Impact of tobacco use on the symptoms of painful temporomandibular joint disorders

This study examines the relationship between the severity of painful temporomandibular joint disorders (TMD) symptoms and current tobacco use in patients evaluated at a specialized orofacial pain clinic. Medical records, including responses to the Chronic Pain Grading Scale (CPGS), from 606 consecutive patients evaluated at the Mayo Clinic orofacial pain clinic with TMD by RDC-TMD criteria were retrospectively reviewed. Univariate analyses were performed comparing tobacco users and non-users. Analysis of covariance and multiple logistic regression models were used to adjust for demographic variables. A p value ≤ 0.05 was accepted as the level of significance. Current tobacco use was reported by 91 subjects (15.1%). Tobacco users were younger (p < 0.01), less frequently married or widowed (p < 0.01), more frequently unemployed (p < 0.01), and less educated (p < 0.01). In univariate analysis, tobacco users were more likely to have moderate to severe pain interference defined as GPGS III-IV (OR = 1.94, 95% CI 1.16-3.22 for tobacco users compared to non-users), but this difference was not significant after adjustment for demographic variables. In the subset of subjects who lacked a myofascial component of pain (N = 333) this difference remained significant in the adjusted analysis (adjusted OR = 4.56, 95% CI 1.46-14.24). Current tobacco use was associated with unfavorable demographic background variables and more pain interference in subjects with TMD presenting to a specialized orofacial pain clinic. These effects were more pronounced in cases where myofascial pain was not present.