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Prevalence of temporomandibular joint disorders in patients: An institutional-

based study

Article in SRM Journal of Research in Dental Sciences · October 2020

DOI: 10.4103/srmjrds.srmjrds_28_20

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Original Article

Prevalence of temporomandibular joint disorders in

patients: An institutional‑based study

Akshat Sachdeva, Sumit Bhateja, Geetika Arora1, Brinda Khanna, Archika Singh
Department of Oral Medicine and Radiology, Manav Rachna Dental College, Faridabad Haryana, 1Department of Public Health Dentistry,
Inderprastha Dental College and Hospital, Sahibabad, Ghaziabad, Uttar Pradesh, India

ABSTRACT
Background: Temporomandibular joint (TMJ) disorders symbolize a multifactorial malady
which manifests as a painful condition in the orofacial region and have a high prevalence
rate among different populations. Aim: The aim of the study was to assess the prevalence
of TMJ disorders among patient visiting the outpatient department (OPD) of a private dental
college situated in Haryana. Materials and Methods: A total of 30,000 people visiting the
OPD of Manav Rachna Dental College were screened for a period of 6 months, and out
of them, 130 patients were having temporomandibular disorders (TMDs). Five parameters
were assessed, and positive as well as negative findings were recorded. The collected
data were subjected to statistical analysis, and P = 0.05 was considered a set point.
Results: Females were found to be more affected with TMDs than males in the age group
ranging from 37 to 46 years. Joint tenderness was the most common symptom among
the parameters that were analyzed. Conclusion: Dental professionals ought to teach and
persuade the patients to take up preventive measures and early treatment to maintain a
strategic distance from further manifestations that fill in as forerunners to TMJ disorders.

Key words: Disorders, joint tenderness, prevalence, temporomandibular, temporoman‑

dibular joint

INTRODUCTION mandible to the temporal bone. TMDs is an aggregate term

that depicts a subgathering of painful orofacial disorders,
Temporomandibular disorders (TMDs) represent a class of including grievances of agony on the TMJ region and
conditions influencing the temporomandibular joint (TMJ), exhaustion of the cranio‑cervico‑facial muscles, especially of
the muscles of mastication, and/or related structures. masticatory muscles, impediment of mandibular movement,
Muscles associated with and incorporating the jaw joint and the presence of articular clicking.
control its position and movement. The TMJ associates the
TMJ dysfunction is a cryptic issue even today because of
Address for correspondence: its multifactorial etiology. However, it is generally assumed
Dr. Sumit Bhateja, that TMDs would mainly affect adult patients; nevertheless,
Department of Oral Medicine and Radiology, Manav Rachna Dental children have also shown a similar incidence of signs and
College, Faridabad, Haryana, India.
E‑mail: bhateja.sumit@gmail.com
This is an open access journal, and articles are distributed under the
Received: 16‑04‑2020, Accepted: 20‑08‑2020, Published: 15-10-2020 terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike
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For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

DOI: How to cite this article: Sachdeva A, Bhateja S, Arora G, Khanna B,

10.4103/srmjrds.srmjrds_28_20 Singh A. Prevalence of temporomandibular joint disorders in patients:
An institutional-based study. SRM J Res Dent Sci 2020;11:123-7.

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Sachdeva, et al.: Prevalence of temporomandibular joint disorders
symptoms in some studies. Maladies of the TMJ and chewing
might be a functional pain portrayed by distress or torment
in the muscles that control jaw developments.
TMDs are a multifactorial disorder, commonly connected
with flawed body posture, parafunctional habits, dental
restorations, orthodontic treatment, emotional stress, injury,
anatomy of the disc, and pathophysiology of the muscles.
It is not evident whether these components are considered
inclining or simply simultaneous elements.
The etiology of TMDs is multifactorial. The variables extend
from biomechanical, neuromuscular, biopsychosocial,
and biological components. Biomechanical factors
including occlusal overburdening and parafunctional
propensities (like bruxism) are oftentimes associated with
causation of TMDs; inflated degrees of estrogen hormones
are considered biological components influencing the
TMJ. Among biopsychosocial factors, stress, tension, or
depression is common that can incline and lead to TMJ
disorders.
TMJ disorders affect up to 15% of adults, and the pinnacle
age ranges from 20 to 40 years– old; these disarranges are
twice as common in females as compared to their male
counterparts.[1]
Till date, there is not much literature available on the
prevalence of TMDs in the population of Faridabad,
Haryana. Hence, the purpose of this study was to determine
the ubiquitousness of TMJ disorders in the patients visiting
the outpatient department (OPD) of Manav Rachna Dental
College, Faridabad.
MATERIALS AND METHODS
A total of 30,000 adults were screened with age ranging from
17 to 70 years. Out of these 30,000 patients, 130 patients
were showing the presence of various symptoms of TMDs
determined based on the inclusion and exclusion criteria and
assessed on the basis of five parameters by the authors on
observation of patients at the Department of Oral Medicine
and Radiology, Manav Rachna Dental College, Faridabad,
Haryana. The study was conducted over a period of 6 months,
i.e., from January 2019 to June 2019, and the findings were
recorded on a pro forma. Informed consent was obtained
from each of the participants. The study was approved by
the institutional ethical committee.
All patients were asked for a history of parafunctional
habits (if any). Any relevant medical history revealed by
patients during routine case history taking was also recorded.
anamnesis history (if any) was also recorded for all patients,
but the data were not applied to statistical analysis. All
patients were asked for a history of tobacco usage habits (if
any), which was recorded.
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Inclusion criteria: Male and female having mixed or
permanent dentition, no previous history of orthodontic
treatment, and no craniofacial anomalies were included in
the study.
Exclusion criteria: Children in the stage of primary dentition,
patients with any musculoskeletal or neurological disorders,
ear pathologies, any other related systemic conditions,
patients with parafunctional habits, patients with a history
of previous TMJ surgeries or fracture, and noncooperative
patients were excluded from the study.
All patients visiting the department who fulfilled the
inclusion criteria were screened for TMD signs and
symptoms. The demographic data and the signs and
symptoms of TMDs were recorded, and P values were drawn
to check for their significance.
Statistical analysis
The collected data were subjected to suitable statistical
analysis using Statistical Package for Social Sciences
(SPSS) software version 20, IBM Corporation, SPSS Inc.,
Chicago, IL, USA. Mean, standard deviation, and the
proportions (percentage of patients affected) were calculated
for each clinical parameter, and the statistical test of
significance Chi‑square was used.
Significance for all statistical tests was predetermined at a
P < 0.05.
RESULTS
The mean age of the patients was 36.05 ± 12.590 years.
Table 1 shows the age‑wise distribution of TMJ disorders.
Out of 130 patients, 39 (30.7%) patients were 17–26 years
old, 29 (22.8%) patients were aged 27–36 years, 30 (23.6%)
patients were aged 37–46 years, 21 (16.5%) patients were aged
47–56 years, and 8 (6.3%) patients were aged 57–70 years.
It also showed the gender‑wise distribution of TMJ disorders.
Out of 127 patients, 63 (49.6%) patients were males and
64 (50.4%) patients were female patients. And also, most of
Table 1: Descriptive data regarding temporomandibular
Joint disorder
Number of patients (%)
Age group (years)
17-26 39 (30.7)
27-36 29 (22.8)
37-46 30 (23.6)
47-56 21 (16.5)
57-70 8 (6.3)
Gender
Male 63 (49.6)
Female 64 (50.4)
Tobacco habit
Absent 56 (43.1)
Present 74 (56.9)
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Sachdeva, et al.: Prevalence of temporomandibular joint disorders

the patients were having tobacco usage history, that is, out of is more common in females as compared to males, which
130 patients, 74 (56.9%) patients were having a habit of tobacco. is in accordance with the results obtained from our study.
This indicates a greater need for treatment in females than
Table 2 shows that symptoms were compared with age males. The observed contrast between genders was credited
groups. A significant association was found between joint to the fact that girls are more anxiety prone and increasingly
tenderness and 37–46 years of age group (P = −0.052, S), sensitive to tenderness and agony on palpation of the
then 17–26 years of age and 47–56 years of age and more TMJ and adjoining muscles mainly in older age because
symptoms as compared to other age groups. of hormonal changes.[7] The present study also shows that
symptoms were observed more frequently in females when
Table 3 shows that symptoms were compared with gender. compared to males.
A significant association was found between joint tenderness,
crepitus, and deviation of the mandible on mouth opening It can be inferred from the data that TMDs in the Haryana
as compared to males (P = 0.009, S; P = 0.030, S; and NCR population are more prevalent among females,
P = 0.044, S, respectively). especially those under 30 years of age. The most significant
symptoms include joint tenderness, crepitus, and deviation
DISCUSSION of the mandible on mouth opening. This is in contrast to
the results of a study conducted by Bagis et al. in Turkey,[8]
The TMJ is a compound articulation shaped from the where clicking sound had a statistically significant difference
articular surfaces of the temporal bone and the mandibular between both the genders. A comparative study conducted
condyle. In light of the condyle’s capacity to translate, the in Israel[9] reported that joint sensitivity was more prevalent
mandible can have a lot higher maximal incisal opening than in females as compared to their counterparts, and this
would be conceivable with rotation alone. The joint is thus
difference was statistically significant. This is analogous to
named as “ginglymoarthrodial:” an amalgamation of the
the results of our study, where joint tenderness had increased
terms ginglymoid (rotation) and arthroidial (translation).[2]
prevalence in females than males.
Our research was focused to find the prevalence of signs
and symptoms of TMDs in patients visiting the OPD of a The present study showed that joint tenderness was most
private dental college, which was accomplished with the help
commonly seen in patients of 37–46‑year age group,
of examination of patients coming for a routine checkup in
followed by 17–26 years’ age group and 47–56 years’ age
the Department of Oral Medicine and Radiology at Manav
group [Table 2]. An epidemiological study carried out in
Rachna Dental College located in Faridabad, Haryana.
The patients were observed for signs and symptoms,
which included clicking sound, crepitus, joint tenderness,
deviation of the mandible on mouth opening, and pain on
mouth opening. For this study, a total of 30,000 patients
were observed and screened for a period of 6 months. In
the Haryana population belt, it was observed that TMDs
were seen most frequently in people of the age group of
17–26 years, and it can be implied from the results that their
incidence decreases as the age of an individual advances.
This is derived from Chart 1, which has provided the
age‑wise distribution of patients. TMDs are generally seen
more commonly in females as compared to males, and this
was corroborated in our study as well since the prevalence
was higher for females as shown in Chart 2. A similar
study conducted by Nair et al. in 2018.[3] concluded that
TMDs were more commonly seen in females. Many more Chart 1: Diagrammatic representation of age-wise distribution
studies[4‑6] have also concluded that the prevalence of TMDs of temporomandibular disorders (%)

Table 2: Age‑wise distribution of temporomandibular joint disorders symptoms

Age 17-26 years 27-36 years 37-46 years 47-56 years 57-66 years P S/NS
Clicking sound 6 (4.7) 4 (3.1) 7 (5.5) 5 (3.9) 4 (3.1) 0.200 NS
Crepitus 1 (0.8) 2 (1.6) 2 (1.6) 1 (0.8) 2 (1.6) 0.217 NS
Joint tenderness 6 (4.7) 2 (1.6) 7 (5.5) 6 (4.7) 4 (3.1) 0.052 S
Deviation of mandible on mouth opening 0 (0) 0 (0) 1 (0.8) 2 (1.6) 1 (0.8) 0.121 NS
Pain on mouth opening 4 (3.1) 5 (3.9) 8 (6.3) 2 (1.6) 2 (1.6) 0.340 NS
P≤0.05 – Significant, CI=95%. CI: Confidence interval, NS: Not significant, S: Significant

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Sachdeva, et al.: Prevalence of temporomandibular joint disorders
Chart 2: Diagrammatic representation of gender-wise
distribution of temporomandibular disorders
Table 3: Gender‑wise distribution of temporomandibular
joint disorders symptoms
Gender Male (%) Female (%)
Clicking sound 11 (8.7) 15 (11.8)
Crepitus 1 (0.8) 7 (5.5)
Joint tenderness 2 (3.2) 11 (17.2)
Deviation of mandible on 0 (0) 4 (3.1)
mouth opening
Pain on mouth opening 11 (8.7) 10 (7.9)
P≤0.05 – Significant, CI=95%. CI: Confidence interval, NS: Not significant, S:
Significant
Chennai[10] to determine the prevalence of TMDs revealed
that deviation of mandible on mouth opening was the most
common parameter. This could be due to the fact that
patients have reported at advanced stage when they became
symptomatic, and TMJ dysfunction interfered with their
quality of life. This possibly is due to the ignorant population
of this region attributed to a low literacy rate compared with
Chennai population.
Another significant factor reported during the course of
our study was that there was an increased incidence of
TMDs in people consuming tobacco (in any form). Out
of 127 patients having symptoms of TMDs, 74 had a
positive history of tobacco consumption, which is a large
fraction. This was more prevalent in the younger age group.
A possible explanation recommended is that smoking may
have an impact on pain either through hypersensitive or
inflammatory pathways or both.[11] It is commonly accepted
that nicotine is the essential substance that alters pain
perception. Chronic presentation to tobacco smoke prompts
changes in torment discernment with the end goal that
smokers deprived of nicotine demonstrate more prominent
sensitivity to pain‑evoking stimuli.[12] One study conducted
in the year 2010 revealed that smokers with TMD reported
higher pain intensity and life interference from pain than
nonsmokers (NS) with TMD.[13] Another study held in the
year 2013 has concluded that smokers with TMD not only
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SRM Journal of Research in Dental Sciences | Volume 11 | Issue 3 | July-September 2020
reported higher pain severity than NS with TMD but also
were at higher risk for factors that may adversely affect
treatment outcomes.[14]
The limitations of the present study were that the
study sample size with respect to the population of the
representative region was less. Furthermore, fewer variables
were included in the study. We recommend that future
studies should incorporate larger sample size with the
inclusion of more variables.
CONCLUSION
The purpose of the current study was to determine the
prevalence of TMDs in the patients visiting the OPD of a
private dental college. It can be thus concluded that, similar
to the prevalence of TMDs in other regions, they are more
frequent in females. The intensity of TMDs that women
suffer from is yet to be studied along with the impact of
various factors such as hormones, stress levels, and genetic
P S/NS proclivity, all of which require further intensive research.
0.404 NS
0.030 S
The dentist thus plays a pivotal role in identifying a TMD,
0.009 S once they encounter a patient. They should be aware of
0.044 S the presenting symptoms and devise a treatment plan for
such patients. Once the diagnosis is established, they can
0.781 NS
be put on appropriate therapeutic modalities, counseling,
and/or medications as per the need. They should also
keep a long‑term follow‑up with such patients so that the
chances of recurrences are minimized, and a healthy life is
what lies ahead. Hence, through the medium of the current
study, we sincerely appeal to the Dental Council of India
to expand subjects such as “TMDs” in the curriculum for
BDS students.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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