Prevalence of Temporomandibular Disorders and Assessment of Factors Associated with it - A Retrospective Study
Sanjana Devi1, Revathi Duraisamy2*
1 Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Senior Lecturer, Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
*Corresponding Author
Revathi Duraisamy,
Senior Lecturer, Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077,
Tamil Nadu, India.
Tel: +91-7598267022
E-mail: revathid.sdc@saveetha.com
Received: July 30, 2021; Accepted: August 10, 2021; Published: August 17, 2021
Citation:Sanjana Devi, Revathi Duraisamy. Prevalence of Temporomandibular Disorders and Assessment of Factors Associated with it - A Retrospective Study. Int J Dentistry Oral Sci. 2021;8(8):3871-3876. doi: dx.doi.org/10.19070/2377-8075-21000792
Copyright: Revathi Duraisamy©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
E The temporomandibular joint has many anatomic and functional features that make it one of the most complex joints of the body. Temporomandibular disorders are a complex group of conditions involving the temporomandibular joint, disc or masticatory muscles. This condition causes a physical and psychological debility in the population, as the pain is widespread and causes disability. Patients can also have clicking or grating sounds, limited or asymmetrical jaw movement. Even though it is not a life threatening disease, the quality of life is reduced. The aim of this study was to evaluate the prevalence of temporomandibular disorders and assessment of factors associated with it. A retrospective study was conducted in the Saveetha Dental College. Ethical clearance was obtained from SRB committee, Saveetha Dental College. Data was collected from a total of 86000 patients who visited Saveetha dental college between Jun,2019 to March,2020. Out of this, the data of 69 patients who had pain in the TMJ in this time frame were retrieved. The data obtained was tabulated in SPSS for windows, version 20. Frequencies were analysed. Chi square test was done to analyse association. There is no significant association between type of TMD with age (P=0.342), gender (P=0.950) and dental status (P=0.404) in the present study. Within the limitations of this study, TMD was more predominant in males, disc displacement was more predominant and the most affected age group was between 30-39 years of age.
2.Introduction
3.Conclusion
4.References
Keywords
Temporomandibular Disorders; Tmd; Condylar Disc Disorder; Mpds; Degenerative Disorders.
Introduction
The temporomandibular joint has many anatomic and functional
features that make it one of the most complex joints of the body
[11]. The part of the mandible in the TMJ is the condyle. Condylar
remodeling is continuous even after cessation of growth. It
is associated with ageing. Condylar remodeling is a physiological,
adaptive process. It is the adaptation of the structure of the condyle
to meet the functional demands [3]. While evaluating panoramic
radiographs, this adaptive mechanism must be kept in mind.
Temporomandibular disorders are a complex group of conditions
involving the temporomandibular joint, disc or masticatory
muscles. It is characterized by chronic facial pain. Sometimes, it
is also associated with other comorbidities, like chronic joint and
muscle pain [1]. This condition causes a physical and psychological
debility in the population, as the pain is widespread and causes
disability. Patients can also have clicking or grating sounds, limited
or asymmetrical jaw movement. Even though it is not a life threatening
disease, the quality of life is reduced [5, 62, 7].
TMD can be caused by trauma, grinding and clenching of teeth,
disc slip, stress, osteoarthritis and rheumatoid arthritis [16]. Also,
a hereditary problem named joint hypermobility where there is
increased range of motion in all joints. This is called TMJ hypermobility.
Winocur et al, after conducting a study about the
prevalence of general joint laxity and TMJ hypermobility among
adolescent girls, stated that there was a 43% prevalence of generalized
joint laxity and out of which 27.3% was recognised as
TMJH [68]. Adair et al, conducted a survey where they discovered
that patients with generalized joint hypermobility were more likely to show signs and symptoms of TMD than ones with normal
joint mobility [68]. Types of TMD include disc condyle disorder,
MPDS and degenerative disorder [9].
Certain genetic factors, like polymorphisms in COMT - catechol
- O - methyltransferase - and ADRB2 – beta - 2 adrenoceptor
genes, are likely to be responsible for hypersensitivity to experimental
pain in at least 50% of the cases studied. These same factors
may make individuals more susceptible to developing chronic
pain throughout life [25]. Joint pains can also be associated with
systemic factors like, hormonal changes, autoimmune diseases,
bacterial and viral infiltration, tissue metabolism, etc [59, 63, 32,
8].
Several studies state that females have more predilections for
TMD due to stress and hormonal changes [36, 48, 57]. Dental status
like occlusal interference, loss of teeth, loss of vertical dimension,
excess vertical dimension in removable or fixed prosthesis,
orthodontic treatment, parafunctional habits like clenching and
bruxism, and talking with phone over shoulder [24, 52, 25, 27].
Dental treatments like implant placements, extraction of teeth,
etc exacerbate the pain [2, 25, 17]. Different studies state different
relationships between age and TMD. According to Österberg T et
al, neither the variation in TMD symptoms between various age
groups and with time is fully understood, nor is the etiology of
TMD clarified [41]. However Ferreira et al stated a higher occurrence
in young adults [21].
Previously our team has a rich experience in working on various
research projects across multiple disciplines. (Jain, 2017 [31]),
(Varghese, Ramesh and Veeraiyan, 2019 [61]), (Ashok and Ganapathy,
2019 [6]), (Padavala and Sukumaran, 2018 [42]), (Ke et
al., 2019 [34]), (Krishnan et al., 2018 [6]), (Ezhilarasan, Sokal and
Najimi, 2018 [20]), (Pandian, Krishnan and Kumar, 2018 [44]),
(Ramamurthy and Mg, 2018 [50]), (Gupta, Ariga and Deogade,
2018 [27]), (Vikram et al., 2017 [66]), (Paramasivam, Vijayashree
Priyadharsini and Raghunandhakumar, 2020 [45]), (Palati et al.,
2020 [43]), (Samuel, Acharya and Rao, 2020 [50]) Now the growing
trend in this area motivated us to pursue this project.
The purpose of this study was to evaluate the prevalence of temporomandibular
disorders.
Materials And Methods
A retrospective study was conducted in the Saveetha Dental College,
Chennai, India. Ethical clearance was obtained from SRB
committee, Saveetha Dental College, Chennai, India. The clinical
portion of this retrospective study was conducted over a 9 month
period,i.e, between June, 2019 to March,2020 and included patients
who came with pain in the TMJ.
Inclusion criteria: Patients who came with pre-existing pain in
TMJ, both males and females.
Exclusion criteria: Patients in whom only clicking was present
without any pain.
Data was collected from a total of 86000 patients who visited
Saveetha dental college between Jun, 2019 to March,2020. Out of
this, the data of 69 patients who had pain in this time frame were
retrieved. The data obtained was tabulated in SPSS for windows,
version 20. Frequencies were analysed. Chi square test was done
to analyse correlation.
Results
In the present study 55.1% were males and 44.9% were females
[Figure 1].13% of the patients were <20 years, 21.7% of the patients
were between 20-29 years of age, 40.6% of the patients
were between 30-39 years of age, 14.5% of the patients were between
40-49 years of age, 8.7% of the patients were 50-59 years of age, 1.4% of the patients were between 60-69 years of age
[Figure 2]. 59.4% had Disc condylar disorder, 33.3% had MPDS,
and 7.2% had degenerative disorder. 27.5% had caries, 14.5% had
restorations, 2.9% had crowns, 15.9% were partially edentulous,
2.9% were completely edentulous, 36.2% had non carious lesions
[Figure 3][Table 1].
There was no significant correlation between Type of TMD with
gender (P=.950), age (P=.342), Dental status (P=.404) and systemic
diseases (P=.205). Significance level was set at P<0.05.
Figure 1 - Bar graph represents the association between gender and type of TMD. X-axis represents the gender and Y-axis represents the percentage of patients with TMD. Chi-square test was done.(Pearson Chi-square P value:0.950(>0.05), hence not statistically significant). There is no statistically significant association between gender and type of TMD.
Figure 2 - Bar graph represents the association between age and type of TMD(. X-axis represents the age and Y-axis represents the percentage of patients with TMD. Chi-square test was done. (Pearson Chi-square P value: 0.342(>0.05), hence not statistically significant). There is no significant association between age and type of TMD.
Figure 3 - Bar graph represents the association between dental status and type of TMD. X-axis represents the dental status and Y-axis represents the percentage of patients with TMD. Chi-square test was done and association was not found to be statistically significant. (Pearson Chi-square P value:0.404(>0.05), hence not statistically significant). There is no significant association between dental status and type of TMD.
Table 1 - Represents the frequencies of age, gender, type of TMD, dental status of participants.
Discussion
In the present study 55.1% were males and 44.9% were females
[Figure 1].13% of the patients were <20 years, 21.7% of the patients
were between 20-29 years of age, 40.6% of the patients
were between 30-39 years of age, 14.5% of the patients were between
40-49 years of age, 8.7% of the patients were 50-59 years
of age, 1.4% of the patients were between 60-69 years of age
[Figure 2]. 59.4% had Disc condylar disorder, 33.3% had MPDS,
and 7.2% had degenerative disorder. 27.5% had caries, 14.5% had
restorations, 2.9% had crowns, 15.9% were partially edentulous,
2.9% were completely edentulous, and 36.2% had non carious
lesions [Figure 3].
In the present study, males with TMD were more predominant
than females. But there was no significant correlation between
type of TMD with gender (P=.950). Haissam Dahan et al state
that gender is a major confounder in TMD [15]. Korszun et al,
Contreras et al, Gonçalves DA, Österberg et al, Plesh et al, also
stated that TMD is more predominant in women due to an increased
predominance of stress related disorders (Website, no
date; [35, 41, 48, 13] Bonato et al stated that 82.5% of their sample
population with TMD was women [10]. A study done by Fillingim
et al on chronic TMD patients stated that women reported
with higher levels of psychological distress across several SCL-
90R scales, along with greater neuroticism, perceived stress, negative
affect, and somatic awareness. Women also reported greater
use of catastrophizing, distraction, and praying & hoping, while
men reported higher scores on coping self-statements, and ignoring
and reinterpreting pain sensations [2]. Another study done by
Ferreira CL et al stated that the number of women who presented a higher prevalence of painful symptoms was greater, followed by
otologic symptoms and complaints of dysphonia [21]. However,
Hiltunen et al stated that no differences based on gender were
found [29].
Disc condylar disorder was more predominant in this study. However,
in a study by Yap et al, Mpds was more common. Bertoli et
al and Franco-Micheloni et al also stated that MPDS is most common
followed by disc displacement and degenerative disorders
[23, 9].
In the present study, patients were predominantly between 30-
39 years of age. This concurs with Bonato et al, who stated that
TMD is more prevalent in women between 20 and 40 years [10].
However, Plesh et al stated that for females, headache or migraine
pain with TMJ pain peaked around age 40 and decreased afterwards.
Joint pains increased with age regardless of gender [48].
Ferreira et al stated a higher occurrence in young adults [19 to 40
years old] [21]. Contreras et al stated that TMD onset tends to
occur after puberty, and the increase in the severity of signs and
symptoms generally reaches its peak during the reproductive age
[48, 13]. However, Hiltunen et al stated that no differences based
on age were found [29]. But there was no significant association
between types of TMD and age (P=.342) in the present study.
27.5% had caries, 14.5% had restorations, 2.9% had crowns,
15.9% were partially edentulous, 2.9% were completely edentulous,
and 36.2% had non carious lesions in the present study. But
there was no significant correlation between type of TMD with
dental status (P=.950). Mathew et al Pereira et al., Sato et al., Hiltunen
et al., Crow et al., and Takayama et al., stated that there is no
significant association between degenerative changes in the condyle
with dentition status [47, 56, 29, 14, 60]. However, Muir et al,
Giesen et al., and Harriman et al were not in agreement [28, 40,
26]. Österberg et al stated that the TMD index was significantly
associated with bruxism [41]. Huang et al reported a correlation
between third molar extraction and TMD [30]. Moon et al stated
that loss of occlusion and centric relation causes loss of equilibrium
leading to TMJ and postural problems[39].
The limitations of this study were firstly,the small sample size.
Secondly, the entire sample was taken from a similar geographic
location. Thirdly, systemic diseases were not assessed. Further
studies need to be done with a larger sample size to assess the
prevalence of TMD with systemic diseases. Our institution is passionate
about high quality evidence based research and has excelled
in various fields ( (Pc, Marimuthu and Devadoss, 2018 [46];
Ramesh et al., 2018 [51]; Vijayashree Priyadharsini, Smiline Girija
and Paramasivam, 2018 [65]; Ezhilarasan, Apoorva and Ashok
Vardhan, 2019 [19]; Ramadurai et al., 2019 [49]; Sridharan et al.,
2019 [58]; Vijayashree Priyadharsini, 2019 [64]; Chandrasekar et
al., 2020 [12]; Mathew et al., 2020 [38]; R et al., 2020; Samuel, 2021
[53]). We hope this study adds to this rich legacy.
Conclusion
The present study was conducted to understand the prevalence
of temporomandibular disorders and assessment of factors associated
with it. Within the limitations of this study, TMD was
more predominant in males, disc displacement was more common
and the most affected age group was between 30-39 years of age. There is no significant association between type of TMD
with age, gender and dental status in the present study.
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