Gender Modifies Effect of Perceived Stress on Orofacial Pain Symptoms: National Survey of Adult Oral Health

Aims: To determine in a representative sample of the Australian adult population the relationship between age, gender, and two components of perceived stress (distress and control) and to investigate whether the relationship of perceived stress and temporomandibular disorder (TMD)-related orofacial pain symptoms was modified by gender or age. Methods: Data were from the National Survey of Adult Oral Health conducted in Australia in 2004-2006 and were collected from 3,954 adults aged 18 to 91 years. TMD-related orofacial pain symptoms were evaluated using seven validated screening questions. Perceived stress was measured with the 14-item Perceived Stress Scale and was investigated to empirically test its two theoretical components (distress and sense of control), using principal components analysis. Results: Prevalence of TMD-related orofacial pain symptoms was 10.1% in the Australian adult population. Prevalence was higher in females than in males, inversely related to age, and positively related to distress and current cigarette smoking. Principal component analysis confirmed the theoretical presence of two factors labeled here as distress and control. An inverse relationship of age and distress was more pronounced in females than in males (P value for interaction = .005). In the adjusted binary logistic regression model, age, smoking, and distress remained positively associated with symptoms. A sense of control was protective against TMD-related orofacial pain symptoms, but only for males (P value for interaction = .040). Conclusion: The higher prevalence of TMD-related orofacial pain symptoms in females was better explained by their lower perception of control than from a greater perception of distress. Keywords: effect modification, emotional stress, facial pain, population-based study, sex