Chronic HPA axis response to stress in temporomandibular disorder.


Journal Article

PURPOSE: Perceived stress is associated with temporomandibular disorder (TMD), but whether cortisol levels are elevated in individuals with TMD is unknown. We hypothesized that cortisol concentration, a biomarker of hypothalamic-pituitary-adrenal (HPA) axis function, was elevated in TMD cases relative to controls, and that perceived stress was positively correlated with cortisol concentration. METHODS: In this case control study, TMD case status was determined by examiners using TMD Research Diagnostic Criteria. Participants (n=116) aged 18 to 59 years were recruited from within a 50 mile radius of the University of North Carolina at Chapel Hill. Following examination, cases (n=45) and controls (n=71) completed the 14-item Perceived Stress Scale using a reference interval of the past 3 months. Approximately 100 strands of hair were cut from the posterior vertex segment of their scalp. The 3 centimeters of hair most proximal to the scalp was analyzed with a commercially available salivary cortisol enzyme immunoassay adapted for hair cortisol. This length corresponds to the last 3 months of systemic HPA axis activity. RESULTS: TMD cases perceived higher stress than controls (p=0.001). However, hair cortisol concentration was lower in TMD cases than controls (p<0.001). The correlation coefficient revealed a weak negative relationship (r=-0.188) between perceived stress and hair cortisol concentration (p=0.044). In analysis stratified by case status, the relationship of perceived stress and hair cortisol concentration was non-significant for cases (p=0.169) and controls (p=0.498). CONCLUSION: Despite greater perceived stress, TMD cases had lower hair cortisol concentrations than controls and the 2 measures of stress were weakly and negatively correlated.

Full Text

Duke Authors

Cited Authors

  • Lambert, CA; Sanders, A; Wilder, RS; Slade, GD; Van Uum, S; Russell, E; Koren, G; Maixner, W

Published Date

  • 2014

Published In

Volume / Issue

  • 88 Suppl 1 /

Start / End Page

  • 5 - 12

PubMed ID

  • 25071145

Pubmed Central ID

  • 25071145

Electronic International Standard Serial Number (EISSN)

  • 1553-0205


  • eng

Conference Location

  • United States