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Temporomandibular Disorders (superset of TMJ) - 3.8 X more likely to be vitamin D deficient – meta-analysis Oct 2024


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
  • Limited jaw movement or locking of the jaw  1  4
  • Headaches, earaches, dizziness  1  4
  • Difficulty chewing or sudden uncomfortable bite  5

See other TMD in VitaminDWiki


138+ VitaminDWiki Chronic Pain pages have VITAMIN D in the title

The list is automatically updated

Items found: 141
Title Modified
Pain sources vs. Vitamin D - Jan 2025 22 Jan, 2025
Vitamin D may influence pain intensity – review Nov 2024 16 Dec, 2024
Jaw joint (TMJ) needs 30-50 ng of Vitamin D and a good VDR – April 2021 17 Oct, 2024
Temporomandibular Disorders (superset of TMJ) - 3.8 X more likely to be vitamin D deficient – meta-analysis Oct 2024 17 Oct, 2024
Growing pains reduced in 91% of children with a single dose of Vitamin D – July 2024 15 Sep, 2024
Growing pains associated with low Vitamin D - many studies 03 Aug, 2024
Vitamin D reduces 5 types of chronic pain 07 Jul, 2024
Vitamin D reduces 5 types of pain 07 Jul, 2024
Willow Bark Extract and Aspirin have many health benefits (Vitamin D might be better) - Dec 2023 28 Dec, 2023
Central Nervous System protection by Vitamin D - Dec 2023 21 Dec, 2023
Knee osteoarthritis treated by Vitamin D - many studies 13 Dec, 2023
Fibromyalgia pain, fatigue, etc. reduced by 50,000 IU of Vitamin D for 12 weeks – Sept 2023 04 Oct, 2023
Pain relieved by Vitamin D if trial lasted more than 5 months (endometriosis, 50K weekly for 12 months) – Aug 2023 30 Aug, 2023
Muscle pain in obese women reduced by aerobic exercise plus 50,000 IU Vitamin D - RCT May 2021 27 Aug, 2023
Less morphine recall if preceded by twice a week Vitamin D (400 IU per kg in rats, human weights 80 kg) – Aug 2023 15 Aug, 2023
Pain not reduced by 60,000 IU monthly vitamin D (need 50,000 IU weekly) – RCT Aug 2023 22 Jul, 2023
Raynaud's pain decreased with 600,000 IU monthly vitamin D – RCT May 2012 17 Jul, 2023
Vitamin D at CureTogether: Fibromyalgia, MS, Psoriasis, etc - Dec 2013 11 Jul, 2023
Overview Fibromyalgia or Chronic Fatigue and vitamin D 11 Jul, 2023
Carpal tunnel syndrome and low vitamin D - many studies 08 May, 2023
Large dose Vitamin D before surgery was found to help by 35 studies 08 May, 2023
Neuropathy treated by vitamin D - many studies 24 Mar, 2023
More post-operative pain if low vitamin D before ( 2.4 X for Thoracoscopic) – Oct 2022 19 Oct, 2022
Opioid addiction related to low vitamin D in many ways (in both mice and men) – June 2021 13 Oct, 2022
Fibromyalgia Syndrome correlated with poor Vitamin D Receptor (less D to cells) in a small study – July 2022 24 Aug, 2022
Fibromyalgia and Musculoskeletal Pain treated by raised Vitamin D levels – July 2022 23 Jul, 2022
Overview Pain and Vitamin D 15 May, 2022
Ageing faster and more knee pain are associated with low vitamin D – March 2022 08 Mar, 2022
Low Level Laser Therapy greatly increased Vitamin D and Magnesium (for diabetics with nephropathy) – March 2019 28 Nov, 2021
Nightmares associated with low Vitamin D and low Calcium – Aug 2021 21 Nov, 2021
Menstrual Pain (PMS) reduced by vitamin D – RCT 2012, 2014, 2016 23 Sep, 2021
Less labor pain if higher level of vitamin D – August 2021 10 Aug, 2021
Pain reduced by Vitamin D (60K weekly, then monthly) plus daily Calcium in 3 months – May 2021 16 Jul, 2021
15,000 US death per year from NSAIDs (0 deaths from Vitamin D) 10 Jun, 2021
Vitamin D deficiency: an unrecognized cause of flank pain – Nov 2017 24 Jan, 2021
Vitamin D interplay with pain - May 2020 27 Nov, 2020
Vitamin D injections of a total of 1,800,000 IU reduced shinbone tenderness – Feb 2013 25 Jul, 2020
Several Diabetic pains reduced by injection of 300,000 IU of Vitamin D – RCT Feb 2020 25 Jul, 2020
Opiate addiction 2.4 X more likely if vitamin D deficient before surgery – June 2020 26 Jun, 2020
Chronic pain if osteoporosis and low vitamin D – June 2020 18 Jun, 2020
3X less Septic Shock in children with sepsis getting 150,000 IU of Vitamin D - RCT June 2020 03 Jun, 2020
Dysmenorrhea substantially reduced by Ginger, just 1,000 IU Vitamin D also helped – RCT Nov 2019 02 Dec, 2019
Fatigued seniors have lower levels of Vitamin D – Oct 2019 20 Oct, 2019
Fibromyalgia treated with Vitamin D (50,000 IU weekly for 3 months) – 2016, 2017, 2018, 2019 19 Oct, 2019
Vitality recaptured with Vitamin D (stories of Swedish immigrant women in this case) – Dec 2019 14 Oct, 2019
Long-term neck and back pains greatly reduced by 50,000 IU of Vitamin D – 4 cases – Sept 2019 14 Sep, 2019
8 Signs of Low Vitamin D - sweating, bones ache, muscle pain, poor immune, fatigue, slow healing etc. – YouTube Dec 2018 05 Aug, 2019
Fibromyalgia severity associated with serotonin but not Vitamin D (almost all were insufficient) – May 2019 27 May, 2019
Growing pains reduced 60 percent by monthly Vitamin D – March 2014 19 May, 2019
Off topic: Transcutaneous enhancers (DMSO, etc) for Vitamin D, Vitamin C, Resveratrol, Magnesium, etc. 30 Apr, 2019
100,000 IU of vitamin D monthly decreases use of NASIDs by 13 percent if low vitamin D – RCT May 2018 25 Dec, 2018
Rheumatoid Arthritis pain reduced by monthly 100,000 IU of Vitamin D – Oct 2018 05 Oct, 2018
Musculoskeletal pain was 5.9 X more likely to be associated with depression if low vitamin D – Aug 2018 07 Aug, 2018
Muscle problems are both treated and avoided by Vitamin D – April 2018 03 Jul, 2018
Fibromyalgia pain substantially reduced by weekly Vitamin D (50,000 IU) – June 2018 23 Jun, 2018
Muscle pain (Low Magnesium) plus Low Vitamin D associated with 10X more Cancer, etc (San Francisco) – Aug 2017 13 Apr, 2018
Widespread pain, arthritis pain and muscle pain are associated with low vitamin D – meta-analysis March 2018 08 Apr, 2018
Hospice and palliative care – Vitamin D, CBD, and Medical Cannabis 14 Mar, 2018
Fibromyalgia associated with lower Vitamin D – meta-analysis Oct 2017 10 Feb, 2018
Trigger points (myofascial pain) may be associated with low Vitamin D and low Magnesium – Jan 2018 16 Jan, 2018
Opioid dependency associated with vitamin D levels which are 8 % higher initially – Jan 2018 15 Jan, 2018
Tibia pain (long term) is 20X more likely if low vitamin D (under 10 ng) – Jan 2018 05 Jan, 2018
Jaw joint pain (Temporomandibular) is associated with low vitamin D in young adults – Nov 2017 16 Dec, 2017
Australians tested for Vitamin D – 40 percent deficient and 60 percent taking vitamin D – Nov 2017 03 Nov, 2017
Chronic widespread pain reduced a bit by vitamin D ignored dose sizes - meta-analysis Aug 2017 17 Aug, 2017
Vitamin D improves sleep and reduces pain – review of studies - July 2017 04 Aug, 2017
Off Topic: 4X increase in Americans taking morphine-type drugs in last decade (consider Vitamin D instead) – Aug 2014 04 Aug, 2017
Shin pain in elderly men 36 X more likely if low vitamin D – March 2017 30 Jul, 2017
Back and leg pain lasts a year longer if low vitamin D – April 2017 30 Jul, 2017
Chronic Pain reported 38 percent less often if supplemented with Vitamin D – meta-analysis Sept 2016 25 Jul, 2017
Knee osteoarthritis treated with vitamin D, weekly 50,000 IU – May 2015 20 Jul, 2017
Opioid use in palliative cancer patients far less if high level of vitamin D – May 2015 11 May, 2017
Angina dramatically reduced by injections of vitamin D twice a month (300,000 IU) – Jan 2015 05 Apr, 2017
Fatigue reduced by a single dose of vitamin D (100,000 IU) – RCT Dec 2016 27 Feb, 2017
Addictive pain relievers Oxycodone and Percocet (not needed as much if have enough vitamin D?) – July 2014 27 Feb, 2017
Fibromyalgia helped by Vitamin D – still not sure how much, and why - June 2016 31 Dec, 2016
Acute Rehab. patients 2.3X more likely to have musculoskeletal pain if low vitamin D – Oct 2014 29 Dec, 2016
Knee osteoarthritis pain reduced by 60,000 IU monthly vitamin D following loading dose – RCT Nov 2013 24 Dec, 2016
Less use of musculoskeletal pain drugs if get vitamin D – Feb 2015 20 Nov, 2016
Calcitriol, not inactive vitamin D, associated with pain in seniors – Aug 2014 30 Oct, 2016
Chronic Widespread Pain - 2 times more likely to be developed if low vitamin D – Jan 2016 10 Oct, 2016
Vitamin D deficiency 4X more likely if illiterate or have bone pain – Lahore Pakistan – Oct 2015 09 Jul, 2016
Reduced palliative cancer pain after Vitamin D supplementation – April 2016 19 Apr, 2016
Fibromyalgia development 1.9 X more likely if low vitamin D – Jan 2016 20 Jan, 2016
If you cannot readily get medical treatment, consider Alternative Med such as vitamin D 24 Dec, 2015
Chronic Widespread Pain associated with Vitamin D under 10 ng – meta-analysis Oct 2015 12 Dec, 2015
Fibromyalgia pain reduced with vitamin D intervention that achieved 30-48 ng – RCT Feb 2014 05 Nov, 2015
Musculoskeletal pain reduced with 4,000 IU of vitamin D – RCT April 2015 05 Nov, 2015
Knee pain in seniors predicted by low vitamin D 5 years before – Feb 2014 27 Oct, 2015
Pain of Diabetic Neuropathy reduced with weekly 50,000 IU vitamin D– CT Feb 2015 22 Oct, 2015
2000 IU of vitamin D reduced fatigue of advanced cancer – RCT May 2012 03 Sep, 2015
Growing pains associated with low vitamin D - Sept 2015 11 Aug, 2015
Pain not reduced by vitamin D (only used 1,000 IU) - RCT Dec 2014 16 Jul, 2015
Pain and Vitamin D - Review April 2015 24 Jun, 2015
Growing pains reduced 57 percent by vitamin D therapy – May 2015 28 May, 2015
Breast Cancer medicine pain reduced with 4300 IU vitamin D – RCT June 2012 24 May, 2015
Does vitamin D treat pain – still not absolutely, positively sure – meta-analysis April 2015 30 Apr, 2015
400,000 IU of vitamin D reduced adult pain and improved quality of life – March 2014 28 Apr, 2015
Knee osteoarthritis more painful if low vitamin D, especially among obese – Jan 2015 12 Apr, 2015
Pain following auto accident is worse if low vitamin D (for African Americans) – April 2015 27 Mar, 2015
Pain reduced when enough vitamin D was given – review March 2015 19 Mar, 2015
Severe chronic disease associated with less than 10 ng vitamin D – July 2011 11 Mar, 2015
Poor sleep strongly associated with pain in seniors (both associated with low vitamin D) – March 2015 07 Mar, 2015
Sleep disorder and nonspecific pain implies low vitamin D, especially if dark skin – March 2013 07 Mar, 2015
Is there a role for vitamin D in the treatment of chronic pain – Oct 2014 09 Jan, 2015
Fatigue substantially reduced by 450,000 IU Vitamin D2 spread over 5 weeks – Aug 2014 06 Jan, 2015
Back pain cured with vitamin D – Book May 2014 21 Dec, 2014
Fibromyalgia pain with trazodone reduced by 50 percent with weekly 50,000 IU of vitamin D – RCT Nov 2014 22 Nov, 2014
Dark skinned in Norway: 1000 IU vitamin D not enough to reduce pain – RCT Sept 2014 28 Sep, 2014
150,000 IU vitamin D reduced pain in immigrants – RCT Dec 2012 17 Sep, 2014
7 improvements in lives of veterans with chronic pain with 50,000 IU vitamin D weekly – June 2012 20 Aug, 2014
Low vitamin D associated with chronic widespread pain for women 06 Aug, 2014
Pain subjectively and objectively lower in people with higher levels of vitamin D – Aug 2014 03 Aug, 2014
More likely to have Chronic Widespread Pain when have less than 15 ng of vitamin D – May 2010 03 Aug, 2014
20,000 IU weekly did not get 43 percent of Scottish Cancer patients to a level of 30 ng of vitamin D – April 2014 29 Jul, 2014
Back pain gone and grew 3 inches with vitamin D - Dec 2010 14 Jul, 2014
Vitamin D reduced skeletal pain in 85 percent of the patients – Nov 2012 29 May, 2014
After back surgery failure, vitamin D greatly reduced the pain of every person 29 May, 2014
Blacks had lower vitamin D and more quantifiable pain than whites with knee osteoarthritis – Nov 2012 11 May, 2014
Chronic pain 40 percent less intense associated with 10 nanogram more vitamin D – April 2014 11 May, 2014
Poor sleep and lack of vitamin D - Nov 2011 08 Mar, 2014
7100 IU vitamin D (50,000 weekly) significantly reduced fibromyalgia – 2009 20 Jan, 2014
Chronic Fatigue and Vitamin D insight – Jan 2014 12 Jan, 2014
Literature review of Fibromyalgia and vitamin D – Sept 2011 18 Dec, 2013
Fibromyalgia patients with low vitamin D have more pain – Dec 2013 18 Dec, 2013
Pain reduction with 600,000 IU Vitamin D: RCT announced Dec 2013 06 Dec, 2013
Daily headaches and musculoskeletal pain may be due to low vitamin D – Oct 2013 29 Nov, 2013
Leg pain 7X more prevalent when vitamin D lower than 20 ng – Oct 2010 24 Sep, 2013
No rise in vitamin D levels of fibromyalgia patients in the summer – Sept 2013 08 Sep, 2013
Most immigrant women in Sweden had little vitamin D and lots of muscle pain – May 2013 22 May, 2013
Vitamin D and Chronic Pain: Promising Correlates - July 2012 12 May, 2013
RADICAL discussion of vitamin D and Nonspecific Musculoskeletal Pain– Nov 2012 16 Jan, 2013
Half of seniors with pain had low levels of vitamin D – April 2012 08 Nov, 2012
Discover the Pain of Vitamin D Deficiency 17 Mar, 2012
Vitamin D relieves pain – 2008 2010 29 Feb, 2012
Fibromalgia reduced with 50,000 IU weekly vitamin D2 – Sept 2011 14 Dec, 2011
More Arab leg pain when less than 20 ng of vitamin D – Aug 2010 30 Aug, 2010
Patients like me survey found vitamin D to be number one supplement 27 Jun, 2010
Chronic Pain not proven to be helped by Vitamin D – June 2010 02 Jun, 2010
Pain 'linked with low vitamin D' BBC Aug 2008 13 Apr, 2010
Tenuous link between vitamin D and chronic pain - April 2009 13 Apr, 2010