participants (mean 22.3 ng/mL), with no significant gender-based variations observed. All participants presented with hallmark symptoms, cephalgia, and muscular tension—accompanied by measurable psychological distress markers. Post-intervention assessments documented substantial clinical improvements, with a 70% reduction in pain and normalized cortisol profiles achieved uniformly across the cohort.
Conclusion: These findings substantiate the psychophysiological dimension of TMD pathology, demonstrating both the biomarker's diagnostic relevance and the therapeutic value of stress-modulating strategies. The results advocate for integrated biopsychosocial management approaches while underscoring the necessity for expanded longitudinal studies to further elucidate these relationships
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hypothalamic-pituitary-adrenal axis, orofacial pain, psychoneuroimmunology, biomarker analysis, musculoskeletal disorders
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