Frequency of Temporomandibular Disorders in Dental Students

Frequency of Temporomandibular Disorders in Dental Students
Abdul Qadir Baloch*, Nazia Yazdanie, Aqeel Shaikh**, Farhat Jafri***, Shahan Waheed****

  • FCPS Trainee, Department of Prosthodontics, de, Montmorency College of Dentistry.
  • Professor & Head Dept of Prothodontics, de, Montmorency College of Dentistry..
  • Associate Professor, Dept of Dentistry, Karachi Medical & Dental College, Karachi
  • Associate Professor, Dept of Community Medicine, Karachi Medical & Dental College Karachi
  • Research Associate, The Aga Khan University Hospital

Correspondence:“Dr. Nadia Yazdanie

How to CITE:

J Pak Dent Assoc.2010; 19(4): 208-210


The purpose of this study is to determine present frequency of temporomandibular disorders among dental students of de’Montmorency College of Dentistry, Lahore and to identify referral need for early management.


This was a cross-sectional survey conducted on 400 dental students selected randomly through convenient sampling from Department of Prosthodontics, de’ Montmorency College of Dentistry/Punjab Dental Hospital, Lahore between July 2006 to January 2007. Subjects complaining of two or more symptoms were classified as those suffering from temporomandibular disorders. Subjects were advised regarding their management of the related dysfunctions.


Out of these 400 subjects, 241 were females and 159 males between 18-25 years of age . Among 400 dental students, the least frequent complain was temporomandibular joint pain (8.4%) while the most frequent sign was temporomandibular joint sound (42.3%). Muscle tenderness, opening deviation of temporomandibular disorders were more frequent in females than males. Opening deviation was 12.8% and 9.6% for females and males respectively


More than 40% of the dental students were having more than 2 signs & symptoms of TMD these students need further evaluation & treatment to avoid future complications.


Temporomandibular disorder, Masticator musculature, Temporomandibular joint, Facial pain..


Temporomandibular disorders (TMDs) denotes collective term used to define a variety of signs and symptoms that are usually localized in the head and neck region and may present with varying level of intensity. Sign & symptoms usually associated with this disorder include oro-facial pain, difficulty in opening the mouth, joint noises and muscle tenderness around the temporomandibular joint. There are other non-specific symptoms which include headache, earache, neck and shoulder pain, tinnitus, ear fullness and perceived hearing loss.1,2Multiple factors have been suggested as cause of temporomandibular disorders (TMDs), including structural abnormality, stress induced hyperactivity, overloading of the joint from trauma and occlusal factors.3

However, due to varied adaptive capacity of patients, the role of the dental occlusal factors remains unclear.4,5Functional disorder of jaw muscles are probably the most common temporomandibular disorder of patient seeking treatment in the dental office. With regard to pain, this is second only to odontalgia (i.e., tooth or periodontal pain) and the muscle disorder is generally known as masticatory muscle disorder. This muscular disorder may induce disc interference disorder by increasing the passive interarticular pressure or disc interference may induce protective muscle splinting symptom. In this phenomenon acute malocclusion is seldom displayed.6Like muscles and joints, dentition and supportive tissues can also show signs and symptoms of functional disorder. These are normally associated with the breakdown created by heavy occlusal forces to the teeth and their supportive structures, which are characterized by mobility, pulpitis and tooth wear.7,8 Therefore, the purpose of this study was to determine the frequency of temporomandibular disorder in dental students, and any disturbances of the stomatognathic system could be managed at an earlier stage by referring them to the temporomandibular disorder clinic


This cross-sectional study was conducted on 400 dental students in Department of Prosthodontics, de’ Montmorency College of Dentistry/Punjab Dental Hospital, Lahore between July 2006 to January 2007. Subjects were selected on convenient sampling. Subjects complaining of two or more symptoms and signs were classified as those suffering from temporomandibular disorders.The Inclusion criteria of our study was patients presenting with Temporomandibular joint pain , temporomandibular joint sound, Muscle tenderness around the joint and the parafunctional habits (i.e; bruxism, nail biting, lip/cheek biting). The exclusion criteria was patients with history of any trauma or malignancy of the orofacial region. Subjects were advised regarding their management of the related dysfunctions. There was no follow-up of the outcome of referral.Data was analyzed using SPSS 11.0 software program. The positive signs were presented in tabular frequency form. The temporomandibular disorder requiring referral for treatment was identified and the need of such treatment listed..


The least frequent symptom was temporomandibular joint pain (8.4%). While the most frequent sign was temporomandibular joint sound (42.3%). Muscle tenderness, opening deviation of temporomandibular joint were more frequent in females than males. Opening deviation was 12.8% and 9.6% for females and males respectively (Table 1) . (Table 2) shows the clenching/Bruxism was the most frequent habit (21.8%) and the females (14.7%) were significantly more affected than males (7.1%). Nail biting was the second most frequent habit (18.4%), lip/cheek biting was the least frequent parafunctional habit (4.5%).There are 2.5% of jaw locking/jaw stuck, 6.4% difficulty in opening of mouth, 11 . 5% pain during chewing, 21 . 8% clenching/bruxism, and 35.2% of temporomandibular

joint noises. These subjects should have comprehensive temporomandibular disorder evaluation in order to further identify the recommended need for TMD therapy (Table 3).


Temporomandibular joint sounds are often an indication of mechanical interferences with the joint.9 In the present study, the most prevalent sign of temporomandibular disorder was temporomandibular joint sound (42.3%) [Table 1]. This is in agreement with the report of Widmalm et al.10 Also the present resultswere higher than the results reported by Farsi.11 A study reported much higher incidence of TMJ sounds but this was due to the use of stethoscope in their clinical examination.12

Frequency of mouth opening restriction was low (12.2%) yet there was a difference between females (7.7%) and males (4.5%) (Table 1). The amplitude of mouth opening, overbite taken into account, reached. 46.5mm and 50.2 mm for females and males respectively. The results showed that the average mouth opening is greater in males than females. More recently, Gallagher et al13 reported almost similar results of 42.6 mm and 44.6 mm for females and males respectively. In the present study, it seems that restricted opening (12.2%) may occur without other accompanying signs of muscle tenderness which was 14.8% or TMJ pain which was 8.4%.

Para functional habits were common in the present study except for lip/cheek biting 4 . 5 % . Clenching/bruxism 21.8% and nail biting 15.4% (Table 2). In Saudi young adults reported by Abdel-Hakim et al14 while Farsi11 reported 38% and 33% respectively. Present study reported generally females have more sign and symptoms of TMD than males. This is in agreement with other reports in the literature.11,15 It has been stated that these gender differences could probably be explained by mental factors i.e. young female seems to present a lower pain threshold.16 Gender difference may also be explained by some physiological changes seen at puberty. The pattern of onset of TMD after puberty and lowered prevalence rate in the post-menopausal year suggest that female reproductive hormone may play an etiological role in temporomandibular disorder.17


It is concluded that 41.5% of dental students were suffering from two or more than two symptoms of TMD. The signs and symptoms were headache 44.2%, joint noise 35.2%, muscular tenderness 14.8% 2.5% of jaw locking/jaw stuck, 6.4% of difficulty in opening of mouth, 11 . 5 % o f p a i n d u r i n g c h e w i n g , 2 1 . 8 % o f clenching/bruxism. These students require further evaluation and treatment to avoid any complication with stomatognathic system.


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