Prevalence of Temporomandibular Joint Disorders in Orthodontic Patients of Bundelkhand Region, India

Received: 04-May-2020, Manuscript No. IJMRHS-20-10310; Editor assigned: 07-May-2020, Pre QC No. IJMRHS-20-10310; Reviewed: 21-May-2020, QC No. IJMRHS-20-10310; Revised: 10-Aug-2022, Manuscript No. IJMRHS-20-10310; Published: 07-Sep-2022, DOI: O

INTRODUCTION

Temporo Madibular Joint (TMJ) is one of the most important joint and Temporo Mandibular Disorder (TMD) are most commonly encountered problems in day to day clinical practice. TMD are a collection of pathologic and functional conditions affecting the temporo Mandibular Joint TMJ and the muscles of mastication as well as adjacent tissue components [1].

TMDs involve musculoskeletal pain, disturbances in the mandibular movement patterns, and/or impairment in functional movement. Pain is the main feature of most TMDs and also the main reason for patients to seek treatment. Many TMDs are chronic conditions, as they continue to bother the individuals for many years. Psychological factors are considered to be pivotal in the causation of several TMDs. Stress, somatic distress, and depression is the main psychological factors responsible for the TMD’s. There is a correlation between the increase in the pain symptom of TMJ with that of the more obvious and eminent psychological factors. Even after a decrease of the somatosensory input, suffering and pain behavior may continue and even increase [2-5].

Epidemiological studies of TMD so often have not been conducted systematically and have used widely different illness criteria and research designs, making them difficult to compare. There exits an uncertainty regarding the prevalence of Temporo Mandibular disorders in the general population. And the study pertaining to the prevalence of TMDs especially in India are limited. Therefore, the current study was undertaken with the aim to evaluate the prevalence of TMDs in Central Indian population.

Materials and Methods

A cross sectional questionnaire based study was conducted on a sample 400 people who visited the OPD of department of orthodontics and dentofacial orthopedics. The Mean age of the study participants was 20.9 ± 2.72 years with the age range of 13 years-40 years. There were 320 (80%) females and 80 (20%) males in the study. A systemic random sampling was executed to select the sample. The ethical clearance for the study was obtained by institutional ethical committee. All the participants were briefed about the purpose of the survey and a signed informed consent was obtained for their willingness contributes towards the survey. The participants who had undergone or undergoing orthodontic treatment, pain related to dental origin, systemic disorders, behavioral or cognitive disorders, syndrome, severe facial/dental anomalies, intraoral prosthetic wearers were excluded from the study [6-10].

A preformed questionnaire prepared both in English and the local language containing the information regarding the personal details of the participant and the TMJ related health status questions was administrated to the participants. They were asked to fill the survey form within the span of 15 minutes with the 0.5 seconds leeway for each question. The questionnaire included the domains like pain, trauma, ear and breathing problems. A pilot study was conducted on 15 participants, for the reliability of the self-administrated questions and Cronbach's alpha value was checked for the same, which was greater than 0.8 indicating the good reliability of the questionnaires. The collected data was tabulated and was subjected to statistical Analysis using SPSS version 22 IBM Chicago. Frequency distribution tables were made for categorical variables and responses of participants for different questions of the TMJ questionnaire. Chi-square test of statistic was used for finding any significant differences between males and females for the responses of the questions. Level of confidence was set as 95% with 5% error. P<0.05 was considered as significant [11,12]

Results

Demographic details of the study population are depicted in Table 1. The mean age of the study participants was 20.9 ± 2.72 years. There were 320 (80%) Females and 80 (20%) males in the study (Table 1).

The Frequency distribution of responses of the participants on pain and its symptoms are about 77.5% had no positive pain symptoms associated with TMJ whereas only 22.5% had positive symptoms. Headaches were the most commonly cited reason for the pain (60.3%) followed by the Stiff neck (32.8%) (Table 2)

Frequency of prevalence of any trauma component is depicted in Table 3. Data showed that only 3.25% study participants reported of past trauma or accidents which affected TMJ. Prevalence of jaw component problems in the study population is represented in second part. On an average 18% of the respondents reported of any jaw joint problems whereas 82% of participants didn’t had any problems. Pain with either jaw was prevalent in 7.8% of the participants. The complaint or problem which was reported by maximum number of participants was Dizziness with 39% of prevalence (Table 3) [13-15].

With respect to eye and ear symptoms more than 2/3rd (78.25%) of the participants had no symptoms. Eye symptoms were more frequent in the study participants than ear symptoms. Second part of Table 4 shows the response for the questions related to breathing. When asked about the presence or absence of allergies 23% of the participants positively responded. About 5.3% of participants said that they were diagnosed with Sleep Apnea. This was the least frequent complaint associated with breathing that was told by the study participants (Table 4) [16].

The comparison of the pain related questionnaire response between the male and females are described in below Table 5. Significantly increased number of females (66.2%) had reported headaches than males (36.2%). The difference noted was highly significant (p<0.05) even for the other head related pains (Table 5) [17].

The trauma and jaw related questionnaire comparison for male and female. When asked for any whiplash neck injuries comparatively increased number of (6.2%) males had responded positively than females (1.9%) this difference was statistically significant (p<0.05). A higher prevalence of crackling sound from either jaw was seen in males (7.5%) as compared to females (2.5%). And the difference noted was statistically significant (Table 6) [18]

The prevalence of hear and eye related problems were more in females in comparisons to males and again the difference noted was statistically significant (p<0.05). Statistically significant (p<0.05) number of males (20%) had sinus problems in comparison to females (9.4%) (Table 7) [19].

Temporomandibular disorders are the set of disorder which may include ranging symptoms involving muscles of mastication, fatigue of muscles, the impaired joint movements and the joint sounds. What makes it more complicated is its multifactorial origin. Most common etiological factors cited so far range from occlusal interferences, psychosomatic factors, simple tooth loss, masticatory muscle dysfunctions, internal and external disarrangement of the joint. Joint disorder can occur due to one of this individual factor or due to the various combination of the above said factors. Consecutively, TMJ disorder can be secondary symptoms of problems involving the other anatomic parts like Ear, nose and throat. Thus, it is important to analyze the TMJ disorders in a whole in terms prevalence of various symptoms [20-24]. In most of the earlier studies, pain was the most common symptom of TMJ disorder. Similar results are seen in the current study, where headaches were the most commonly cited reason for the pain (60.3%) followed by the Stiff neck (32.8%). In a study done on the Brazilian adolescent, it was reported that, the most frequently reported symptoms of TMJ disorders were headache and neck ache (20.9%). There is a positive association between TMJ disorder and headache and it is reported that around 48% and 77% of TMJ disorder individuals had headaches, whereas, in general population 45% of people have headache [25-28]. There is known association between Trauma to the head, neck or jaw and TMJ disorders. The results of the current study also showed the similar trend. Around 3.25% study participants reported of past trauma or accidents which affected TMJ. Contrastingly, higher prevalence of injury to head, neck or jaw was reported in earlier study on the Brazilian adolescent population by 6.1%. Similar results are also reported in the earlier studies of similar nature.

Around 18% of the respondents had jaw joint problems along with the pain in 7.8% of the participants. Dizziness was prevalent in 39% of population. These findings are in accordance to the earlier studies done on UAE population, Brazilian population, and in the population of Faridabad in India [29-31]. The results of the current study, eye symptoms were more frequently spotted in the participants than ear symptoms. Nevertheless, the ear symptoms were more predominately seen in the university students of Jordanian origin. Whereas, the association between the xerophthalmia, dizziness, rhinitis and the TMJ disorder has been emphasized in the previous study done in the Korean adult population. Concurrent results are reported in the current study as well with 23% of study participants reporting allergies and 11.5% of them showed sinus problems. The gender wise prevalence of TMJ disorder showed that, females were more prone to TMJ problems in comparison to the males. Similar results are cited throughout the TMJ related literature. In a study done on Indian origin undergraduate students, females double the prevalence of TMJ disorder in comparison to the males. Similar trend is also noticed in the earlier studies conducted in the population of Norway. However, there was no gender wise difference for the TMJ disorder severity in Brazilian population [32-35].

The reason behind this increase in the prevalence of TMJ disorder in females can be linked to the uniqueness in their physiological and anatomical structure in comparison to the male counterparts. Present study was based on the selfevaluation of the individuals using the questionnaires, but it would be beneficial if the findings of the current study are evaluated clinical by an experienced physician. The study was done exclusively on Bundelkand population of India, further it can be done on the other ethnic groups of India to have concreate knowledge about the prevalence of TMJ disorder signs and symptoms [36].

Conclusions

The results of the study can be concluded as follows,

•Headaches were the most commonly cited reason for the pain (60.3%) followed by the Stiff neck (32.8%).

•  3.25% study participants reported of past trauma or accidents which affected TMJ.

•  18% of the respondents had jaw joint problems

• Pain with either jaw was prevalent in 7.8% of the participants.

• Dizziness was prevalent by 39%.

•  Eye symptoms were more frequent in the study participants than ear symptoms.

•  23% of the participants had allergic problems.

•  Significant difference was noted between males and females for most of the symptoms of TMJ disorder.

•  Significantly increased number of females (66.2%) had reported headaches than males (36.2%).

•  Increased number of (6.2%) males had met with whiplash injury than females (1.9%).

•  A higher prevalence of crackling sound from either jaw was seen in males (7.5%) as compared to females (2.5%).

It can be suggested that the current group of population needs attention in terms of further diagnosis and the treatment plan to cure the existing TMJ disorder symptoms.