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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 65-68

Relationship Between Malocclusion and Temporomandibualr Disorders Among 12-18 Year Old Adolescents in Davangere City-A Cross Sectional Survey


1 Department of Public Health Dentistry, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
2 Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
3 Department of Public Health Dentistry, Dayananda Sagar Dental College and Hospital, Bangalore, Karnataka, India
4 Department of Public Health Dentistry, Government Dental College, Kottayam, Kerala, India

Date of Web Publication3-Aug-2018

Correspondence Address:
B K Sujatha
Department of Public Health Dentistry, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_23_18

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  Abstract 


Introduction: Masticatory system consists of the organs and structures primarily functioning in mastication. Health-care professionals are faced with the stark reality that the most common reason for which the patients seek medical care is due to pain or dysfunction. Even today, the relationship between malocclusion and temporomandibular disorders (TMD) remains controversial. Aim: The aim of this study was to assess the relationship between malocclusion and TMD in a selected sample of 12—18-year-old school and college going adolescents in Davangere city. Materials and Methods: An observational, cross-sectional survey was conducted among 1600 school and college-going adolescents using a self-structured pro forma to record general information, the examination of malocclusion according to the Dental Aesthetic Index introduced by Cons et al. which was adopted by WHO, examination of TMD as per the WHO guidelines, and perceived stress scale by Sheldon Cohen. Statistical analysis was done using Chi-square test, Z-test using SPSS software version 18, IBM, Chicago, USA. A statistical significance level was fixed at P ≤ 0.05. Results: Out of 1600 participants, 47.3% were found to have malocclusion, and 52.7% were found to have no malocclusion, and there was a statistically significant relationship between malocclusion and TMD (P = 0.002) with an odds ratio (OR) of 1.54 and confidence interval (CI) = 1.2—2.0. Conclusion: The prevalence of malocclusion was found to be 47.3% which was significantly higher in females when compared to males, and there was a statistically significant relationship between malocclusion and TMD (P = 0.002) with an OR of 1.54 and CI = 1.2—2.0.

Keywords: Malocclusion, perceived stress scale, temporomandibular disorders


How to cite this article:
Sujatha B K, Yavagal PC, Nagesh L, S. Gomez MS. Relationship Between Malocclusion and Temporomandibualr Disorders Among 12-18 Year Old Adolescents in Davangere City-A Cross Sectional Survey. J Dent Res Rev 2018;5:65-8

How to cite this URL:
Sujatha B K, Yavagal PC, Nagesh L, S. Gomez MS. Relationship Between Malocclusion and Temporomandibualr Disorders Among 12-18 Year Old Adolescents in Davangere City-A Cross Sectional Survey. J Dent Res Rev [serial online] 2018 [cited 2022 Jun 27];5:65-8. Available from: https://www.jdrr.org/text.asp?2018/5/2/65/238534




  Introduction Top


The masticatory system consists of the organs and structures primarily functioning in mastication. Health-care professionals are faced with the stark reality that the most common reason for which the patients seek medical care is due to pain or dysfunction. Certainly, the most common orofacial pain is odontogenic. However, nonodontogenic orofacial pain due to temporomandibular disorders (TMD) is not an exception.[1]

According to the American dental association, TMD can be defined as a cluster of related disorders characterized by pain in the preauricular area, temporomandibular joint (TMJ), or in the muscles of mastication; limitation, or deviation in the mandibular range of motion and noises in the TMJ during the mandibular function.[2] Epidemiologic studies have shown that TMD is common in children, adolescents, and adults.[3] In India, it has been estimated that 25% of the general population suffer from TMJ-related symptoms, and only 2% of them seek treatment.[4] The etiology of TMD remains a subject of controversy and is generally viewed as multifactorial.[5] Malocclusion is one such factor which can be considered as a predisposing factor for TMD.[6]

Exploration of literature reveals the relationship between malocclusion and TMD as controversial.[7] Limited studies have been conducted among children and adolescents to investigate the relationship between malocclusion and TMD which shows contradictory results. Hence, an attempt has been made in the present study, to assess the relationship between malocclusion and TMD in a selected sample of 12—18-year-old school and college-going adolescents in Davangere city.


  Materials and Methods Top


The present study is an observational, cross-sectional survey conducted to assess the relationship between malocclusion and TMD, among 12—18-year-old adolescents in Davangere city. Ethical clearance was obtained by the Institutional Review Board of Bapuji Dental College and Hospital, Davangere. Permission to conduct the study was obtained from the deputy director of public instruction, pre—university board, and also from school authorities in Davangere city. A self-structured Pro forma, exclusively designed for recording all the data about general information, examination of malocclusion according to the Dental Aesthetic Index (DAI) introduced by Cons et al. which was adopted by the WHO[8],[9] examination of TMD as per the WHO guidelines,[9] and perceived stress scale by Cohen[10] was used and scrutinized for its feasibility by conducting a pilot study on 50 randomly selected study participants. The sample size was calculated on the basis of data obtained from the national oral health survey reported in literature related to malocclusion in Karnataka,[11] and it was found to be 1600. The significance level α was fixed at 5%.

Parental consent and assent were obtained after explaining the purpose of the study. Participants belonging to the age groups 12—15 years were selected from schools, and age groups 16—18 years were selected from colleges. Four schools and four colleges were randomly selected from the list of schools and colleges by using the lottery method. Of seven age groups, 229 participants were selected from each age group to make a total of 1600 participants. Participants were selected in such a manner that the sample contained equal number of males and females to prevent the influence of gender on the variables.

Participants, who were undergoing orthodontic treatment, with parafunctional habits, developmental anomalies of dentofacial region such as cleft lip and cleft palate, suffering from any systemic diseases which have an influence on occlusion such as respiratory disorders, syndromes related to dentofacial region which has an influence on occlusion such as Marfan's syndrome, down syndrome, traumatic injuries to dentofacial region, erupting third molars, and mentally disabled/incapacitated, were excluded from the present study. All the examinations were carried out by a single-calibrated examiner (BKS). A maximum of 30 students were examined per day. Required instructions were given to fill the demographic details and the questionnaire related to stress. On an average, it took 15 min for the participants to complete the questionnaire. The stress questionnaire was prepared both in English and Kannada version. Kannada version of the questionnaire was administered to the participants who were not able to follow the English version.

Statistical analyses

A statistical analysis was done using Chi-square test, Z-test using SPSS version 18, IBM, Chicago, USA. A statistical significance level was fixed at P ≤ 0.05.


  Results Top


A cross-sectional survey was conducted to assess the relationship between malocclusion and TMD in a sample of 12—18-year-old school and college going adolescents in Davangere city. Data obtained from the study were subjected to statistical analyses.

[Table 1] shows the prevalence of malocclusion in the study participants. Of 1600 participants, 47.3% were found to have malocclusion, and 52.7% were found to have no malocclusion.
Table 1: Prevalence of malocclusion in the study participants

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[Table 2] shows the distribution of malocclusion classified using DAI in study participants. Majority of the participants (52.7%) had minor or no malocclusion whereas 31.8% had definite malocclusion, 10.6% had severe malocclusion, and 4.9% had very severe or handicapping type of malocclusion.
Table 2: Distribution of the study participants based on Dental Aesthetic Index scores (malocclusion)

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[Table 3] shows the prevalence of TMD in study participants. Of 1600 study participants, 14.9% had TMD, and 85.1% were free from TMD.
Table 3: Prevalence of temporomandibular disorder in the study participants

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[Table 4] shows the relationship between stress and TMD in the study participants. Out of 682 participants, 13.3% had both stress and TMD, 86.7% had only stress but no TMD; and out of 918 participants, 16.1% had only TMD but no stress, and 83.9% did not have both stress and TMD. The difference was not statistically significant (χ2 = 2.38, P = 0.12, not significant).
Table 4: Relationship between stress and temporomandibular disorder in the study participants

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[Table 5] shows the relationship between malocclusion and TMD in the study participants. Out of 757 participants, 17.8% had both malocclusion and TMD, 82.2% had only malocclusion but no TMD; and out of 843 participants, 12.3% had only TMD but no malocclusion, and 87.7% did not have both malocclusion and TMD. The difference was statistically significant (χ2 = 9.48, P = 0.002). Odds ratio (OR) is 1.54 and confidence interval (CI) = 1.2—2.0.
Table 5: Relationship between malocclusion and temporomandibular disorder in the study participants

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  Discussion Top


TMD is a heterogeneous group of psychophysiologic disorders with the common characteristics of orofacial pain, masticatory dysfunction, or both.[12] The prevalence of malocclusion was found to be 47.3% in the present study. According to some Indian studies, the prevalence of malocclusion was found to be as follows: it was 36.42% in the study conducted by Dhar et al.,[13] 20%—43% according to a study conducted by Suresh Babu et al.[14] In the present study, there was a significant association between the malocclusion and TMD (P = 0.002) with OR = 1.55 and CI = 1.2—2.0. These results are in agreement with the studies conducted by Gesch et al.[15] and Thilander et al.[16] However, the present study results are controversial to the results of few studies conducted by Godoy et al.[17] In the present study, there was no significant relationship between stress and TMD (P = 0.12) as analyzed using Chi-square test. These results are contradictory to the results of the studies by Pesqueira et al.[18] The probable reason could be the age group of the study population (12—18-year-old adolescents). Adolescents are relatively less likely to experience stress caused due to these factors when compared to adults.


  Conclusion Top


The prevalence of malocclusion was found to be 47.3% which was significantly higher in females when compared to males, and there was a significant relationship between malocclusion and TMD (P = 0.002) with an OR of 1.54 and CI = 1.2—2.0.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gremillion HA. The relationship between occlusion and TMD: An evidence-based discussion. J Evid Based Dent Pract 2006;6:43-7.  Back to cited text no. 1
    
2.
Dworkin SF, Huggins KH, LeResche L, Von Korff M, Howard J, Truelove E, et al. Epidemiology of signs and symptoms in temporomandibular disorders: Clinical signs in cases and controls. J Am Dent Assoc 1990;120:273-81.  Back to cited text no. 2
    
3.
Goodman JE, McGrath PJ. The epidemiology of pain in children and adolescents: A review. Pain 1991;46:247-64.  Back to cited text no. 3
    
4.
McNeill C. Introduction. In: Temporomandibular Disorders: Guidelines for Classification, Assessment, and Management. Chicago: Quintessence; 1993. p. 11-3.  Back to cited text no. 4
    
5.
Bhat S. Etiology of temporomandibular disorders: The journey so far International Dentistry SA 2010;12:88-92.  Back to cited text no. 5
    
6.
Eriksson EI, Ingervall B, Carlsson GE. The dependence of mandibular dysfunction in children on functional and morphologic malocclusion. Am J Orthod 1983;83:187-94.  Back to cited text no. 6
    
7.
Laskin DM. Etiology of the pain-dysfunction syndrome. J Am Dent Assoc 1969;79:147-53.  Back to cited text no. 7
    
8.
Cons NC, Jenny J, Kohout FJ, Songpaisan Y, Jotikastira D. Utility of the dental aesthetic index in industrialized and developing countries. J Public Health Dent 1989;49:163-6.  Back to cited text no. 8
    
9.
World Health Organization. Temporomandibular disorders, Malocclusion. Oral Health Surveys: Basic Methods: Oral Health Unit. 3rd ed. New Delhi: A.I.T.B.S; 1987. p. 31-2, 47-51.  Back to cited text no. 9
    
10.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.  Back to cited text no. 10
    
11.
Bali RK, Hiremath SS, Puranik MP. Temporomandibular disorders, Malocclusion. National Oral Health Surveys and Fluoride Mapping, 2002-2003 Karnataka. New Delhi: Dental Council of India; 2004. p. 109-10, 118-9.  Back to cited text no. 11
    
12.
Phillips JM, Gatchel RJ, Wesley AL, Ellis E 3rd. Clinical implications of sex in acute temporomandibular disorders. J Am Dent Assoc 2001;132:49-57.  Back to cited text no. 12
    
13.
Dhar V, Jain A, Van Dyke TE, Kohli A. Prevalence of gingival diseases, malocclusion and fluorosis in school-going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent 2007;25:103-5.  Back to cited text no. 13
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14.
Sureshbabu AM, Chandu GN, Shafiulla MD. Prevalence of malocclusion and orthodontic treatment needs among 13-15 year old school children of Davangere city, Karnataka, India. J Indian Assoc Public Health Dent 2005;6:32-5.  Back to cited text no. 14
    
15.
Gesch D, Bernhardt O, Kirbschus A. Association of malocclusion and functional occlusion with temporomandibular disorders (TMD) in adults: A systematic review of population-based studies. Quintessence Int 2004;35:211-21.  Back to cited text no. 15
    
16.
Thilander B, Pena L, Infante C, Parada SS, de Mayorga C. Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development. Eur J Orthod 2001;23:153-67.  Back to cited text no. 16
    
17.
Godoy F, Rosenblatt A, Godoy-Bezerra J. Temporomandibular disorders and associated factors in Brazilian teenagers: A cross-sectional study. Int J Prosthodont 2007;20:599-604.  Back to cited text no. 17
    
18.
Pesqueira AA, Zuim PR, Monteiro DR, Ribeiro Pdo P, Garcia AR. Relationship between psychological factors and symptoms of TMD in university undergraduate students. Acta Odontol Latinoam 2010;23:182-7.  Back to cited text no. 18
    



 
 
    Tables

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



 

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