Temporomandibular Disorders (superset of TMJ) - 3.8 X more likely to be vitamin D deficient – meta-analysis
Vitamin D Serum Levels and Temporomandibular Disorders: A Systematic Review and Meta-analysis
Archives of Oral Biology https://doi.org/10.1016/j.archoralbio.2024.106108
Objective
This systematic review evaluates the connection between vitamin D serum levels, deficiency, and temporomandibular disorders (TMD), offering a meta-analysis of the existing evidence in this domain.
Design
The Scopus, ISI Web of Science, and Pubmed databases were searched for human studies concerning the connection between vitamin D and TMD comprising a control group. A random-effect model with forest plots was used for vitamin D serum levels mean difference (MD), vitamin D deficiency odds ratio (OR), and risk difference (RD) between subjects with and without TMD. Subgroup analysis was conducted based on ethnicity, overall risk of bias, TMD diagnosis method, and study designs. A p-value lower than 0.05 was considered significant. The certainty of the meta-evidence was evaluated according to the GRADE approach.
Results
Of the 2621 identified unique records, 15 studies were included in the study, eight of which were considered for the meta-analysis. The meta-analysis revealed a significant vitamin D deficiency OR (3.85; 95% CI: 2.35 – 5.43; Certainty: Low) and RD (22%; 95% CI: 11% - 32%; Certainty: Very low), and vitamin D serum levels MD (-5.03; 95% CI: -9.92 – -0.13; Certainty: Very low) between subjects with and without TMD. Among subgroup analyses, only the difference in vitamin D MD between Middle Eastern and European patients was significant (P < 0.01).
Conclusion
Considering the low to very low certainty of the evidence, vitamin D serum levels are significantly lower, and vitamin D deficiency is significantly more prevalent in TMD patients.
Introduction
Vitamin D is a group of fat-soluble vitamins. It is crucial in maintaining adequate serum calcium and phosphate concentration, which are key to bone health and normal muscle function (Norman, 2008, Straube et al., 2015). The primary natural source of vitamin D is a synthesis of cholecalciferol in the skin through a photochemical reaction with UV radiation from sun exposure. Also, it can be obtained from dietary sources (Bikle, 2014). Vitamin D deficiency mainly arises from insufficient Vitamin D intake through diet and inadequate exposure to sunlight (Holick et al., 2011). Vitamin D deficiency is a global concern prevalent among the elderly, but it persists as a common issue in both children and adults worldwide (Palacios & Gonzalez, 2014). This condition could result in several bone, cartilage, and muscle disorders. Moreover, it is established that vitamin D deficiency is associated with musculoskeletal disorders (e.g., osteoarthritis, rheumatoid arthritis, and osteoporosis) (Amirkhizi et al., 2022, Bolland et al., 2018, Gkekas et al., 2021, Penner et al., 2018).
Temporomandibular disorders (TMDs) include a range of pathological conditions affecting the temporomandibular joints, masticatory muscles, surrounding tissues, and bone structures, individually or in combination (Schiffman et al., 2014). The prevalence of TMDs within the general population is estimated at 5%; however, studies suggest that anywhere from 5% to 60% of individuals may experience at least one symptom associated with TMDs (Gauer and Semidey, 2015, Schiffman et al., 2014). According to the most recent classification for temporomandibular disorders by the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group,
TMDs are categorized into four main groups:
I) Temporomandibular joint disorders (intra-articular disorders),
II) Masticatory muscle disorders (extra-articular disorders),
III) Headache, and IV) Disorders of associated structures (Schiffman et al., 2014).
While the precise etiology of TMD remains uncertain, it is believed to originate from various factors, including mechanical displacement, bruxism, repetitive trauma to the TMJ, and occlusal abnormalities (Cairns, 2010). Systemic diseases such as rheumatoid arthritis, osteoarthritis, inflammatory conditions, ankylosing spondylitis, and immune diseases like lupus are recognized contributors to TMD (Paduano et al., 2020). Furthermore, psychosocial, genetic, hormonal, and environmental factors are thought to trigger this pathology (Ryan et al., 2019).
Although there are available reviews in the literature regarding the association and relationship of vitamin D with TMD, a lack of meta-analysis and a proper consequent conclusion can be sensed. Thus, this systematic review aims to evaluate the connection between vitamin D serum levels and deficiency and TMDs, aiming to offer meta-evidence of the existing evidence in this domain. The results of this study could be beneficial for clinicians in identifying a possible risk factor for TMD to help patients lower the risk of TMD or alleviate their signs and symptoms of TMD.
Section snippets
Protocol
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to prepare the protocol for this study (Page et al., 2021). The protocol of this systematic review was prospectively registered in the PROSPERO in March 2024 (CRD42024525658). The available literature was qualitatively and quantitatively analyzed.
PECO Question
Population: Patients diagnosed with TMD
Exposure: Vitamin D serum level
Comparison: Healthy patients without TMD
Outcomes: Different vitamin D serum level
“Is the
Study Selection
Fig. 1 depicts the study's flow diagram. The electronic search identified 4044 records, of which 2621 remained after duplication removal. Twenty-three studies were selected to check their eligibility for inclusion after screening based on their title and abstract. Finally, 15 studies were included in this review, of which eight were selected to be included in the meta-analysis. The features, characteristics, follow-up times, methods, and results of the included studies are summarized in Table 1.
Summary of Findings
The main objective of this study was to evaluate the connection between vitamin D serum levels and vitamin D deficiency with TMDs. The results showed that the prevalence and odds of vitamin D deficiency are significantly higher among TMD patients than among healthy patients. Moreover, vitamin D serum levels are significantly lower in TMD patients. Calcium serum levels showed no significant difference between subjects with and without TMD. Regarding the expression of VDR gene expressions,
Conclusion
Upon considering the limitations of the present study and the high risk of bias of the included studies, the following points can be concluded:
Vitamin D deficiency is significantly more prevalent among TMD patients than healthy ones.
Vitamin D serum levels are significantly lower in TMD patients than in healthy subjects, especially in the Middle Eastern population.
According to the current literature, the calcium serum levels are not significantly different between subjects with and without TMD.
Some of the references
M.J. Bolland et al. – Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis The Lancet. Diabetes & Endocrinology – (2018)
S. Yildiz et al.– Relation of vitamin D and BsmI variant with temporomandibular diseases in the Turkish population – British Journal of Oral and Maxillofacial Surgery (2021)
S. Bashir et al. – Association of VDR gene BsmI polymorphism with temporomandibular joint disorders: A case control study in Kashmiri population – Gene Reports (2022)
M. Ferrillo et al. – Temporomandibular Disorders and Vitamin D Deficiency: What Is the Linkage between These Conditions? A Systematic Review – Journal of Clinical Medicine (2022)
A. Gupta et al. – 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 – Journal of Indian Prosthodontic Society (2022)
TMD portions from Perplexity AI
Temporomandibular disorders (TMDs) are a group of conditions that affect the jaw joints and surrounding muscles.
Here are the key points about TMDs:
What are TMDs?
Temporomandibular disorders are problems affecting the temporomandibular joints (TMJs) - the joints connecting the lower jaw to the skull - and the muscles that control jaw movement 1 2
. They involve disorders of the jaw muscles, joints, and associated nerves.
Common symptoms
Pain or tenderness in the jaw, face, neck, and shoulders 1 4
Clicking, popping, or grating sounds when opening/closing the mouth 1 4
Difficulty chewing or sudden uncomfortable bite 5
See other TMD in Vitamin D Life
Jaw joint pain (Temporomandibular) is associated with low vitamin D in young adults – Nov 2017
- contains many studies and charts
Jaw joint (TMJ) needs 30-50 ng of Vitamin D and a good VDR – April 2021
Overlap between Fibromyalgia and other Chronic Pains – 2012
- 23% overlap of TMJ with Fibromyalgia
138+ Vitamin D Life Chronic Pain pages have VITAMIN D in the title
The list is automatically updated
{LIST()}