- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04495777
Prevalence of Temporomandibular Disorders and Its Association With Oral Parafunctions, Neck Pain and Function
Prevalence of Temporomandibular Disorders and Its Association With Oral Parafunctions, Neck Pain and Function in Female Turkish Healthcare Students: A Cross-Sectional Study
Purpose: To determine the prevalence of temporomandibular disorders (TMD) in female healthcare students and to assess its association with oral parafunctions, neck pain and function.
Methods: Female medical students will be included in the study on a voluntary basis using stratified sampling method according to the department they were being educated. The presence and severity of TMD will be assessed with the Fonseca's Anamnestic Index (FAI). The oral parafunctions will be self-reported with the Oral Behavior Checklist (OBC). The neck pain and function will be recorded with the Core Outcome Measure Index (COMI). A Chi-square test and Spearman correlation analysis will used for statistical analysis.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Temporomandibular disorder (TMD) has a multifactorial etiology related to parafunctional habits, emotional and psychological factors, trauma, posture, other musculoskeletal, or rheumatic disorders (1). Symptoms of TMD may include temporomandibular joint pain and clicks, headache, myofascial pain, decreased mandibular range of motion, masticatory muscle fatigue, limitation of mouth opening, pain when chewing, tinnitus, neuralgias, and bruxism (1,2). The severity of symptoms is related to the age and gender of the patients. Women showed a higher prevalence of TMD symptoms, with proportions varying from two to six women for each man, usually with ages between 20 and 40 years3. The distribution of age and gender in TMD, suggests a possible link between its pathogenesis and the female sex hormone, the estrogen, or between TMD and the mechanisms of pain modulation, as women show more sensitivity to most of the pain modalities (3,4) Epidemiologic studies showed that TMD prevalence in the students ranges from 50% to 77% (5-7). Several studies reported that a higher prevalence of TMD ranges from 47% to 81% in the Turkish student population (8-13). However, in some cases especially in students, the presence of TMD is asymptomatic. Therefore, the diagnosis of early symptoms and signs of TMD is crucial in preventing or minimizing TMD signs and symptoms (9).
Parafunctional habits such as bruxism, tooth clenching, gum chewing, biting foreign objects, and prolonged nail-biting might increase the risk of developing TMD (14). Even there are several studies examining the association of TMD and oral parafunctions in students (15-17); still, more studies are need to identify which oral behaviors cause TMD patients and healthy populations (18). Therefore, understanding the TMD symptoms in association with the oral parafunctions could provide different perspectives and an efficient treatment program (15).
To our knowledge, there is no study about TMD prevalence in female healthcare students and its association with oral parafunctions, neck pain, and function. The aims of this cross-sectional study were: (1) to evaluate the prevalence of TMD in female healthcare students and (2) to determine the association of TMD severity with oral parafunctional habits, neck pain and function.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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-
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Aydın, Turkey, 09010
- Gul Oznur KARABICAK
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- be Adnan Menderes University student
- female gender
- express consent to participate voluntarily in the study
Exclusion Criteria:
- with recent trauma to head and face,
- history of systematic diseases and neurological disorders
- currently an ongoing orthodontic treatment
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Only
- Time Perspectives: Cross-Sectional
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
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students
students were assessed in order to have a risk for TMD in order to their status of having parafunctional habits and neck pain
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Fonseca Anamnestic Index was developed to assess the severity of temporomandibular disorders, based on its signs and symptoms.
It has been proposed as a low cost and easy to apply alternative and has been used in screening for TMD in a non-patient population5.
It was created with 10 items with 3 options of answers (specific scores): "yes (10 points)", "sometimes (5 points)" and "no (0 points)".
The final score of the instrument is determined by the sum of the scores of all items, allowing the following classifications: the absence of signs and symptoms of TMD (0-15 points), mild TMD (20-45 points), moderate TMD (50-65 points), and severe TMD (70-100 points) (19).
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Fonseca Anamnestic Index
Time Frame: baseline
|
Fonseca Anamnestic Index was developed to assess the severity of temporomandibular disorders, based on its signs and symptoms.
It has been proposed as a low cost and easy to apply alternative and has been used in screening for TMD in a non-patient population5.
It was created with 10 items with 3 options of answers (specific scores): "yes (10 points)", "sometimes (5 points)" and "no (0 points)".
The final score of the instrument is determined by the sum of the scores of all items, allowing the following classifications: the absence of signs and symptoms of TMD (0-15 points), mild TMD (20-45 points), moderate TMD (50-65 points), and severe TMD (70-100 points) (19).
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baseline
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Oral parafunction
Time Frame: baseline
|
Oral behaviors checklist is a self-report questionnaire for determining the frequency of oral parafunctional behaviors which are any abnormal behavior or functioning of the oral structures and associated muscles in the past one month.
Original questionnaire consists of 21items, 2 items for oral behaviors during sleep, and 19 items for oral behaviors during waking hours.
In this study the questionnaire was modified and two of the questions were exctracted due to study of Hayek et al25.
Each item is scored from 0-4 based on the frequency of activity performed: a score of 0=none of the time; a score of 1=a little of the time; a score of 2=some of the time; a score of 3=most of the time and score of 4=all the time; with a range of 0-76 18.The sum of scoring had the following scheme: none = 0, low = 1-16, and high = 17-76 (20).
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baseline
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Neck pain and function
Time Frame: baseline
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The COMI-neck is a short, self-administered outcome instrument consisting of just seven items to evaluate the five dimensions pain, neck-related function, symptom-specific well-being, general quality of life, and disability (social and work) (21,22).
The two pain items use a 0-10 graphic rating scale; all other items use a 5-point adjective scale.
For COMI summary score, each of the domain scores is transformed to a 0-10 scale and these are then averaged to give a score ranging from 0 to 10, with higher scores indicating a worse status (23).
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baseline
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Gul Oznur KARABICAK, Phd, Aydin Adnan Menderes University
Publications and helpful links
General Publications
- Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D. The quality of spine surgery from the patient's perspective. Part 1: the Core Outcome Measures Index in clinical practice. Eur Spine J. 2009 Aug;18 Suppl 3(Suppl 3):367-73. doi: 10.1007/s00586-009-0942-8. Epub 2009 Mar 25.
- Oliveira LK, Almeida Gde A, Lelis ER, Tavares M, Fernandes Neto AJ. Temporomandibular disorder and anxiety, quality of sleep, and quality of life in nursing professionals. Braz Oral Res. 2015;29:S1806-83242015000100265. doi: 10.1590/1807-3107BOR-2015.vol29.0070.
- Pedroni CR, De Oliveira AS, Guaratini MI. Prevalence study of signs and symptoms of temporomandibular disorders in university students. J Oral Rehabil. 2003 Mar;30(3):283-9. doi: 10.1046/j.1365-2842.2003.01010.x.
- Kuc J, Szarejko KD, Sierpinska T. Evaluation of Orofacial and General Pain Location in Patients With Temporomandibular Joint Disorder-Myofascial Pain With Referral. Front Neurol. 2019 May 29;10:546. doi: 10.3389/fneur.2019.00546. eCollection 2019.
- Schmid-Schwap M, Bristela M, Kundi M, Piehslinger E. Sex-specific differences in patients with temporomandibular disorders. J Orofac Pain. 2013 Winter;27(1):42-50. doi: 10.11607/jop.970.
- Nekora-Azak A, Evlioglu G, Ceyhan A, Keskin H, Berkman S, Issever H. Estrogen replacement therapy among postmenopausal women and its effects on signs and symptoms of temporomandibular disorders. Cranio. 2008 Jul;26(3):211-5. doi: 10.1179/crn.2008.028.
- Nomura K, Vitti M, Oliveira AS, Chaves TC, Semprini M, Siessere S, Hallak JE, Regalo SC. Use of the Fonseca's questionnaire to assess the prevalence and severity of temporomandibular disorders in Brazilian dental undergraduates. Braz Dent J. 2007;18(2):163-7. doi: 10.1590/s0103-64402007000200015.
- Karthik R, Hafila MIF, Saravanan C, Vivek N, Priyadarsini P, Ashwath B. Assessing Prevalence of Temporomandibular Disorders among University Students: A Questionnaire Study. J Int Soc Prev Community Dent. 2017 Jun;7(Suppl 1):S24-S29. doi: 10.4103/jispcd.JISPCD_146_17. Epub 2017 Jun 20.
- Lung J, Bell L, Heslop M, Cuming S, Ariyawardana A. Prevalence of temporomandibular disorders among a cohort of university undergraduates in Australia. J Investig Clin Dent. 2018 Aug;9(3):e12341. doi: 10.1111/jicd.12341. Epub 2018 Mar 31.
- Emel Dervis N. Prevalence of Temporomandibular Disorder in Turkish University Students: a Questionnaire Study. Balk J Dent Med. 2019; 23 (2): 80-87 doi:10.2478/bjdm-2019-0015
- Türken R, Büyük SK, Yaşa Y. Diş Hekimliği Fakültesi Öğrencilerinde Temporomandibular Eklem Rahatsızlıklarının ve Ağız Sağlığı Alışkanlıklarının Değerlendirilmesi. Acıbadem Üniversitesi Sağlık Bilim Derg. 2020;11(2):208-213. https://doi.org/10.31067/0.2018.83.
- Tanhan A, Yıldız A, Demirbüken İ, Polat MG. Sağlık Bilimleri Öğrencilerinde Temporomandibular Eklem Disfonksiyon Riskinin Araştırılması. Sak Med J. 2019. doi:10.31832/smj.490740
- Yalcin Yeler D, Yilmaz N, Koraltan M, Aydin E. A survey on the potential relationships between TMD, possible sleep bruxism, unilateral chewing, and occlusal factors in Turkish university students. Cranio. 2017 Sep;35(5):308-314. doi: 10.1080/08869634.2016.1239851. Epub 2016 Oct 6.
- Ozdinc S PhD, Ata H MSc, Selcuk H MSc, Can HB MSc, Sermenli N MSc, Turan FN PhD. Temporomandibular joint disorder determined by Fonseca anamnestic index and associated factors in 18- to 27-year-old university students. Cranio. 2020 Sep;38(5):327-332. doi: 10.1080/08869634.2018.1513442. Epub 2018 Sep 8.
- Ayalı A, Ramoğlu S. KUZEY KIBRIS'TA DİŞ HEKİMLİĞİ FAKÜLTESİ ÖĞRENCİLERİNDE TEMPOROMANDİBULER EKLEM DİSFONKSİYONU'NUN PREVALANSI. Atatürk Üniversitesi Diş Hekim Fakültesi Derg. 2015;24(3). doi:10.17567/dfd.91850
- Chatzopoulos GS, Sanchez M, Cisneros A, Wolff LF. Prevalence of temporomandibular symptoms and parafunctional habits in a university dental clinic and association with gender, age, and missing teeth. Cranio. 2019 May;37(3):159-167. doi: 10.1080/08869634.2017.1399649. Epub 2017 Nov 16.
- Lovgren A, Osterlund C, Ilgunas A, Lampa E, Hellstrom F. A high prevalence of TMD is related to somatic awareness and pain intensity among healthy dental students. Acta Odontol Scand. 2018 Aug;76(6):387-393. doi: 10.1080/00016357.2018.1440322. Epub 2018 Feb 18.
- Paduano S MD, DDS, Bucci R DDS, PhD, Rongo R DDS, PhD, Silva R DDS, Michelotti A DDS. Prevalence of temporomandibular disorders and oral parafunctions in adolescents from public schools in Southern Italy. Cranio. 2020 Nov;38(6):370-375. doi: 10.1080/08869634.2018.1556893. Epub 2018 Dec 14.
- Leketas M, Saferis V, Kubilius R, Cervino G, Bramanti E, Cicciu M. Oral Behaviors and Parafunctions: Comparison of Temporomandibular Dysfunction Patients and Controls. J Craniofac Surg. 2017 Nov;28(8):1933-1938. doi: 10.1097/SCS.0000000000003945.
- Bevilaqua-Grossi D, Chaves TC, de Oliveira AS, Monteiro-Pedro V. Anamnestic index severity and signs and symptoms of TMD. Cranio. 2006 Apr;24(2):112-8. doi: 10.1179/crn.2006.018.
- Al Hayek SO, Al-Thunayan MF, AlGhaihab AM, AlReshaid RM, Omair A. Assessing stress associated with temporomandibular joint disorder through Fonseca's anamnestic index among the Saudi physicians. Clin Exp Dent Res. 2018 Dec 26;5(1):52-58. doi: 10.1002/cre2.157. eCollection 2019 Feb.
- Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D. The quality of spine surgery from the patient's perspective: part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index. Eur Spine J. 2009 Aug;18 Suppl 3(Suppl 3):374-9. doi: 10.1007/s00586-009-0931-y. Epub 2009 Mar 19.
- Karabicak GO, Hazar Kanik Z, Gunaydin G, Pala OO, Citaker S. Reliability and validity of the Turkish version of the Core Outcome Measures Index for the neck pain. Eur Spine J. 2020 Jan;29(1):186-193. doi: 10.1007/s00586-019-06169-w. Epub 2019 Oct 31.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- tmd_101
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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