CC BY 4.0 · European Journal of General Dentistry 2022; 11(03): 189-194
DOI: 10.1055/s-0042-1759750
Original Article

Assessment of Knowledge and Self-Awareness about Temporomandibular Joint Disorders among Dental Students

Mohammed Najmuddin
1   Department of Maxillofacial Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
,
Afnan Y. Shabi
2   Intern, College of Dentistry, Jazan University, Jazan, Saudi Arabia
,
Amna M. Alqadi
2   Intern, College of Dentistry, Jazan University, Jazan, Saudi Arabia
,
Reem N. Moafa
2   Intern, College of Dentistry, Jazan University, Jazan, Saudi Arabia
,
Safeena Abdul Khader Saheb
3   Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
,
Maisah A. Attafi
4   Private Practice, Jazan, Saudi Arabia
,
Fatimah B. Khormi
5   Dental Student, College of Dentistry, Jazan University, Jazan, Saudi Arabia
,
Aziza M. Alqadi
4   Private Practice, Jazan, Saudi Arabia
,
Haifa F. Bokamani
5   Dental Student, College of Dentistry, Jazan University, Jazan, Saudi Arabia
,
5   Dental Student, College of Dentistry, Jazan University, Jazan, Saudi Arabia
› Author Affiliations
 

Abstract

Objectives This Study Aimed To Find The Relationship Between Lack Of Knowledge And Self-Awareness About Temporomandibular Disorders (Tmds) And Their Signs And Symptoms Among Dental Students Of College Of Dentistry, Jazan University, Jazan, KSA.

Materials and Methods A self-administered structured questionnaire was used to assess the demographic variables, information regarding self-awareness and knowledge about TMDs among dental students. The data obtained were subjected to statistical analysis using the IBM SPSS version 20.0 software.

Statistical Analysis The data obtained were subjected to statistical analysis using the IBM SPSS version 20.0 software. Descriptive statistics, that is, frequencies and percentages were computed. The comparative analysis was done using Chi-square statistical analysis.

Results Out of 406 participants, 44.08% were male and 55.91% were female. Also, 329 were undergraduate students and 77 were interns. Almost a similar percentage of undergraduates and interns were suffering with trismus, articular sounds, pain, and arthralgia. Interns had more incidence of injuries of the head and neck, and had undergone orthodontic treatment, with a significant difference statistically (p < 0.05). A significant relation (p < 0.05) was observed between responses, with interns having better knowledge regarding investigations and treatment interventions.

Conclusion A direct relationship exists between the level of knowledge about temporomandibular joint (TMJ) and TMDs and self-awareness of its signs and symptoms. A thorough knowledge is required among the students to investigate, diagnose, and treat TMDs at early stages.


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Introduction

The temporomandibular joint (TMJ) complex is a part of the musculoskeletal system comprising different components, that is, bone, cartilage, ligaments, muscles and associated neurovascular channels supplying to the structures. It helps to perform various mandibular functions such as phonation, mastication, and deglutition.[1]

The disorders arising from TMJ and its related structures are complex in nature with varied symptoms such as the displacement of the articular disc, articular sounds, pain originating from the bone and muscles, and degenerative changes to bony components.[2] Various etiological factors such as postural, structural, and psychological factors combine together, leading to TMDs. These disorders are caused due to the derangement of the functional balance between the three elements of the stomatognathic system, that is, TMJ, dental occlusion, and masticatory muscles.[3]

Since long, TMDs is an enigmatic issue and have been widely studied because of its multifactorial etiology. Patients reporting with complaint of TMDs symptoms are very rare. This could be due to a complete absence of symptoms, confusion, patient's ignorance, disability, excuses, and lack of knowledge and awareness.[4] Thus, the complex nature of TMDs and their varied symptoms; and subjectivity in recording the condition poses issues in its evaluation.

Various studies[5] [6] [7] have been conducted on medical and dental undergraduates or postgraduates, evaluating the prevalence of TMDs in them, as they are subjected to a complex academic and clinical curriculum. We observed very limited studies being conducted on dental or medical students, especially those that belong to universities. Until now, we have not observed any study comparing undergraduates and interns. So we took and compared these two groups of students primarily affected with stress during their course.

We preferred to conduct the study on dental students, as they are being taught about the TMDs and their signs and symptoms, so they could have been more enthusiastic in participating and responding to the study. Thus, the present study was conducted to find the relationship between lack of knowledge and self-awareness about TMDs and their signs and symptoms among dental students of College of Dentistry, Jazan University, Jazan, KSA.


#

Materials and Methods

The present cross-sectional study was a questionnaire-based study conducted from November 2020 to February 2021. The self-administered structured questionnaire was used to assess the demographic variables, information regarding the knowledge about TMDs, and self-awareness among dental university students. The validity of questionnaire was assessed by consulting the staff of other departments and was found to be appropriate (α = 0.85). The study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee of the institute (reference number CODJU-20151 on October 20, 2020). Informed written consent was obtained from all subjects prior to their enrolment in this study. Then, two sets of questionnaires were distributed to each student to analyze their self-awareness and knowledge about TMDs.

Subjects who were on analgesics or on any other medications related to the head and neck pain or disorder were excluded from the study.

The demographic data were collected to analyze the impact of various demographic factors on the prevalence of TMDs among dental students. Besides demographic parameters, 20 well-constructed questions were framed and asked from dental undergraduate students and interns. The response to all these questions was recorded. Demographic characteristics such as gender distribution and year of their study were asked. Questions regarding the signs and symptoms of TMDs such as pain, trismus, articular sounds, previous history of TMDs, or any related treatment were recorded by asking questions with options of “Yes” or “No.” Various factors determining the knowledge of students about TMDs were analyzed and compared among undergraduates and interns by asking questions with different options.

The data obtained were subjected to statistical analysis using the IBM SPSS version 20.0 software. Descriptive statistics, that is, frequencies and percentages were computed. The comparative analysis was done using chi-square statistical analysis.


#

Results

A total of 406 dental students were included in the study, out of which 44.08% were male and 55.91% were female. Also, 329 were undergraduate students and 77 were interns. An insignificant difference was observed statistically in relation to demographic parameters ([Table 1]).

Table 1

Distribution of study subjects according to study year

Demographic

Frequency

Percentage

Chi-square

p-Value

Gender

Male

179

44.08867

23.918

0.918

Female

227

55.91133

Total

406

100

Year

2nd

51

12.56158

25.001

1.341

3rd

50

12.31527

4th

56

13.7931

5th

78

19.21182

6th

94

23.15271

Intern

77

18.96552

Signs and symptoms of temporomandibular joint disorders among students were evaluated and compared. Almost a similar percentage of undergraduates and interns were suffering with trismus, articular sounds, pain, and arthralgia. Interns had more incidences of injuries of the head and neck, and have undergone orthodontic treatment, with a significant difference statistically (p < 0.05) ([Table 2]).

Table 2

Distribution of study subjects according to the questionnaire regarding signs and symptoms of temporomandibular joint disorders

Questionnaire

Undergraduates (N = 329)

Interns (N = 77)

Statistical analysis

Frequency

Percentage

Frequency

Percentage

Chi square

p-Value

Do you have trismus (reduced mouth opening)?

Yes

7

2.12766

2

2.597403

3.887

0.87

No

322

97.87234

75

97.4026

Do you hear sound within your TMJ while opening or closing the jaw?

Yes

21

6.382979

9

11.68831

1.09

0.021*

No

308

93.61702

68

88.31169

Did you ever had pain in and around ear?

Yes

26

7.902736

4

5.194805

2.191

0.918

No

303

92.09726

73

94.80519

Do you have pain on chewing?

Yes

23

6.990881

1

1.298701

2.718

0.012*

No

306

93.00912

76

98.7013

Do you have pain on opening the mouth wide or during yawning?

Yes

9

2.735562

3

3.896104

11.817

1.78

No

320

97.26444

74

96.1039

Have you ever had lock jaw? If yes, how many times a year?

Yes

10

3.039514

1

1.298701

7.615

0.89

No

319

96.96049

76

98.7013

Have you ever had injury to your jaw, head or neck?

Yes

22

6.68693

1

1.298701

12.017

0.034*

No

307

93.31307

76

98.7013

Have you undergone orthodontic treatment before?

YES

73

22.18845

7

1.298701

10.715

0.002*

No

256

77.81155

70

98.7013

Do you have arthralgia in other joints of your body?

Yes

11

3.343465

1

1.298701

6.92

0.091

No

318

96.65653

76

98.7013

Have you ever taken treatment for TMDs?

Yes

14

4.255319

1

1.298701

5.761

0.05*

No

315

95.74468

76

98.7013

*p-Value < 0.05 is significant.


Questions regarding the knowledge-based assessment were asked and responses were compared among interns and undergraduates. It was observed that a significant relation (p < 0.05) was observed between responses, with interns having a better knowledge regarding investigations and treatment interventions ([Table 3]).

Table 3

Distribution of study subjects according to the questionnaire for knowledge-based assessment

Questionnaire

Undergraduates (N = 329)

Interns (N = 77)

Statistical analysis

Frequency

Percentage

Frequency

Percentage

Chi square

p-Value

TMJ is a type of

 Fibrous joint

26

7.902736

10

12.98701

12.0018

0.023*

 1.

 Hinge joint

42

12.76596

14

18.18182

 1.

 Ball and socket joint

64

19.45289

23

29.87013

 1.

 Diarthrodial joint

197

59.87842

30

38.96104

Trismus is due to the inflammation of

 Facial nerve irritation

21

6.382979

2

2.597403

11.615

0.056

 1.

 Lateral pterygoid

119

36.17021

25

32.46753

 1.

 Medial pterygoid

134

40.72948

41

53.24675

 1.

 Temporalis

55

16.71733

9

11.68831

The most common cause of TMJ dislocation is

 Smaller articular eminence

50

15.19757

7

9.090909

8.761

0.021*

 1.

 Reduced freeway space

17

5.167173

2

2.597403

 1.

 Spasm of muscles of mastication

218

66.2614

59

76.62338

 1.

 Thin articular disc

44

13.37386

9

11.68831

Which one of the following is not a feature of TMJ dislocation?

 Anterior open bite

54

16.41337

14

18.18182

12.001

0.031*

 1.

 Anterior displacement of condyle

31

9.422492

12

15.58442

 1.

 Deafness

211

64.13374

42

54.54545

 1.

 Can be reduced by applying pressure on mandible

33

10.0304

9

11.68831

Dislocation is treated by forcing the mandible

 Upward and forward

83

25.22796

6

7.792208

31.810

0.002*

 1.

 Upward and backward

75

22.79635

17

22.07792

 1.

 Downward and forward

59

17.93313

19

24.67532

 1.

 Downward and backward

112

34.04255

35

45.45455

Hydrocortisone acetate is injected into painful arthritic TMJ to

 Lubricate synovial joint

59

17.93313

9

11.68831

11.413

0.021*

 1.

 Increase blood supply to the TMJ

42

12.76596

9

11.68831

 1.

 Decrease the inflammatory response

185

56.231

53

68.83117

 1.

 Anesthetize the nerve supply of TMJ

43

13.06991

6

7.792208

Which of the following is not a normal feature of TMJ?

 Pain while opening the mouth

183

55.6231

59

76.62338

21.241

0.012*

 1.

 Joint sound

58

17.62918

3

3.896104

 1.

 Deviation of the mouth to the opposite side while opening the mouth is eccentric movements

43

13.06991

8

10.38961

 1.

 Bilateral synchronous movements

45

13.67781

7

9.090909

Which one of the following is the most common type of articular disc displacement?

Anterior and lateral

90

27.35562

19

24.67532

9.991

0.045*

 1.

Anterior and medial

107

32.5228

19

24.67532

 1.

Posterior and lateral

97

29.48328

21

27.27273

 1.

Posterior and medial

35

10.6383

18

23.37662

The most commonly prescribed medicine for TMDs

Opioid analgesics

23

6.990881

10

12.98701

10.016

0.024*

 1.

Antihistaminic

8

2.431611

2

2.597403

 1.

Diazepam

26

7.902736

7

9.090909

 1.

NSAID

272

82.67477

58

75.32468

The best imaging modality for articular disc derangement is

Transpharangeal radiograph

6

1.823708

3

3.896104

7.779

0.034*

MRI

209

63.52584

62

80.51948

CT scan

91

27.65957

7

9.090909

Arthroscopy

23

6.990881

5

6.493506

Abbreviations: CT, computed tomography; NSAID, nonsteroidal anti-inflammatory drug; MRI, magnetic resonance imaging;


*p-Value < 0.05 is significant.



#

Discussion

The prevalence of temporomandibular joint and muscle disorder (TMJD) is between 5 and 12%. A few studies reported a higher prevalence rate of 25 to 33%.[8] In the Saudi Arabian general populations, the prevalence rate of TMD was reported to be 35%.[9] The heterogeneity in the prevalence rates may be due to different populations, races, and the use of different assessment tools by researchers.[10] [11] [12]

Due to the demanding nature of the study patterns in universities of Saudi Arabia and complex dental curriculum, the present study was done to assess the self-awareness and knowledge of students about TMJ disorders using the self-reported questionnaire-based survey. The questionnaire used had a collection of good information in a relative period of time with better understanding and minimal cost.

In the present study, we observed that more than 90% of undergraduates and interns suffered from symptoms of TMJ disorders. Srivastava et al[5] conducted a study on dental undergraduates and reported a TMD prevalence of 36.99%. However, the higher prevalence of TMD has been reported in earlier studies by Alkhudhairy et al[6] (38%), Habib et al[7] (46.8%), and AlHussaini et al[8] (62.8%) conducted on the population groups in Saudi Arabia.

In our study and other studies[13] [14] [15] conducted in Saudi Arabia among dental students, the higher prevalence of TMD was observed among the students, being 1.65 times higher than students of other streams. This could be due to the fact that the dental students have theoretical and clinical knowledge about the TMDs as a part of their curriculum. Hence, they could identify and relate the signs and symptoms of TMD well. Various etiological factors related to TMDs are demanding such as the curriculum of university studies, patient care, inherent challenges, and apprehension about the career.[5]

We observed that undergraduates and interns both have similar incidences of pain, articular sounds, trismus, and lock jaw. As they both suffer from a similar level of stress of academic and clinical courses. Increased levels of anxiety and stress-related symptoms have been observed in TMD patients. This is common among university students as they undergo role transitions, being away from their family home, residing in hostels with other students, with lack of adult guidance, supervision, and care.[16] [17]

Similar to our study, Bonjardim et al[18] reported that the common subjective symptoms observed were TMJ sounds (26.72%), headache (21.65%), tooth grinding (17.98%), and pain in the face or jaw regions (12.9%).

We also observed that more interns had undergone trauma to the head and neck areas and got their orthodontic treatment done in the past. However, still almost an equal percentage of undergraduates and interns suffered from TMD symptoms. Findings were in relation with the study by Egermark et al[19] who concluded that patients who had undergone orthodontic treatment during childhood did not have a higher risk of developing signs or symptoms of TMDs later in life. They also stated that correlations between signs and symptoms of TMDs and different types of malocclusion are commonly weak or nonexistent.

Thus, psychological factors have an important role in causing TMDs. It has been observed that an increase in the level of knowledge about TMJ and TMDs among students increase the response rate and self-awareness about the identification of TMDs.

However, the conclusions and associations observed from our study should be carefully interpreted in the light of limitations of this study, such as a convenient sample size, use of a brief questionnaire, unequal distribution of student groups and genders. Although our study gives some information regarding the self-awareness and knowledge of TMDs among dental students of Jazan University, Saudi Arabia, long-term clinical studies should be conducted in the future to compare the students of different streams, institutes, and universities.


#

Conclusion

The present study showed a similar percentage of undergraduates and interns were suffering with trismus, articular sounds, pain, and arthralgia. Interns had better knowledge regarding investigations and treatment interventions. A direct relationship exists between the level of knowledge about TMJ and TMDs and self-awareness of its signs and symptoms.


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Conflict of Interest

None declared.


Address for correspondence

Mohammed Najmuddin, MDS
Department of Maxillofacial Diagnostic Sciences, College of Dentistry, Jazan University
Jazan 82511
Saudi Arabia   

Publication History

Article published online:
04 January 2023

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