PREVALENCE OF TEMPOROMANDIBULAR JOINT DISORDER AMONG GULF MEDICAL UNIVERSITY STUDENTS

Transcription

1 GMJ GULF MEDICAL JOURNAL ORAL PROCEEDINGS PREVALENCE OF TEMPOROMANDIBULAR JOINT DISORDER AMONG GULF MEDICAL UNIVERSITY STUDENTS Mohammed Elyasi 1, Sohail Majeed 1 *, Milad Elyassi 1, Abdul Aziz 1, Komeil Rashid 1, Sharif Ali1, Mohamed Said 2 1Students, 2 Dean, College of Dentistry, Gulf Medical University, Ajman, UAE *Presenting Author ABSTRACT Objective: The aim of this study is to report the prevalence of temporomandibular disorder (), and the risk factors and indicators associated with it. Materials & Methods: A cross-sectional question-based survey was carried out among students of Gulf Medical University (n = 265). The participants were between 17 and 30 years, with the majority being in the age group of years (55.8% of total sample size). Logistic regression models were used to investigate the association of with age, gender, ethnicity, stress levels, and set criteria of common clinical manifestations and signs. The data was analyzed using the chi-square test. Results: Of the total students participating in the study, 59 students (22.3%) showed positive signs of, with 39 of those being females. Regarding the ethnic group, the Arab students had a higher prevalence rate of 25.4%. Moreover, several indicators exhibited a positive correlation between the stress levels of an individual and. Conclusion: GMU students did not display a significantly high prevalence of compared with the general population. However, among the participants that did show positive signs of, the majority were females, indicating a gender/genetic risk factor. In addition, there was a strong positive correlation between the stress levels of an individual and the risk of developing. Keywords: Temporomandibular disorder, prevalence, etiology, risk factor Citation: Elyasi M, Majeed S, Elyassi M, Aziz A, Rashid K, Ali S, Said M. Prevalence of temporomandibular joint disorder among Gulf Medical University students. Gulf Medical Journal. 2016;5(S1):S123 S130. INTRODUCTION Temporomandibular disorder () is a term used to indicate various problems associated with the temporomandibular joints (TMJs) and muscles of mastication, including pain, limited development, and joint sounds. About 60 70% members of any population group have at some stage in their lives, but just 5% undergo treatment 1. can be caused by numerous factors, with traumatic stress on the TMJs and Correspondence: Prof. Mohamed Said Hamed (PhD), Dean and Professor of Oral & Maxillofacial Surgery, Consultant A, Oral & Maxillofacial Surgery, College of Dentistry, Gulf Medical University, Ajman, UAE. prof.mohamedsaidhamed@gmu.ac.ae sudden changes in an individual s bite pattern being some examples. In addition, grinding and clenching of teeth are considered as predisposing factors for 2. Epidemiological surveys found that 50 70% of the general population exhibit indications of a disorder at some stage in their life. In contrast to this generalized finding, 20 25% of the population was observed to have specific symptoms related to. However, just 2 7% sought treatment for their condition 3. The results of several studies indicated that the signs and symptoms of continually decrease as age increases. As a general consensus, elderly people are not the primary sufferers of ; just 4% of the very elderly population suffers severely from

2 MOHAMMED ELYASI, ET AL However, physical and traumatic factors can influence the cause and development of. One factor that is associated with age is the use of complete and removable partial dentures. Hence, older patients that use dentures tend to have a higher prevalence rate of. Moreover, older patients using a removable partial denture are more likely to develop than a complete denture wearer 3. Although is very common among patients vising dental clinics, the mechanisms to treat this condition are not clearly understood. In our study, we tried to study the prevalence of, and the risk factors and indicators associated with it. MATERIALS & METHODS A cross-sectional study was carried out at Gulf Medical University (GMU), with 265 students being randomly selected from the four colleges of the university. The inclusion criteria for the study were as follows: 1. Students who signed the consent form 2. Aged below 30 years 3. Any gender 4. Students of any nationality The exclusion criteria were as follows: 1. Staff or external members 2. Any student above 30 years 3. Any student undergoing treatment with orthodontic headgear The approvals of both the GMU Ethical and Research Committees were taken before commencing the study. Prior to participation (filling the questionnaire) in the study, each student was required to sign a consent form. Permissions were obtained from the deans of all colleges. Class representatives were approached to identify a slot in the timetable when most students were present in the class. The questionnaire was handed out in the classroom; the researcher was present at the venue to clarify any questions. The data obtained from the questionnaires was tabulated in Microsoft Excel and analyzed using Statistical Package for Social Sciences, Version 22.0, and presented as percentages, tables, and graphs. The chi-square test was used for associations. Pearson s chi-square test was used for calculations carried out using SPSS, Version 19.0 (IBM Corp, Armonk, NY, USA). RESULTS Of the total students that participated in the study, 55.8% were aged years, while just 6% were between the ages of 26 and 30 years. Females accounted for 72% of the study population; Arabs constituted 47.7% of the study population, with the remainder being non-arabs. We analyzed the study population in terms of age group based on any indication of. The results showed that 25.7% of the study population within the age group of years displayed positive signs of. In contrast, just 22.3% of the study population exhibited signs of (Table 1). Moreover, in terms of the year of study, the findings indicated that the highest number of students with were fifth-year students (35.3% of fifth-year students). In addition, based on the course of study, the prevalence of was the highest among students from the MBBS program, with 23 of 84 MBBS students participating in the study showing signs of ; however, just 3 of 31 BBMS students displayed positive signs of. Table 1. Participants with by age group Age years years years Yes No Count age 19.6% 80.4% 100.0% Count age 25.7% 74.3% 100.0% Count age 25.0% 75.0% 100.0% age 124

3 PREVALENCE OF TEMPOROMANDIBULAR JOINT DISORDER AMONG GMU STUDENTS Of the 59 students showing positive signs of, 12 faced difficulty in opening and closing their mouth (Table 2). Moreover, 22 students with felt pain while chewing. The results also indicated that 23 students with positive signs of were accustomed to one-sided chewing (Table 3). Table 2. Participants facing difficulty in opening and closing their mouth 2 (Q2) Count Yes 100.0% 0.0% 100.0% Q2 Count No 18.6% 81.4% 100.0% Q2 Q2 Table 3. Participants accustomed to one-sided chewing 12 (Q12) Count Yes 47.9% 52.1% 100.0% Q12 Count No 16.6% 83.4% 100.0% Q12 Q12 Table 4 shows the prevalence of among males and females. Of the 59 students showing signs of, just 20 were male students, whereas 39 were female students. Table 4. Participants with by gender Count Female 20.4% 79.6% 100.0% gender Gender Count Male 27.0% 73.0% 100.0% gender gender Table 5 displays the prevalence of according to ethnic group. The findings indicate that despite non-arabs accounting for a large share in the overall sample size, the Arab population had higher number of students with. Table 5. Participants with by ethnic group (Arab and non-arab) Ethnic group Arab Non- Arab Count % 74.6% 100.0% group Count % 80.4% 100.0% group Count group Table 6 shows that 39 of the 59 students with heard a sound around their ears during chewing or opening/closing their mouth. Table 6. Participants who heard a sound while opening/closing their mouth 9 (Q9) Count Yes 100.0% 0.0% 100.0% Q9 Count No 8.8% 91.2% 100.0% Q9 Q9 As shown in Table 7, of the 59 students with, 14 recognized that the way they open and close their mouth to be abnormal. Table 8 shows that of the 59 students with, 23 suffered from morning pain in the head and neck region. As observed in Table 9, 25 of the 59 students with were aware of a clenching habit. 125

4 MOHAMMED ELYASI, ET AL Table 7. Participants who considered the way they open and close their mouth to be abnormal 10 (Q10) Count Yes 100.0% 0.0% 100.0% Q10 Count No 17.9% 82.1% 100.0% Q10 Q10 Table 8. Participants who experienced morning pain in the head and neck region 13 (Q13) Count Yes 52.3% 47.7% 100.0% Q13 Count No 16.3% 83.7% 100.0% Q13 Q13 Table 9. Participants having with clenching habit 14 (Q14) Count Yes 40.3% 59.7% 100.0% Q14 Count No 16.7% 83.3% 100.0% Q14 Q14 Table 10 shows that 26 of the 59 students with described themselves as nervous individuals. Moreover, just 3 students with had a history of facial trauma. Table 10. Etiology of among participants 15 (Q15) DISCUSSION Count Yes 35.6% 64.4% 100.0% Q15 Count No 17.2% 82.8% 100.0% Q15 Q15 The findings of our research indicate that is a significant correlation between the stress levels of an individual and the risk of developing. Moreover, the results suggest genderand genetic-linked factorial processes. Furthermore, we can draw conclusions from the participants demographic characteristics, particularly the age group, as most research studies indicate that the prevalence of decreases as age increases and it is most prevalent between 20 and 40 years 4. Table 1 shows an in-depth analysis of the study population showing signs of in terms to their age group. Nearly 25.7% of the study population within the age group of years displayed positive signs of. In contrast, just 22.3% showed indicative signs of. The mode and mean of the study population by age group are significant as other studies conclude that rarely affects children and is most prevalent during the late teens and between 20 and 40 years 4. The results of several studies showed that the signs and symptoms of continually decrease as age increases. As a general consensus, the elderly population is not the main sufferer of ; just 4% of the very old population suffers severely from 3. Table 4 displays the prevalence of in the study population by gender. Of the 59 students with positive signs of, just 20 were male students, while 39 were female students. These results are similar to the findings of a recent epidemiological study 126

5 PREVALENCE OF TEMPOROMANDIBULAR JOINT DISORDER AMONG GMU STUDENTS conducted by O.A. Al-Jabrah and Y.R. Al- Shumailan, which showed a higher prevalence of signs and symptoms in females than males 3. Moreover, the results of a study carried out by M.P. Warren and J.L. Fried indicated that is times more prevalent in females than in males and 80% of those who seek treatment are females 5. Furthermore, the findings of a study conducted by E. Yasuda et al. found a correlation of gender with the risk of developing, with the prevalence of being higher in female junior high school students than their male counterparts 2. Numerous studies have reported that the side effects of masticatory framework, which results in a higher prevalence and regular occurrence of in females than males, could be caused by differences at a biological level, including hormonal and psychosocial aspects 6, 7. Moreover, M.P. Warren and J.L. Fried agree with the finding that the gender and age distribution patterns of suggest a link between the pathogenesis of the disorder and the female hormone axis 5. M. Wieckiewicz et al. reported that could potentially be caused by a higher number of progesterone and estrogen receptors located in the intra-articular cartilage of females with 8. O.A. Al-Jabrah and Y.R. Al-Shumailan, however, suggest that the findings of higher prevalence of in females is less to do with genes, biological factors, or gender, and more to do with the fact that more females seek treatment for symptoms 3. M.W. Parker indicates that the higher prevalence of in females could be due to the structural differences between males and females in terms of the components of articulation 9, 10. The results of our research, however, are contradictory to the findings of O.D. Otuyemi et al., which showed no gender predilection toward among young Nigerian adults; hence, the results had to be pooled as the number of people with significant symptoms of was negligible 11. Conversely, it has been suggested that the low prevalence of among the Nigerian population is partly due to a racial genetic factor. This statement can be supported by our findings displayed in Table 5, which shows the prevalence of based on ethnic groups. The table indicates that despite non-arabs accounting for a larger share in the overall sample size, the Arab population had higher number of students with. The overall consensus indicates that the prevalence of in females is higher than males as majority of studies conducted in the recent past observed this finding. The study carried out by O.D. Otuyemi et al. on an African population is a rare study in the field of 11 ; hence, the unorthodox findings of the study led to the reasonable theory of genetic factors influencing the prevalence of. Table 2 displays the number of the students having difficulty while opening or close their mouth. Of the 59 students with, 12 faced difficulty in opening and closing their mouth. Moreover, 22 of the 59 students with felt pain while chewing. Of the 59 students showing positive signs of in our study, 39 heard a sound around their ears during chewing or opening/closing their mouth (Table 6); this was the most common symptom experienced by those with. However, these findings contradict the results of the study carried out by O.A. Al- Jabrah and Y.R. Al-Shumailan, which showed that the most common symptom, in line with the results of other studies, was tenderness in the periauricular region 3. However, a study conducted by S. Ryalat et al. had findings similar to those of our study, with problems in the periauricular region being the most common symptom 11. The most likely explanation for pain around the ear being a common symptom is that students may confuse ear problems with symptoms of due to their proximity and lack of understanding. This theory was confirmed as 50% of the participants with stated that they were reviewed by otolaryngologists 12. In our study, 14 of the 59 students with recognized that the way they open and close their mouth to be abnormal (Table 7), 127

6 MOHAMMED ELYASI, ET AL while 23 students with were accustomed to one-sided chewing (Table 3). Moreover, of the 59 students showing positive signs of, 23 suffered from morning pain in the head and neck region. These findings are in line with the suggested signs and symptoms of described in the majority of literature. Epidemiological surveys found that 20 25% of the population had specific symptoms related to. However, just 2 7% sought treatment for their condition 3. The results of our study show that 25 of the 59 students with were aware of a clenching habit (Table 9), while 26 students with described themselves as nervous individuals (Table 10). The relatively high number of students with displaying a clenching habit and admitting to being nervous individuals suggests a link between their stress levels and the risk of developing. This link is supported by a study conducted by M. Wieckiewicz et al. In their study, the participants that admitted to having long-term emotional burdens and becoming easily excitable had higher levels of fatigue and tightness of facial musculature, increased cervical muscle pain, and frequent headaches than other participants 8. In addition, psychological factors increase the risk of developing ; for instance, a rise in psycho-emotional activity and stress can lead to and other related oral parafunctional habits, as described in several studies 8. Moreover, a study carried out by L.R. Bonjardim et al. found nervousness may be an imperative element in the impression of pain, with restless subjects giving careful consideration to pain and intensifying the apparent degree of pain 1. This has been affirmed by different studies, which demonstrate that tension is identified with enhanced pain in clinical settings 1. Furthermore, J.F. Casanova-Rosado et al. found that in terms of stress-related factors, the cases of selfreported high levels of anxiety and stress were positively associated with 9. This finding is further supported by the results of our study, which show that the prevalence of was the highest among students from the MBBS program, with 23 of 84 MBBS students participating in the study showing signs of. However, just 3 of 31 BBMS students displayed signs of. The MBBS program is a difficult and intense course. The students enrolled in this program are often under stress and nervous because of constant pressure, tough examinations, and intense course work. The BBMS program, although difficult in its own right, is significantly less intense, with students facing lower stress levels than those enrolled in the MBBS program. Furthermore, in terms of the year of study, the findings of our study indicate that the highest number of students with were fifth-year students (35.3% of fifth-year students). This result supports the link between the stress levels of an individual and the risk of developing. In addition, S. Ryalat et al. concluded that there is a high prevalence of within the student population, with stress being a key factor that causes in a higher number of health science students 12. However, additional studies are required to identify and establish risk factors that are associated and linked with for finding means to not only prevent but also treat. REFERENCES 1. Bonjardim LR, Lopes-Filho RJ, Amado G, Albuquerque RL Jr, Goncalves SR. Association between symptoms of temporomandibular disorders and gender, morphological occlusion, and psychological factors in a group of university students. Indian J Dent Res. 2009;20(2): Yasuda E, Honda K, Hasegawa Y, Matsumura E, Fujiwara M, Hasegawa M, et al. Prevalence of temporomandibular disorders among junior high school students who play wind instruments. Int J Occup Med Environ Health. 2016;29(1): Al-Jabrah OA, Al-Shumailan YR. Prevalence of temporomandibular disorder signs in patients with complete versus partial dentures. Clin Oral Investig. 2006;10(3):

7 PREVALENCE OF TEMPOROMANDIBULAR JOINT DISORDER AMONG GMU STUDENTS 4. Luther F. and occlusion part II. Damned if we don t? Functional occlusal problems: epidemiology in a wider context. Br Dent J. 2007;202(1):E3. 5. Warren MP, Fried JL. Temporomandibular disorders and hormones in women. Cells Tissues Organs. 2001;169(3): Ozdemir-Karatas M, Peker K, Balık A, Uysal O, Tuncer EB. Identifying potential predictors of pain-related disability in Turkish patients with chronic temporomandibular disorder pain. J Headache Pain. 2013;14(1): Perez CV, de Leeuw R, Okeson JP, Carlson CR, Li HF, Bush HM, et al. The incidence and prevalence of temporomandibular disorders and posterior open bite in patients receiving mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath. 2013;17(1): Wieckiewicz M, Grychowska N, Wojciechowski K, Pelc A, Augustyniak M, Sleboda A, et al. Prevalence and correlation between based on RDC/ diagnoses, oral parafunctions and psychoemotional stress in Polish university students. Biomed Res Int. 2014;2014: Casanova-Rosado JF, Medina-Solís CE, Vallejos-Sánchez AA, Casanova-Rosado AJ, Hernández-Prado B, Ávila-Burgos L. Prevalence and associated factors for temporomandibular disorders in a group of Mexican adolescents and youth adults. Clin Oral Investig. 2006;10(1): Parker MW. A dynamic model of etiology in temporomandibular disorders. J Am Dent Assoc. 1990;120(30): Otuyemi OD, Owotade FJ, Ugboko VI, Ndukwe KC, Olusile OA. Prevalence of signs and symptoms of temporomandibular disorders in young Nigerian adults. J Orthod. 2000;27(1): Ryalat S, Baqain ZH, Amin WM, Sawair F, Samara O, Badran DH. Prevalence of temporomandibular joint disorders among students of the University of Jordan. J Clin Med Res. 2009;1(3): APPENDIX naire to Check Prevalence of among Gulf Medical University Students 1. Do you have any family history of temporomandibular joint disorder? 2. Do you feel difficulty when you open/close your mouth? 3. Do you feel difficulty when you move your mandible sideways? 4. Do you feel discomfort or pain while chewing? 5. Do you feel difficulty or pain when talking or eating? 6. Do you feel headache often? 7. Do you feel neck/shoulder pain? 8. Do you feel pain in your ear or the area around it? 9. Do you hear a sound around your ears when you open or close your mouth? 10. Do you consider the way you open and close your mouth to be abnormal? 11. Have you noticed any change recently in the way you open and close your mouth? 12. Do you use only one side of your mouth to chew? 13. Do you feel pain in your face or head when you wake up in the morning? 14. Do you clench/grind your teeth? 129

8 MOHAMMED ELYASI, ET AL 15. Do you have pain or soreness in your teeth? 16. Do you consider yourself as a nervous/tense individual? C. Not Sure 17. Do you have a history of facial trauma? 18. Do you have a history of articular trauma? 19. Are you missing more than one molar (back tooth) in your mouth? 20. If your answer to the previous question is yes, please mention the reason. 21. Have you undergone/currently undergoing orthodontic treatment? 22. Do you feel any discomfort when you swallow and do all your teeth come in contact with each other? 23. If your answer to the previous question is yes, please explain briefly. 24. Do you feel any limitation on opening your mouth? 25. Does it hurt when you open your mouth widely or when you yawn? 26. Does your jaw get locked or stock at times? 27. Did you recently suffer any trauma to the head, neck, or jaw? 28. Have you received any previous treatment for unexplained facial pain or jaw joint problem? 130