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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 17-21

Association between parafunctional habit and sign and symptoms of temporomandibular dysfunction


Department of Public Health Dentistry, Sharad Pawar Dental College, DMIMS (DU), Wardha, Maharashtra, India

Date of Web Publication14-May-2018

Correspondence Address:
Dr. Harshali Fale
Department of Public Health Dentistry, Sharad Pawar Dental College, DMIMS (DU), Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_1_18

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  Abstract 


Introduction: Temporomandibular disorder (TMD) is a group of condition affecting the temporomandibular joint, masticatory muscles, and the adjacent structures. The etiology of TMD in children and adolescents is considered multifactorial in nature and has been related to trauma, malocclusion, and parafunctional habits. Aim: The aim of this study is to find whether harmful oral habits are associated with sign and symptoms of TMD among adolescents in Wardha district. Materials and Methods: A short-span study was conducted in Wardha, Maharashtra. A self-administered based study was done among 200 adolescents which comprised of 107 females and 93 males. Data were collected using self-administered questionnaire and clinical oral examination that was conducted. The questionnaire was consist of knowledge responses (yes/no) and attitude responses (never, rarely, sometimes, often, and always). Chi-square test was used to perform statistical analysis and level of significance was set at P < 0.05. Results: The main method used was self-administered questionnaires with sample characteristics of 53.5% female and 46.5% male. Population was divided into two age groups. Total number of adolescents in age Group 1 (9–14 years) was 85 and age Group 2 (15–19 years) was 115. Seventy-seven (38.5%) adolescent reported no sign and symptoms of TMD and rest of them reported yes to at least one statement of questionnaire. Bruxism (67%) was the most frequently observed habit whereas chewing gums (5%) as the least observed habit. Statistically significant gender difference was not observed in the questionnaire. Higher frequency of TMD symptoms was reported in the age group of 15–19 years. Sixteen (8%) subjects reported nonparafunctional habits whereas 184 (92%) subjects had parafunctional habits. During clinical examination, muscle sensitivity to palpation was most frequent sign in the age of group 15–19 years with P = 0.023. Higher severity was reported are morning facial pain, pain while chewing, clicking sound, and using one side while chewing. Conclusion: Result shows that there was no association between parafunctional habits and signs and symptom of TMD. In age group of 15–19 years, it was statistically significant. Hence, while treating patient dentist should give attention to parafunctional habits in this age group especially.

Keywords: Adolescent, orofacial pain, parafunction, prevalence, temporomandibular disorder


How to cite this article:
Fale H, Hnamte L, Deolia S, Pasad S, Kohale S, Sen S. Association between parafunctional habit and sign and symptoms of temporomandibular dysfunction. J Dent Res Rev 2018;5:17-21

How to cite this URL:
Fale H, Hnamte L, Deolia S, Pasad S, Kohale S, Sen S. Association between parafunctional habit and sign and symptoms of temporomandibular dysfunction. J Dent Res Rev [serial online] 2018 [cited 2022 Jul 1];5:17-21. Available from: https://www.jdrr.org/text.asp?2018/5/1/17/232358




  Introduction Top


Temperomandibular disorder (TMD) is defined as heterogeneous group of psychophysiological disorders commonly characterized by orofacial pain, chewing dysfunction, or both.[1] The American Academy of Orofacial Pain defined TMD as “a collective term embracing a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) and associated structures, or both.” These disorders have been principally characterized by:

  1. Pain in the temporomandibular region or the muscles of mastication
  2. Limitations or deviations in mandibular range of motion
  3. TMJ sound during jaw functions
  4. Masticatory muscle soreness.[2]


The signs and symptoms of TMD could be best understood by studying some epidemiological studies that reported the prevalence of TMD in certain populations. It is known that 60%–70% of common population today has at least one sign of TMD, and the ratio of women to men is about 4:1.[2] TMD would mainly affect adult patients, and similar incidences have been seen in children also.[3] After 5 years of age, growth velocity diminishes significantly. The TMJ is sufficiently formed at an early age to be affected by parafunctional habits. The etiology of TMD in children and adolescents is considered multifactorial in nature and has been related to trauma, malocclusion, occlusal disharmony, and parafunctional habits such as bruxism, nail-biting, and nonnutritional sucking.[4] In adolescents with TMD, psychosocial factors such as increased level of stress, somatic complaints, and emotional problems seem to play a more prominent role than dental problems.[5]

Predisposing factors such as systematic, genetic, structural, psychological, metabolic factors, and muscle stress are reported. The patient usually experiences joint pain followed by clicking sound in joint, difficulty in mouth opening. Other sign and symptoms are soreness of muscles of mastication, attrition of teeth and sensitivity, pain in the area of forehead and eyes, pain in the back of the head extending to the shoulders and neck, fullness in the ears, tinnitus, pressure on the eyes, sensitivity to light, vertigo, nausea, lack of concentration.”[1] Recent studies suggest that subjects with muscular diagnosis have more severe pain and psychological distress than those with joint diagnosis. Subjects in the myogenous group more often reported with parafunctions, depression, worrying.[2]

The term oral parafunctional habit is used to describe any abnormal behavior or functioning of the oral structures and associated muscles. Abnormal behaviors commonly include bruxism, clenching, excessive gum chewing, lip/nail biting or nonnutritive sucking. During parafunctional activities, however, it seems that neuromuscular protective mechanism is suppressed and therefore not fully capable of protecting masticatory components, specially masticatory muscle from high level of their activity, this leads to an increase parafunctional activity.[3],[6],[7]

While treating TMD, the dentists give less attention to oral parafunctional habit than other factors. The factors leading to oral parafunctional habits includes psychological disturbances, which are also seen in TMD suffers. Hence, studies and comparisons are necessary for better understanding. As late diagnosis of TMDs may result in irreversible and destructive effect on TMJ, its early evaluation play important role in the treatment process.[8]

The present study aimed to find whether harmful oral habits are associated with sign and symptoms of TMD among adolescents in Wardha district.


  Materials and Methods Top


Ethical clearance was obtained from the Institutional Ethical Committee. This study was carried out among 200 adolescents (10–19 years) reporting to the dental hospital from October 2017 to March 2017 in Wardha district of Maharashtra, India. Initially, parents and children were informed regarding the purpose of the study and consent forms were obtained. Data were collected using self-administered questionnaire and clinical oral examination that was conducted by an examiner. The clinical examination was conducted under adequate illumination and proper patient's position. The patient was seated upright and examination was done using mouth mirror and probe. An examiner palpated the TMJ bilaterally for any asymmetry, swelling in preauricular region, TMJ noise for any irregularities on closing or opening of mouth, deviation of mandible. Masticatory muscle and accessory muscle were palpated to check tenderness using index, middle and third finger.

Inclusion criteria were all permanent dentition (absence of primary teeth), no craniofacial anomalies. Exclusion criteria were mental disorder, any gross pathology of ear.

A self-administered questionnaire was prepared in Marathi language and distributed among the patient.

The questionnaire consists of two parts. The first part includes sociodemographic data (age and gender). Second part includes questions based on 2 point and 5 point Likert scale. The subject were requested to answer a questionnaire, if the subject is unable to answer then parents of the patient was ask to feel the questionnaire.

Statistical Package for Social Science (SPSS) of version 11.5 was used for statistical analysis of obtained data. P < 0.05 was considered as statistically significant. To find the association between parafunctional habits and sign and symptoms of TMD Chi-square test was applied.


  Results Top


Study population of 200 adolescent compromised of 93 (46.5%) males and 107 (53.5%) females. With the mean age of 13.52 ± 1.8, population was divided into two age groups. Total number of adolescents in age Group 1 (9–14 years) and age Group 2 (15–19 years) was 85 (42.5%) and 115 (57.5%), respectively. Seventy-seven (38.5%) adolescent reported no sign and symptoms of TMD and rest of them reported yes to at least one statement of questionnaire. There was no statistically significant association between the gender and the symptoms of temporomandibular disorder [Table 1] and [Table 2].
Table 1: Association between symptoms of temporomandibular disorder and habit in relation with gender

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Table 2: Association between symptoms of temporomandibular disorder and habit in relation with gender

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Sixteen (8%) subjects reported nonparafunctional habits whereas 184 (92%) subjects had parafunctional habits [Figure 1]. Percentage distribution of habits according to pie chart shows that the most frequently observed habit was bruxism (67%) whereas chewing gums (5%) as the least observed habit [Figure 1].
Figure 1: Percentage distribution of habits. (1) Bruxism – 67, (2) nail biting – 38, (3) Clenching – 30, (4) lip/object biting – 44, (5) chewing gum – 5, (6) none of the above – 16

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Statistically significant gender difference was not observed in the questionnaire. Higher frequency of TMD symptoms was reported in group of 15–19 years. Symptoms of TMD like difficulty or pain in mouth opening or yawning, pain in or around temple, ear or cheek and jaw stiff, tight or tired and morning facial pain, pain while chewing, clicking sound and using one side while chewing were found statistically significant [Table 3] and [Table 4].
Table 3: Association between ages in relation with habit

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Table 4: Association between ages in relation with habit

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There was no statistically significant difference between signs of temporomandibular disorder and gender [Table 5]. However, during clinical examination, muscle sensitivity to palpation was most frequent sign in age group of 15–19 years with P = 0.023 [Table 6]. There was a statistically signiifcant association between signs of temporomandibular disorder and age group except for the 2 signs (deviation of the mandible upon opening and extent of dental wear) [Table 6].
Table 5: Association between sign of temporomandibular disorder and gender

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Table 6: Association between sign of temporomandibular disorder and age group

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  Discussion Top


A number of studies of the prevalence of TMD in children and adolescents have been published from different parts of the world.

The main goal of the study was to find association between parafunctional habits and sign and symptoms of TMD among adolescents residing in Wardha district. The difference in the mean ages between the groups was statistically significant (P< 0.05).[5]

Headache, neck pain, and toothache were most frequent reported sign and symptoms of TMD in previous study (46.2%).[1] Significant gender difference was observed, which was similar to the reports among Iranian adolescents.[4],[8],[9] Whereas in the present study, muscle sensitivity, difficulty in mouth opening and while using jaw, pain in or around temple region and jaw stiffness are most statistically significantly reported sign and symptoms of TMD. There was no statistically significant association found between gender and sign and symptoms of TMD. Lack of gender differences reported in this study tends to agree with other investigations.[5],[9]

In the present study, no statistically significant association was found between parafunctional habit and TMD. However, significant association was found in the study conducted by Alamoudi N.[10] Although these parafunctional habits should be considered as risk factor for TMD as they act as triggering point for appearance of TMD due to its effect on stomatognathic system.

Bruxism (67%) was the most frequent parafunctional habit seen in the adolescent with sign and symptoms of TMD. In some surveys, bruxism was not considered related to signs and symptoms of TMD in young children [11] but a number of studies showed that there is significant relationship between attrition, symptoms of TMD and deviation on opening [12],[13] and also in some investigations there was a significant association between bruxism and most of the TMD signs and symptoms in children.[14],[15]

TMJ sound is an indication for mechanical interferences with joint. In age Group 2, TMJ sound is 9.23% (P = 0.308) with no apparent gender differences. TMJ sound has been found significantly more common in girls than boys.[15] This was not confirmed in this study or other previous reports.[16] Methods and criteria for recording joint sounds differ in every study thus variable reports are possible reason for wide range of joint sounds.

In this study, the prevalence of TMJ and masticatory muscle tenderness is 12.17% (P = 0.016) and morning facial pain is 20% which appears significant association between ages in relation with habit. No significant gender difference was found. Higher frequency of myofascial pain in girls has been reported previously.[17] One of the studies in Sweden and China, however, this finding is partly in contrast showing that tenderness or pain is significantly correlated with increase in TMD in both ages.[18],[19]

Out of 200 samples, 123 (61.5%) adolescent shows sign and symptoms of TMD in this study. Differences between these findings and the whole sample in the present study may be related to the age of the sample because half the adolescents were under 15 years of age and therefore, at an age of lower risk to develop TMD problems.

Limitation

However, there are some limitations in this study. The severity of signs and symptoms of TMD was not mentioned in the screening questionnaire, and no clear association between different parafunctional habits and TMD was established. Hence, further studies need to be conducted for generalizability of the results.


  Conclusion Top


Parafunctional habits, in general, are considered as predisposing factors for many dysfunctions related to those in head, neck, face region, and oral cavity. Due to the dynamic relationship between head and neck posture, jaw position, dental occlusion and its disturbance that is seen in TMJ dysfunction, it becomes necessary to provide an appropriate and comprehensive treatment protocol for optimum results. To get rid of TMD, first, the person should be deprived from such habits for which it is necessary to estimate the root reason behind exposing to the habit and deciding treatment options accordingly. It is important for dentist to rule out disorders that mimic TMD, to identify non-TMD disorders. Hence, dentist should give attention to parafunctional habits to develop appropriate management strategies in the adolescents especially. Awareness for TMD should be made in adolescent and their parents by means of media.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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Conti A, Freitas M, Conti P, Henriques J, Janson G. Relationship between signs and symptoms of temporomandibular disorders and orthodontic treatment: A cross-sectional study. Angle Orthod 2003;73:411-7.  Back to cited text no. 6
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Ebrahimi M, Dashti H, Mehrabkhani M, Arghavani M, Daneshvar-Mozafari A. Temporomandibular disorders and related factors in a group of Iranian adolescents: A Cross-sectional survey. J Dent Res Dent Clin Dent Prospects 2011;5:123-7.   Back to cited text no. 8
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Alamoudi N. Correlation between oral parafunction and temporomandibular disorders and emotional status among Saudi children. J Clin Pediatr Dent 2001;26:71-80.   Back to cited text no. 10
    
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Fujita Y, Motegi E, Nomura M, Kawamura S, Yamaguchi D, Yamaguchi H, et al. Oral habits of temporomandibular disorder patients with malocclusion. Bull Tokyo Dent Coll 2003;44:201-7.   Back to cited text no. 13
    
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Farsi NM. Symptoms and signs of temporomandibular disorders and oral parafunctions among Saudi children. J Oral Rehabil 2003;30:1200-8.   Back to cited text no. 15
    
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Hongxing L, Astrøm AN, List T, Nilsson IM, Johansson A. Prevalence of temporomandibular disorder pain in Chinese adolescents compared to an age-matched Swedish population. J Oral Rehabil 2016;43:241-8.  Back to cited text no. 19
    


    Figures

  [Figure 1]
 
 
    Tables

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


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