Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 2  |  Page : 139-143

Prevalence of temporomandibular disorders and its association with parafunctional habits among senior-secondary school children of Lucknow, India


Department of Public Health Dentistry, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication10-Jun-2016

Correspondence Address:
Kriti Agarwal
Department of Public Health Dentistry, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Utrathia, Raebareily Road, Lucknow, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.183809

Rights and Permissions
  Abstract 


Introduction: Temporomandibular disorders (TMD) are defined as heterogeneous group of psychological disorders, commonly characterized by orofacial pain, chewing dysfunction, or both. Aim: To determine the prevalence of TMD and to describe the association between parafunctional habits and signs and symptoms of TMD among 15–17-year-old school children in Lucknow. Materials and Methods: This study followed a cross-sectional design, with a sample of 407 school children aged 15–17-year-old. A single, trained, calibrated investigator interviewed the participants according to Fonseca's Anamnestic Questionnaire-1994, which provided information on the prevalence of TMD, followed by the clinical examination of temporomandibular joint (TMJ) according to WHO (1997). Chi-square test and Univariate and Multivariate Logistic Regression analysis were used. Results: The prevalence of TMD was (22.4%). There was no statistically significant association was found between age, (P = 0.81) gender (P = 0.09) and TMD. Nail-biting (88.3%) was the most common habit, followed by clenching/grinding (68.4%) and mouth breathing (53.4%). However, habits and TMJ symptoms were found statistically significant P < 0.01 or P < 0.001 associated to TMD. Further, adjusted (age and gender) logistic regression analysis revealed that digit-sucking, mouth breathing, nail biting, and clenching has made a significant contribution to prediction (P < 0.001). Conclusion: The habits especially digit-sucking, mouth breathing, nail biting, and clenching had statistically significantly associated with TMD.

Keywords: Adolescent health, orofacial pain, parafunction


How to cite this article:
Agarwal K, Saha S, Sinha P. Prevalence of temporomandibular disorders and its association with parafunctional habits among senior-secondary school children of Lucknow, India. J Indian Assoc Public Health Dent 2016;14:139-43

How to cite this URL:
Agarwal K, Saha S, Sinha P. Prevalence of temporomandibular disorders and its association with parafunctional habits among senior-secondary school children of Lucknow, India. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Oct 21];14:139-43. Available from: http://www.jiaphd.org/text.asp?2016/14/2/139/183809




  Introduction Top


Temporomandibular disorders (TMD) are considered as the common cause of orofacial pain of nondental origin.[1] Thus, it is an enigmatic issue for dental professional all around the globe as it affects the deleterious effects on the stomatognathic system.[2] The common symptoms of TMD are muscle and/or joint pain on palpation, impaired mandibular function, and joint noises. As temporomandibular joint (TMJ) remodeling occurs in adolescence, there is a direct need for accurate assessment of dental conditions, the joint itself and the neuromuscular apparatus in this period.[3]

Adolescents need to be informed about the negative effects of parafunctional habits. The early diagnosis of signs and symptoms of TMD can help to improve the course of treatment and quality of life of adolescents. Thus, the aim of this study to assess the prevalence of TMD and to describe the association between parafunctional habits and signs and symptoms of TMD among 15–17-year-old school children in Lucknow.


  Materials and Methods Top


A descriptive cross-sectional survey was designed among 15–17-year-old school going children of Lucknow from March 2014 to August 2014. Ethical clearance was obtained from the Institutional Ethical Committee. Approval was obtained from the principals of the concerning schools. Written consent was obtained from the parents for the participation of their children during parents-teachers meeting.

A pilot study was conducted on 50 school going children. The sample size was estimated using n Master software (version 2, CMC, Vellore, Tamil Nadu, India). Anticipating a 15% prevalence of TMD was obtained during the pilot study in the study population, an absolute precision of 5% and a 95% confidence interval, a sample size of 205 is found to be sufficient. As the study population was selected using multi-stage cluster sampling technique; hence, this sample size was multiplied by 2 (i.e., design effect). Thus, the minimum sample size required was 205 which was rounded off to 410.

The estimated sample was selected by multistage cluster random sampling technique. In the first stage, Lucknow city was divided geographically into five areas, that is, East, West, North, South, and Central. List of all the wards from the five geographic areas was obtained from census enumeration areas data. A list of schools located within the Lucknow municipality was obtained from District School Officer. Approximately, 22 wards came under each of these geographic areas. In the second stage, one ward was randomly selected from each of these geographic areas. In the third stage, two schools from each of the 5 wards were randomly selected. This was followed by a school survey in which all the students aged 15–17 years meeting the following inclusion and exclusion criteria.

Inclusion criteria

  • School children who were present on the day of examination
  • Parents of children who gave consent.


Exclusion criteria

  • Children with special health care needs like physically handicapped children
  • Students undergoing orthodontic treatment
  • Students with a history of trauma or dental pain.


Three students were absent on the day of the examination, hence final sample size was attained 407.

Method of data collection

The single investigator was trained and calibrated in the department before the commencement of the survey, and the kappa coefficient was estimated to be 0.86. The study proforma had two parts: The first part consisted of the demographic characteristics of subjects included the name, age, gender, address, and name of the school. The second part consisted of The Fonseca Anamnestic Questionnaire (FAQ) (1994)[4] to assess the severity of the TMD symptoms and clinical examination of TMJ as per WHO 1997.[5] FAQ (1994) consists of 10 questions, whose answer options are no, sometimes, and yes. The questionnaire included questions on the presence of TMJ pain, head and neck pain, pain while chewing, questions on parafunctional habits, limitation of joint movement, the perception of malocclusion, and emotional stress. Each answer has a value; answer “NO” = 0, “SOMETIMES” = 5, and “YES” = 10. The sum of the values obtained provides an index that classifies individuals in the absence of TMD (0–15), mild TMD (20–45), moderate TMD (50–65), and severe TMD (70–100). Participants' history and clinical examination was used to determine parafunctional habits like attrition on mandibular incisors, etc., Each parafunction was reported as either present or absent.

The children were interviewed and examined by single, trained calibrated examiner as per American Dental Association Type III criteria [6] using mouth mirrors while seated on chair under natural light.

Statistical analysis

Data were entered into Microsoft Excel and analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0 (SPSS, Inc., Chicago, IL, USA). Results were subjected to statistical analysis using descriptive statistics, were made to all variables in the study. Chi-square Test was applied to evaluate the association between the occurrence of TMD and gender, age group, and parafunctional habits. The influence of the variables use in this study with the presence of TMD was assessed using Univariate and Multivariate-Logistic regression analysis. For all the tests, the level of significance was set up at P < 0.05.


  Results Top


Out of 407 students, who were interviewed and examined, 158 were 15-year-old (38.8%), 173 were 16-year-old (42.5%) and 76 were 17-year-old (18.7%). Among children further, 190 were female children (46.7%) and 217 were male children (53.3%) [Table 1]. The overall prevalence of TMD (mild and moderate) was found to be 21.4%. A total of 19.2% had mild TMD and 2.2% had moderate TMD, none of the children had severe TMD and majority of school children (78.6%) did not have TMD [Table 2].
Table 1: Distribution of participants by age groups and gender

Click here to view
Table 2: Distribution of children according to different grades of temporomandibular disorders according to the Fonseca's Anamnestic Questionnaire

Click here to view


There was statistically significant association was found between sign and symptoms of TMD (P< 0.001). The most common symptom was frequent headache which was most prevalent in both with TMD (86.2%) and without TMD (12.2%), morning facial pain was common in cases of TMD (86.2%) but was less common in cases not having TMD (3.4%), among cases of TMD pain in ear or about the ear was the most common item (89.7%) [Table 3]. The most common habit was nail biting (88.3%), clenching (68.4%), mouth breathing (53.4%), thumb/digit sucking (21.4%), lip biting (19.4%), and tongue thrusting (1.3%), respectively [Table 4]. In the present study, we used a clinical examination of TMJ as per WHO (1997). [Table 5] depicts TMJ examination as per the WHO (1997) evaluation. Among all participants, majority of children did not have any sign or symptoms. There were 22.6% symptomatic children. The most common sign was clicking 22.4%, followed by tenderness 2.5% and reduced jaw mobility 2.2%, respectively.
Table 3: Association between Fonseca Anamnestic Questionnaire and temporomandibular disorders according to Fonseca criteria

Click here to view
Table 4: Association between parafunctional habits and temporomandibular disorders among children

Click here to view
Table 5: Temporomandibular joint examination as per World Health Organization (1997) evaluation

Click here to view


A univariate and multivariate logistic regression analysis was depicted in [Table 6] for the presence of TMD by different variables conducted to predict the occurrence of TMD among adolescents using age, gender, thumb/digit sucking, mouth breathing, nail biting, lip biting, and clenching as predictors. Tongue thrusting was not included in the model as there was only one case found among the study population. The Wald criterion demonstrated that thumb sucking, mouth breathing, nail biting, and clenching has made a significant contribution to prediction (P< 0.001). Age, gender, and lip-biting were not appeared as significant predictors.
Table 6: Logistic regression analysis for presence of temporomandibular disorders with different variables

Click here to view



  Discussion Top


This survey identified the prevalence of TMD was 22.4% among 15–17-year-old school children of Lucknow. A similar observation was reported by Feteih [7] also revealed TMD prevalence of 21.3% in 385 adolescents aged between 12 and 16 years. Some studies [8],[9] have shown a higher prevalence than in the present study, such as Gazit et al.[10] which evaluated 369 Israeli students in the age group of 10–18 years (56.4%).

Study done by Motta et al.,[1] and Thilander et al.,[11] showed the prevalence was 20% and 25% among adolescents, Morinushi et al.,[12] showed the prevalence was 31% among aged between 12 and 14 years and 39.6% among 15–17 years and Magnusson et al.,[13] assessed through Helmiko index concluded that 34% adolescents showed mild symptoms of TMD.[1],[11],[12],[13] The diversity of TMD prevalence among different studies have been attributed to the differences in the age group studied, the sample size and its composition, the numbers of examiners as well as diagnostic criteria used between different studies.

In the present study regarding severity, most students exhibited mild TMD (19.2%) as there is repitition, (2.2%) had moderate TMD and (0%) had severe TMD. Almost similar findings were also reported in a longitudinal study done by Magnusson et al.,[13] which evaluated 119 children at intervals of 4 years and found that in most cases, the signs were mild; however, moderate TMD was noted in 11% of the 11-year-old children and 17% of the 15-year-old children.

For all the items of FAQ, the most common symptom observed was frequent headaches (28%), followed by morning facial pain (21.1%), pain in ear or about the ear (20.4%), respectively. Clenching or grinding teeth (15.7%) and using only one side of mouth while chewing (11.5%) were the other less commonly reported symptoms.

In the present study, we used a clinical examination of TMJ as per WHO (1997). Among all participants majority of children did not have any sign or symptoms. There were 22.6% symptomatic children. The most common sign was clicking 22.4%, followed by tenderness 2.5% and reduced jaw mobility 2.2%, respectively.

The most common parafunction reported was nail biting (23.3%), clenching/grinding (15.0%), mouth breathing (14.5%), thumb/digit sucking (5.7%), lip biting (4.7%), and tongue thrusting (1.3%). These data are similar to the study done by Motta et al.[1] in 244 adolescents in the age group of 10–20 years from the city of Sao Roque, Brazil.

This survey highlighted no statistically significant association was found between age (P = 0.81), gender (P = 0.09) and signs and symptoms of TMD. which was in accordance with the study done by Motta et al.[1] they also found that signs and symptoms of TMD were not associated with age and gender.

A statistically significant association was found between parafunctional habits and TMD. The results were in accordance to study done by Winocur et al.,[14] Troeltzsch et al.[15] and Motghare et al.[16] These parafunctional habits should be considered as risk factor for TMD as they act as triggering point for the appearance of TMD due to its effect on the stomatognathic system.

The present study was a cross-sectional survey. Since TMD is a fluctuating disorder, hence further longitudinal study relating stress and occlusal interferences are needed for better associations. The questionnaire employed here can be useful to determining the complex diagnosis of TMD to send affected adolescents for further clinical diagnosis and preventive treatment.


  Conclusion Top


The results of this study revealed that there was an association between signs and symptoms of TMD and parafunction habits. These data highlighted the need to carry out screening to send affected adolescents for further treatment. This can help to prevent problems that predispose individuals to TMJ pain as this could manage orofacial pain in a large contingent of people.

Acknowledgment

All the participants' and their parents' and school authorities and faculty mem'bers of our department.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Motta LJ, Guedes CC, De Santis TO, Fernandes KP, Mesquita-Ferrari RA, Bussadori SK. Association between parafunctional habits and signs and symptoms of temporomandibular dysfunction among adolescents. Oral Health Prev Dent 2013;11:3-7.  Back to cited text no. 1
    
2.
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;20:190-4.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Pereira LJ, Pereira-Cenci T, Del Bel Cury AA, Pereira SM, Pereira AC, Ambosano GM, et al. Risk indicators of temporomandibular disorder incidences in early adolescence. Pediatr Dent 2010;32:324-8.  Back to cited text no. 3
    
4.
Nomura K, Vitti M, Oliveira AS, Chaves TC, Semprini M, Siéssere S, et al. Use of the Fonseca's questionnaire to assess the prevalence and severity of temporomandibular disorders in Brazilian dental undergraduates. Braz Dent J 2007;18:163-7.  Back to cited text no. 4
    
5.
World Health Organization. Oral Health Surveys – Basic Methods. 4th ed. Geneva: World Health Organization; 1999.  Back to cited text no. 5
    
6.
American Dental Association. Official Policies of the American Dental Association on Dental Health Programmes. Chicago: American Dental Association; 1957.  Back to cited text no. 6
    
7.
Feteih RM. Signs and symptoms of temporomandibular disorders and oral parafunctions in urban Saudi Arabian adolescents: A research report. Head Face Med 2006;2:25.  Back to cited text no. 7
    
8.
Minghelli B, Cardoso I, Porfírio M, Gonçalves R, Cascalheiro S, Barreto V, et al. Prevalence of temporomandibular disorder in children and adolescents from public schools in southern portugal. N Am J Med Sci 2014;6:126-32.  Back to cited text no. 8
    
9.
Nilner M. Functional disturbances and diseases of the stomatognathic system. A cross-sectional study. J Pedod 1986;10:211-38.  Back to cited text no. 9
[PUBMED]    
10.
Gazit E, Lieberman M, Eini R, Hirsch N, Serfaty V, Fuchs C, et al. Prevalence of mandibular dysfunction in 10-18 year old Israeli schoolchildren. J Oral Rehabil 1984;11:307-17.  Back to cited text no. 10
[PUBMED]    
11.
Thilander B, Rubio G, Pena L, de Mayorga C. Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: An epidemiologic study related to specified stages of dental development. Angle Orthod 2002;72:146-54.  Back to cited text no. 11
    
12.
Morinushi T, Ohno H, Ohno K, Oku T, Ogura T. Two year longitudinal study of the fluctuation of clinical signs of TMJ dysfunction in Japanese adolescents. J Clin Pediatr Dent 1991;15:232-40.  Back to cited text no. 12
    
13.
Magnusson T, Egermark I, Carlsson GE. A longitudinal epidemiologic study of signs and symptoms of temporomandibular disorders from 15 to 35 years of age. J Orofac Pain 2000;14:310-9.  Back to cited text no. 13
    
14.
Winocur E, Gavish A, Finkelshtein T, Halachmi M, Gazit E. Oral habits among adolescent girls and their association with symptoms of temporomandibular disorders. J Oral Rehabil 2001;28:624-9.  Back to cited text no. 14
    
15.
Troeltzsch M, Troeltzsch M, Cronin RJ, Brodine AH, Frankenberger R, Messlinger K. Prevalence and association of headaches, temporomandibular joint disorders, and occlusal interferences. J Prosthet Dent 2011;105:410-7.  Back to cited text no. 15
[PUBMED]    
16.
Motghare V, Kumar J, Kamate S, Kushwaha S, Anand R, Gupta N, et al. Association between harmful oral habits and sign and symptoms of temporomandibular joint disorders among adolescents. J Clin Diagn Res 2015;9:ZC45-8.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


This article has been cited by
1 Prevalence of otological symptoms and parafunctional habits in patients with temporomandibular dysfunction
Bianca Lopes Cavalcante de Le„o,Flavia Carolina Trentini Gabriel,Kaliane Rodrigues da Cruz,Amanda Luquesi Kagawa,Bianca Simone Zeigelboim,Josť Stechman-Neto
Revista CEFAC. 2019; 21(1)
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed1583    
    Printed13    
    Emailed0    
    PDF Downloaded325    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]