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University of Jordan, particularly among students of health and sci- ence studies, which signify the role of stress in the development and/or progression of TMD.
Elmer Press

Original Article

J Clin Med Res • 2009;1(3):158-164

Prevalence of Temporomandibular Joint Disorders among Students of the University of Jordan Soukaina Ryalata, Zaid H Baqaina, Wala M. Amina, c, Faleh Sawaira, Osama Samarab, Darwish H. Badranb

Abstract

Introduction

Background: This study aimed to investigate the prevalence of temporomandibular disorder (TMD) among students of the University of Jordan.

Keywords: TMD; Clicking; Health sciences; Humanitarian studies

Temporomandibular joint disorder (TMD) represents a common health problem [1]. It is an umbrella term embracing a number of clinical manifestations that involve the temporomandibular joint (TMJ), the masticatory muscles and the teeth. Patients with TMD usually suffer from muscle and/or joint pain on palpation and on mandibular movements, joint sounds and the mandibular range of motion may be limited [2]. TMD can affect any patients regardless of age including children [3] or gender with varying signs and symptoms [4]. However, due to the variation in symptoms among different patients and in the same patient at different times, the diagnosis of this clinical entity may be difficult [5].   The prevalence of TMD in the general population is high [6], between 40% to 60% [7]. One study reported that 87% of a sample of 1040 subjects had one or more positive symptoms or clinical signs of TMD [4]. Individuals with low self esteem are more likely to suffer from TMD [8], psychological and emotional factors are clearly involved in the development of the disorder [9, 10]. Questionnaires are usually used to gather information about the prevalence of TMD in the population. The objectives of the present investigation were: to study the prevalence of TMD among students at the University of Jordan, using the guidelines recommended by the American Dental Association in 1982 [4], and secondly, to compare the prevalence of TMD among students of different faculties in an attempt to recognize the risk factors for TMD development. It is hoped that the findings of the present study would serve as baseline data for future investigations in this field.

Manuscript accepted for publication May 26, 2009

Subjects and Methods

Methods: Information about the symptoms of TMD and the possible risk factors were collected using specifically designed questionnaires. The collected data sets were treated statistically using the SPSS release 14 package. Results: The results of the present investigation showed that pain in or about the ears or cheeks was the most prevalent symptom whereas locking of the temporomandibular joint (TMJ) was the least prevalent. Nearly one-third of the investigated sample (31.4%, 346/1103) had no symptoms of TMD whereas 68.6% (757/1103) had at least one symptom. Students of health science studies had significantly the highest risk in developing TMJ clicking compared to students studying pure science or humanitarian studies. Conclusions: TMD is of a high prevalence among students of the University of Jordan, particularly among students of health and science studies, which signify the role of stress in the development and/or progression of TMD. The findings of this study are alarming and entailing further investigations to identify risk factors associated with TMD in order to establish measures for prevention and treatment.

Faculty of Dentistry, University of Jordan Faculty of Medicine, University of Jordan c Corresponding author: [email protected]; [email protected] P. O. Box 13455, Amman 11942, Jordan a

b

doi:10.4021/jocmr2009.06.1245

158

The study sample consisted of 1103 students studying at the University of Jordan. There were 276 males and 827 females and their age range was between 18 and 25 years old. The sample comprised 353 (32.0%) first year students; 548 (49.7%) second year students; 168 (15.2%) third year students; and 34 (3.1%) fourth year students. Of the 1103

Articles © The authors, Journal compilation © J Clin Med Res and Elmer Press™, www.jocmr.org

J Clin Med Res • 2009;1(3):158-164

Ryalat et al

Figure 1. A histogram showing the prevalence of TMD symptoms in the investigated sample.

students, 482 (43.7%) were studying in humanitarian colleges; 163 (14.8%) were studying in science colleges; and 458 (41.5%) were studying in health colleges. A questionnaire was composed and distributed randomly to students belonging to faculties of health, science and humanitarian studies. The completed questionnaire contained the following items regarding the different symptoms of TMD, and the possible risk factors: Do you hear joint sounds? Do you have limitation in mouth opening? Do you have pain in or about the ears? Have you ever had joint locking? If yes, how many times? Do you have pain on chewing? Have you ever had trauma to head and neck area? If yes, how many times? Do you have stress, or under stressful conditions? Do you have arthralgia in other joints in your body? Do you live with your family? Students were asked to check items that were most relevant to their conditions. Statistical analysis was performed using SPSS for Windows release 14.0 (SPSS Inc., Chicago, IL, USA). Chisquare tests were used to determine the associations between the TMD symptoms (clicking, trismus, pain in or about the ears, TMJ locking and pain on chewing or yawing) and independent factors. Stepwise multivariate logistic regression was then used to control for potential confounding variables and to calculate the odd ratios (ORs) for potential independent variables for the TMD symptoms. Differences at the 5%

level were accepted as significant.

Results The prevalence of various symptoms of TMD in the study population is shown in figure 1. The most frequently reported TMD symptom in this study was pain in or about the ears or cheeks followed by clicking, and the least common was TMJ locking (Table 1). Nearly one-third of the students (31.4%, 346/1103) had no symptoms of TMD and 68.6% (757/1103) had at least one symptom. Of the 757 students who had TMD symptoms, the prevalence ranged from 35.4% (268 students) who had only one symptom to 8.9% (67 students) who had five concurrent TMD symptoms (Fig. 2). Significant associations were found between the five symptoms of TMD. Factors associated with TMD symptoms in the study sample are shown in table 1. The prevalence of TMD symptoms in the study population was not affected by age. Significantly more females than males had pain in or about the ears. Clicking was significantly highest in students of health colleges while trismus, pain in or about the ears, TMJ locking and pain on chewing were significantly highest in students of the science colleges. Stress was more common among students of health colleges (56.8%) than humanitarian colleges (44.8%) (P = 0.001) but comparable to those in the science colleges (55.2%). All the TMD symptoms were significantly more prevalent in students who had stress, positive history of trauma to the jaw, head, or neck, or positive history of

Articles © The authors, Journal compilation © J Clin Med Res and Elmer Press™, www.jocmr.org

159

160

70

399

Yes

291

Yes

No

178

155

Yes

No

314

No

57

Yes

Health

412

73

227

Science

No

169

Humanity

347

12

24-25

Female

83

22-23

122

235

20-21

Male

139

18-19

No.

42.0

42.5

51.4

33.1

53.1

38.7

54.3

41.3

49.6

44.8

35.1

42.0

44.2

35.3

49.4

42.9

39.4

%

Clicking

* P value of Chi square, ** Living with family

Family**

Stress

Arthralgia

Trauma

College

Gender

Age/years

Factor

0.51

0.47

0.47