Trauma Exposure and Childhood Trauma in Temporomandibular Joint Disorders

Effects of Trauma Exposure and Childhood Trauma on Function and Quality of Life in Patients With Temporomandibular Joint Disorders

Temporomandibular disorder is a multifactorial condition that involves the temporomandibular joint, masticatory muscles, and surrounding structures and is influenced by biological, psychological, and social factors. Parafunctional habits, bruxism, trauma, and occlusal discrepancies have been recognized as important etiological contributors, while psychosocial stressors and early life experiences also play a critical role. Adverse childhood experiences, including neglect and abuse, have been identified as risk factors for long-term psychological vulnerability and physical health problems. Trauma exposure throughout life may further increase the risk of temporomandibular symptoms and negatively affect functional outcomes and quality of life.

The present prospective, cross-sectional case-control study aims to investigate the frequency and impact of childhood trauma and lifetime trauma exposure on functional outcomes and health-related quality of life in patients with temporomandibular disorder. A clinical sample of patients diagnosed with temporomandibular disorder is compared with healthy individuals matched for age and sex. All participants complete standardized questionnaires assessing mandibular function, symptoms of anxiety and depression, cumulative trauma exposure across childhood, adolescence, and adulthood, childhood maltreatment, and health-related quality of life.

By systematically integrating validated measures of both early and later traumatic experiences, this study seeks to provide a comprehensive understanding of the contribution of trauma to the severity and psychosocial burden of temporomandibular disorder. The findings are expected to emphasize the importance of incorporating trauma screening and psychological assessment into the routine evaluation and multidisciplinary management of patients with temporomandibular disorder.

Temporomandibular disorder encompasses a spectrum of neuromuscular and musculoskeletal conditions affecting the temporomandibular joint, masticatory muscles, and related structures. Although its etiology is complex, psychological and social factors have been shown to strongly influence symptom severity and persistence. Previous studies have demonstrated associations between temporomandibular disorder, anxiety, depression, and somatization. Childhood trauma and lifetime traumatic experiences are important determinants of long-term psychological and physical health. However, limited research has investigated the combined influence of adverse childhood experiences and cumulative trauma exposure on functional impairment and quality of life in patients with temporomandibular disorder.

This study was designed to evaluate the prevalence and impact of childhood trauma and lifetime trauma exposure on mandibular function and quality of life in patients with temporomandibular disorder compared with healthy controls.

Study Design

This is a prospective, cross-sectional, observational, case-control study conducted between May 2025 and October 2025. The study protocol was approved by the Human Research Ethics Committee (Approval No: 197/2025). Written and verbal informed consent was obtained from all participants prior to enrollment.

Participants

The patient group consists of adults aged 18 to 65 years with a clinical diagnosis of temporomandibular disorder who are cognitively competent, literate, and willing to participate. The control group consists of healthy individuals without a diagnosis of temporomandibular disorder who are matched with the patient group for age and sex. Control participants are also required to be cognitively competent, literate, and willing to provide informed consent.

Data Collection and Assessments

Data are collected through structured, face-to-face interviews conducted by trained researchers at the otorhinolaryngology outpatient clinic of Gaziantep City Hospital. Participants complete a sociodemographic questionnaire and the following validated assessment instruments:

Mandibular Function Impairment Questionnaire: A seventeen-item self-report measure assessing functional limitations of the mandible, with higher scores indicating greater impairment.

Hospital Anxiety and Depression Scale: A fourteen-item questionnaire assessing symptoms of anxiety and depression through two separate subscales.

International Trauma Exposure Measure: A checklist used to identify exposure to potentially traumatic events across childhood, adolescence, and adulthood. It provides subscale scores for each developmental stage as well as a cumulative lifetime trauma score.

Childhood Trauma Questionnaire: A twenty-eight-item instrument assessing retrospective experiences of childhood maltreatment across five domains, including physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect.

Short Form 36 Health Survey: A thirty-six-item questionnaire evaluating health-related quality of life across eight domains, including physical functioning, role limitations due to physical health, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, and mental health.

All instruments are administered in person by the same research team to ensure consistency, reliability, and minimization of measurement bias.

Inclusion Criteria

Adults aged 18 to 65 years

Clinically diagnosed with temporomandibular disorder according to standardized clinical evaluation

Cognitively competent and literate individuals capable of completing questionnaires

Voluntary agreement to participate and provision of written informed consent

Exclusion Criteria

History of neurological, psychiatric, or systemic diseases that may affect study participation or data reliability

Cognitive impairment that prevents completion of questionnaires

History of major maxillofacial surgery or trauma not related to temporomandibular disorder

Current substance abuse or alcohol dependence

Refusal or inability to provide informed consent