|Year : 2020 | Volume
| Issue : 3 | Page : 123-127
Prevalence of temporomandibular joint disorders in patients: An institutional-based study
Akshat Sachdeva1, Sumit Bhateja1, Geetika Arora2, Brinda Khanna1, Archika Singh1
1 Department of Oral Medicine and Radiology, Manav Rachna Dental College, Faridabad, Haryana, India
2 Department of Public Health Dentistry, Inderprastha Dental College and Hospital, Sahibabad, Ghaziabad, Uttar Pradesh, India
|Date of Submission||16-Apr-2020|
|Date of Acceptance||20-Aug-2020|
|Date of Web Publication||15-Oct-2020|
Dr. Sumit Bhateja
Department of Oral Medicine and Radiology, Manav Rachna Dental College, Faridabad, Haryana
Background: Temporomandibular joint (TMJ) disorders symbolize a multifactorial malady which manifests as a painful condition in the orofacial region and have a high prevalence rate among different populations. Aim: The aim of the study was to assess the prevalence of TMJ disorders among patient visiting the outpatient department (OPD) of a private dental college situated in Haryana. Materials and Methods: A total of 30,000 people visiting the OPD of Manav Rachna Dental College were screened for a period of 6 months, and out of them, 130 patients were having temporomandibular disorders (TMDs). Five parameters were assessed, and positive as well as negative findings were recorded. The collected data were subjected to statistical analysis, and P = 0.05 was considered a set point. Results: Females were found to be more affected with TMDs than males in the age group ranging from 37 to 46 years. Joint tenderness was the most common symptom among the parameters that were analyzed. Conclusion: Dental professionals ought to teach and persuade the patients to take up preventive measures and early treatment to maintain a strategic distance from further manifestations that fill in as forerunners to TMJ disorders.
Keywords: Disorders, joint tenderness, prevalence, temporomandibular, temporomandibular joint
|How to cite this article:|
Sachdeva A, Bhateja S, Arora G, Khanna B, Singh A. Prevalence of temporomandibular joint disorders in patients: An institutional-based study. SRM J Res Dent Sci 2020;11:123-7
|How to cite this URL:|
Sachdeva A, Bhateja S, Arora G, Khanna B, Singh A. Prevalence of temporomandibular joint disorders in patients: An institutional-based study. SRM J Res Dent Sci [serial online] 2020 [cited 2021 Jan 16];11:123-7. Available from: https://www.srmjrds.in/text.asp?2020/11/3/123/298259
| Introduction|| |
Temporomandibular disorders (TMDs) represent a class of conditions influencing the temporomandibular joint (TMJ), the muscles of mastication, and/or related structures. Muscles associated with and incorporating the jaw joint control its position and movement. The TMJ associates the mandible to the temporal bone. TMDs is an aggregate term that depicts a subgathering of painful orofacial disorders, including grievances of agony on the TMJ region and exhaustion of the cranio-cervico-facial muscles, especially of masticatory muscles, impediment of mandibular movement, and the presence of articular clicking.
TMJ dysfunction is a cryptic issue even today because of its multifactorial etiology. However, it is generally assumed that TMDs would mainly affect adult patients; nevertheless, children have also shown a similar incidence of signs and symptoms in some studies. Maladies of the TMJ and chewing might be a functional pain portrayed by distress or torment in the muscles that control jaw developments.
TMDs are a multifactorial disorder, commonly connected with flawed body posture, parafunctional habits, dental restorations, orthodontic treatment, emotional stress, injury, anatomy of the disc, and pathophysiology of the muscles. It is not evident whether these components are considered inclining or simply simultaneous elements.
The etiology of TMDs is multifactorial. The variables extend from biomechanical, neuromuscular, biopsychosocial, and biological components. Biomechanical factors including occlusal overburdening and parafunctional propensities (like bruxism) are oftentimes associated with causation of TMDs; inflated degrees of estrogen hormones are considered biological components influencing the TMJ. Among biopsychosocial factors, stress, tension, or depression is common that can incline and lead to TMJ disorders.
TMJ disorders affect up to 15% of adults, and the pinnacle age ranges from 20 to 40 years– old; these disarranges are twice as common in females as compared to their male counterparts.
Till date, there is not much literature available on the prevalence of TMDs in the population of Faridabad, Haryana. Hence, the purpose of this study was to determine the ubiquitousness of TMJ disorders in the patients visiting the outpatient department (OPD) of Manav Rachna Dental College, Faridabad.
| Materials and Methods|| |
A total of 30,000 adults were screened with age ranging from 17 to 70 years. Out of these 30,000 patients, 130 patients were showing the presence of various symptoms of TMDs determined based on the inclusion and exclusion criteria and assessed on the basis of five parameters by the authors on observation of patients at the Department of Oral Medicine and Radiology, Manav Rachna Dental College, Faridabad, Haryana. The study was conducted over a period of 6 months, i.e., from January 2019 to June 2019, and the findings were recorded on a pro forma. Informed consent was obtained from each of the participants. The study was approved by the institutional ethical committee.
All patients were asked for a history of parafunctional habits (if any). Any relevant medical history revealed by patients during routine case history taking was also recorded. anamnesis history (if any) was also recorded for all patients, but the data were not applied to statistical analysis. All patients were asked for a history of tobacco usage habits (if any), which was recorded.
Inclusion criteria: Male and female having mixed or permanent dentition, no previous history of orthodontic treatment, and no craniofacial anomalies were included in the study.
Exclusion criteria: Children in the stage of primary dentition, patients with any musculoskeletal or neurological disorders, ear pathologies, any other related systemic conditions, patients with parafunctional habits, patients with a history of previous TMJ surgeries or fracture, and noncooperative patients were excluded from the study.
All patients visiting the department who fulfilled the inclusion criteria were screened for TMD signs and symptoms. The demographic data and the signs and symptoms of TMDs were recorded, and P values were drawn to check for their significance.
The collected data were subjected to suitable statistical analysis using Statistical Package for Social Sciences (SPSS) software version 20, IBM Corporation, SPSS Inc., Chicago, IL, USA. Mean, standard deviation, and the proportions (percentage of patients affected) were calculated for each clinical parameter, and the statistical test of significance Chi-square was used.
Significance for all statistical tests was predetermined at a P < 0.05.
| Results|| |
The mean age of the patients was 36.05 ± 12.590 years. [Table 1] shows the age-wise distribution of TMJ disorders. Out of 130 patients, 39 (30.7%) patients were 17–26 years old, 29 (22.8%) patients were aged 27–36 years, 30 (23.6%) patients were aged 37–46 years, 21 (16.5%) patients were aged 47–56 years, and 8 (6.3%) patients were aged 57–70 years.
It also showed the gender-wise distribution of TMJ disorders. Out of 127 patients, 63 (49.6%) patients were males and 64 (50.4%) patients were female patients. And also, most of the patients were having tobacco usage history, that is, out of 130 patients, 74 (56.9%) patients were having a habit of tobacco.
[Table 2] shows that symptoms were compared with age groups. A significant association was found between joint tenderness and 37–46 years of age group (P = −0.052, S), then 17–26 years of age and 47–56 years of age and more symptoms as compared to other age groups.
|Table 2: Age-wise distribution of temporomandibular joint disorders symptoms|
Click here to view
[Table 3] shows that symptoms were compared with gender. A significant association was found between joint tenderness, crepitus, and deviation of the mandible on mouth opening as compared to males (P = 0.009, S; P = 0.030, S; and P = 0.044, S, respectively).
|Table 3: Gender-wise distribution of temporomandibular joint disorders symptoms|
Click here to view
| Discussion|| |
The TMJ is a compound articulation shaped from the articular surfaces of the temporal bone and the mandibular condyle. In light of the condyle's capacity to translate, the mandible can have a lot higher maximal incisal opening than would be conceivable with rotation alone. The joint is thus named as “ginglymoarthrodial:” an amalgamation of the terms ginglymoid (rotation) and arthroidial (translation). Our research was focused to find the prevalence of signs and symptoms of TMDs in patients visiting the OPD of a private dental college, which was accomplished with the help of examination of patients coming for a routine checkup in the Department of Oral Medicine and Radiology at Manav Rachna Dental College located in Faridabad, Haryana. The patients were observed for signs and symptoms, which included clicking sound, crepitus, joint tenderness, deviation of the mandible on mouth opening, and pain on mouth opening. For this study, a total of 30,000 patients were observed and screened for a period of 6 months. In the Haryana population belt, it was observed that TMDs were seen most frequently in people of the age group of 17–26 years, and it can be implied from the results that their incidence decreases as the age of an individual advances. This is derived from [Chart 1], which has provided the age-wise distribution of patients. TMDs are generally seen more commonly in females as compared to males, and this was corroborated in our study as well since the prevalence was higher for females as shown in [Chart 2]. A similar study conducted by Nair et al. in 2018. concluded that TMDs were more commonly seen in females. Many more studies ,, have also concluded that the prevalence of TMDs is more common in females as compared to males, which is in accordance with the results obtained from our study. This indicates a greater need for treatment in females than males. The observed contrast between genders was credited to the fact that girls are more anxiety prone and increasingly sensitive to tenderness and agony on palpation of the TMJ and adjoining muscles mainly in older age because of hormonal changes. The present study also shows that symptoms were observed more frequently in females when compared to males.
It can be inferred from the data that TMDs in the Haryana NCR population are more prevalent among females, especially those under 30 years of age. The most significant symptoms include joint tenderness, crepitus, and deviation of the mandible on mouth opening. This is in contrast to the results of a study conducted by Bagis et al. in Turkey, where clicking sound had a statistically significant difference between both the genders. A comparative study conducted in Israel  reported that joint sensitivity was more prevalent in females as compared to their counterparts, and this difference was statistically significant. This is analogous to the results of our study, where joint tenderness had increased prevalence in females than males.
The present study showed that joint tenderness was most commonly seen in patients of 37–46-year age group, followed by 17–26 years' age group and 47–56 years' age group [Table 2]. An epidemiological study carried out in Chennai  to determine the prevalence of TMDs revealed that deviation of mandible on mouth opening was the most common parameter. This could be due to the fact that patients have reported at advanced stage when they became symptomatic, and TMJ dysfunction interfered with their quality of life. This possibly is due to the ignorant population of this region attributed to a low literacy rate compared with Chennai population.
Another significant factor reported during the course of our study was that there was an increased incidence of TMDs in people consuming tobacco (in any form). Out of 127 patients having symptoms of TMDs, 74 had a positive history of tobacco consumption, which is a large fraction. This was more prevalent in the younger age group. A possible explanation recommended is that smoking may have an impact on pain either through hypersensitive or inflammatory pathways or both. It is commonly accepted that nicotine is the essential substance that alters pain perception. Chronic presentation to tobacco smoke prompts changes in torment discernment with the end goal that smokers deprived of nicotine demonstrate more prominent sensitivity to pain-evoking stimuli. One study conducted in the year 2010 revealed that smokers with TMD reported higher pain intensity and life interference from pain than nonsmokers (NS) with TMD. Another study held in the year 2013 has concluded that smokers with TMD not only reported higher pain severity than NS with TMD but also were at higher risk for factors that may adversely affect treatment outcomes.
The limitations of the present study were that the study sample size with respect to the population of the representative region was less. Furthermore, fewer variables were included in the study. We recommend that future studies should incorporate larger sample size with the inclusion of more variables.
| Conclusion|| |
The purpose of the current study was to determine the prevalence of TMDs in the patients visiting the OPD of a private dental college. It can be thus concluded that, similar to the prevalence of TMDs in other regions, they are more frequent in females. The intensity of TMDs that women suffer from is yet to be studied along with the impact of various factors such as hormones, stress levels, and genetic proclivity, all of which require further intensive research. The dentist thus plays a pivotal role in identifying a TMD, once they encounter a patient. They should be aware of the presenting symptoms and devise a treatment plan for such patients. Once the diagnosis is established, they can be put on appropriate therapeutic modalities, counseling, and/or medications as per the need. They should also keep a long-term follow-up with such patients so that the chances of recurrences are minimized, and a healthy life is what lies ahead. Hence, through the medium of the current study, we sincerely appeal to the Dental Council of India to expand subjects such as “TMDs” in the curriculum for BDS students.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician 2015;91:378-86.
Herb K, Cho S, Stiles MA. Temporomandibular joint pain and dysfunction. Curr Pain Headache Rep 2006;10:408-14.
Nair P, Hedge K, Chatterjee R, Srivastava H, Lalwani R, Patel R. Prevalence of type of temporomandibular disorders in dental OPD patients-a cross sectional study. IOSR J Dent Med Sci 2018;17:27-31.
Dhanda M, Gomes AF, Meru S, Ranjan R, Devrani A, Choudhary S. Comparative evaluation of signs of temporomandibular joint dysfunction and occlusal discrepancies in asymptomatic men and women: A cross-sectional study. Indian J Dent Sci 2018;10:164-8. [Full text]
Chauhan D, Kaundal J, Karol S, Chauhan T. Prevalence of signs and symptoms of temporomandibular disorders in urban and rural children of northern hilly state, Himachal Pradesh, India: A cross sectional survey. Dent Hypotheses 2013;4:21-5. [Full text]
Ahmed LI, Abuaffan AH. Prevalence of temporomandibular joint disorders among Sudanese University students. J Oral Hyg Health 2016;4:200.
List T, Wahlund K, Wenneberg B, Dworkin SF. TMD in children and adolescents: Prevalence of pain, gender differences, and perceived treatment need. J Orofac Pain 1999;13:9-20.
Bagis B, Ayaz EA, Turgut S, Durkan R, Özcan M. Gender difference in prevalence of signs and symptoms of temporomandibular joint disorders: A retrospective study on 243 consecutive patients. Int J Med Sci 2012;9:539-44.
Winocur E, Littner D, Adams I, Gavish A. Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescents: A gender comparison. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:482-7.
Muthukrishnan A, Sekar GS. Prevalence of temporomandibular disorders in Chennai population. J Indian Acad Oral Med Radiol 2015;27:508-15. [Full text]
Silverstein B. Cigarette smoking, nicotine addiction, and relaxation. J Pers Soc Psychol 1982;42:946-50.
Melis M, Lobo SL, Ceneviz C, Ruparelia UN, Zawawi KH, Chandwani BP, et al
. Effect of cigarette smoking on pain intensity of TMD patients: A pilot study. Cranio 2010;28:187-92.
de Leeuw R, Eisenlohr-Moul T, Bertrand P. The association of smoking status with sleep disturbance, psychological functioning, and pain severity in patients with temporomandibular disorders. J Orofac Pain 2013;27:32-41.
Katyayan PA, Katyayan MK. Effect of smoking status and nicotine dependence on pain intensity and outcome of treatment in Indian patients with temporomandibular disorders: A longitudinal cohort study. J Indian Prosthodont Soc 2017;17:156-66.
] [Full text]
[Table 1], [Table 2], [Table 3]