Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life

Paulino, Marcilia Ribeiro; Moreira, Vanderlucia Gomes; Lemos, George Azevedo; Silva, Pâmela Lopes Pedro da; Bonan, Paulo Rogério Ferreti; Batista, André Ulisses Dantas

doi:10.1590/1413-81232018231.18952015

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Free Themes • Ciênc. saúde colet. 23 (1) • Jan 2018 • https://doi.org/10.1590/1413-81232018231.18952015 copy

Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) signs and symptoms, its correlation with gender, parafunctional habits, emotional stress, anxiety, and depression and its impact on oral health-related quality of life (OHRQL) in college preparatory students at public and private institutions in João Pessoa, Paraíba (PB). The sample consisted of 303 students. Presence of TMD symptoms was determined by an anamnesis questionnaire containing questions related to the presence of parafunctional habits and emotional stress. A simplified clinical evaluation protocol was used. Anxiety and depression were determined with the Hospital Anxiety and Depression (HAD) scale and the OHRQL using the short version contained in the Oral Health Impact Profile (OHIP-14). The Chi-square, Fisher Exact, Mann Whitney, and Kruskal-Wallis tests were performed. Presence of signs and symptoms of TMD was statistically associated (p ≤ 0,05) with female gender, parafunctional habits, emotional stress, and anxiety, and represented greater impairment of the OHRQL. The physical pain domain was the most affected. The increased prevalence of signs and symptoms of TMD among college preparatory students indicates that there is a need for education and clarification among teachers and students to improve early diagnosis and to prevent the problem.

Key words
Temporomandibular joint disorders; Adolescence; Habits; Anxiety; Quality of life

Variables		TMD symptoms (DMF index)					p
		Absent		Present		Total
		n	%	n	%	%
Gender
	Female	11	3.6	198	65.3	69.0	< 0.001
	Male	20	6.6	74	24.4	31.0	< 0.001
Educational institution
	Private	4	1.3	73	24.1	25.4	0.065^* * Fisher Exact Test Statistically significant, p < 0.05.
	Public	27	8.9	199	65.7	74.6
Parafunctional habits
	No	7	2.3	7	2.3	4.6	< 0.001
	Yes	24	7.9	265	87.5	95.4	< 0.001
Presence/report of stress
	No	17	5.6	36	11.9	17.5	< 0.001
	Yes	14	4.6	236	77.9	82.5	< 0.001
Anxiety
	No	31	10.2	150	49.5	59.7	< 0.001 ^* * Fisher Exact Test Statistically significant, p < 0.05.
	Yes	0	0	122	40.3	40.3
Depression
	No	29	9.6	242	79.9	89.4	0.337^* * Fisher Exact Test Statistically significant, p < 0.05.
	Yes	2	0.7	30	9.9	10.6

Variables		Need for TMD treatment (DMF index)
		Absent		Present		Total	p
		n	%	n	%	%
Gender
	Female	107	35.3	102	33.7	69.0	< 0.001
	Male	76	25.1	18	5.9	31.0	< 0.001
Educational institution
	Private	43	14.2	34	11.2	25.4	0.344
	Public	140	46.2	86	28.4	74.6	0.344
Parafunctional habits
	No	12	4.0	2	0.7	4.7	0.039 ^* * Fisher Exact Test Statistically significant, p < 0.05.
	Yes	171	56.4	118	38.9	95.3
Presence/report of stress
	No	44	14.5	9	3.0	17.5	< 0.001
	Yes	139	45.9	111	36.6	82.5	< 0.001
Anxiety
	No	136	44.8	45	14.9	59.7	< 0.001
	Yes	47	15.5	75	24.8	40.3	< 0.001
Depression
	No	175	57.8	96	31.7	89.5	< 0.001
	Yes	8	2.6	24	7.9	10.5	< 0.001

Variables		Clinical signs of TMD (simplified clinical exam protocol)
		Absent		Present		Total	p
		n	%	n	%	%
Gender
	Female	77	25.4	132	43.6	69.0	< 0.001
	Male	55	18.2	39	12.2	31.0	< 0.001
Teaching institution
	Private	32	10.6	45	14.8	25.4	0.681
	Public	100	33.0	126	41.6	74.6	0.681
Parafunctional habits
	No	10	3.3	5	1.7	5.0	0.064
	Yes	122	40.3	166	54.4	95.0	0.064
Presence/report of stress
	No	24	7.9	29	9.6	17.5	0.781
	Yes	108	35.6	142	36.9	82.6	0.781
Anxiety
	No	97	32.0	91	30.0	62.0	< 0.001
	Yes	35	11.6	80	26.4	38.0	< 0.001
Depression
	No	120	39.6	153	50.5	90.1	0.678
	Yes	12	4.0	18	5.9	9.9	0.678

Variables			TMD symptoms (DMF index)					p
			Absent		Present		Total
			n	%	n	%	%
Types of parafunctional habits
	Grinding teeth
		No	29	9.6	235	77.6	87.1	0.204^* * Fisher Exact Test. Statistically significant, p < 0.05
		Yes	2	0.7	37	12.2	12.9
	Clenching teeth
		No	28	9.2	197	65.0	74.3	0.020 ^* * Fisher Exact Test. Statistically significant, p < 0.05
		Yes	3	1.0	75	24.8	25.7
	Biting nails
		No	18	5.9	163	53.8	59.7	0.841
		Yes	13	4.3	109	36.0	40.3	0.841
	Chewing on objects (e.g., pencil)
		No	19	6.3	155	51.2	57.4	0.646
		Yes	12	4.0	117	38.6	42.6	0.646
	Chewing gum
		No	22	7.3	136	44.9	52.1	0.027
		Yes	9	3.0	136	44.9	47.9	0.027
	Biting cheeks
		No	25	8.3	192	63.4	71.6	0.239
		Yes	6	2.0	80	26.4	28.4	0.239
	Sucking a finger
		No	31	10.2	264	87.1	97.4	0.417^* * Fisher Exact Test. Statistically significant, p < 0.05
		Yes	0	0	8	2.6	2.6
	Resting your chin on your hand
		No	25	8.3	139	45.9	54.1	0.002
		Yes	6	2.0	133	43.9	45.9	0.002
	Biting the tongue
		No	31	10.2	235	77.6	87.8	0.014 ^* * Fisher Exact Test. Statistically significant, p < 0.05
		Yes	0	0	37	12.2	12.2
	Biting lips
		No	22	7.3	125	41.3	48.5	0.008
		Yes	9	3.0	147	48.5	51.5	0.008
	Unilateral chewing
		No	30	9.9	214	70.6	80.5	0.008 ^* * Fisher Exact Test. Statistically significant, p < 0.05
		Yes	1	0.3	58	19.1	19.5
	Lateral sleep position
		No	24	7.9	135	44.6	52.5	0.003
		Yes	7	2.3	137	45.2	47.5	0.003
	Chewing ice and/or lollipops
		No	22	7.3	140	46.2	53.5	0.039
		Yes	9	3.0	132	43.6	46.5	0.039

TMD Classification		Mean OHIP-14 ± SD	p
TMD symptoms (DMF index)
	Absent	5.42 ± 4.581	< 0.001 ^* * Statistically significant (p < 0.05) (Mann-Whitney test).
	Present	11.65 ± 8.482
Need for treatment (DMF index)
	Absent	8.02 ± 6.531	< 0.001 ^* * Statistically significant (p < 0.05) (Mann-Whitney test).
	Present	15.53 ± 8.855
Severity of TMD (DMF index)
	No TMD	5.42 ± 4.581	0.019 ^ Statistically significant (p < 0.05) (Kruskal-Wallis test).
	Mild TMD	8.60 ± 6.745
	Moderate TMD	14.54 ± 8.474	< 0.001 ^ Statistically significant (p < 0.05) (Kruskal-Wallis test).
	Severe TMD	20.45 ± 9.512	< 0.001 ^ Statistically significant (p < 0.05) (Kruskal-Wallis test).
Clinical signs of TMD (simplified clinical examination protocol)
	No TMD	9.98 ± 8.046	0.320^ Statistically significant (p < 0.05) (Kruskal-Wallis test).
	Clinical signs of articular TMD	10.52 ± 8.421
	Clinical signs of muscular TMD	12.26 ± 8.743	0.127^ Statistically significant (p < 0.05) (Kruskal-Wallis test).
	Clinical signs of mixed articular and muscular TMD	14.30 ± 8.348	0.01 ^ Statistically significant (p < 0.05) (Kruskal-Wallis test).

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[1] Collaborations

MR Paulino and VG Moreira participated in the study conception and design, collected and analyzed data, and reviewed the manuscript; GA Lemos, PLP Silva and PRF Bonan contributed to the statistical analysis, interpretation of the data, and manuscript review. AUD Batista supervised all the project phases, from conception and design to data collection, data analysis, and writing and revising the final manuscript. All of the authors read the final manuscript and approved the final version.