Incidence of Temporomandibular Disorders in Patients in a University Hospital Setting

Sagana M1, Senthil Murugan P*2, Jeevitha3 1Saveetha Institute of Technical sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India 2Department of Oral Maxillofacial Surgery, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India 3Department of Periodontics, Saveetha dental college, Saveetha institute of medical and technical sciences(SIMATS), Saveetha University, Chennai, Tamil Nadu, India


INTRODUCTION
Temporomandibular disorders are a set of joint and muscle dysfunctions of the craniofacial area (de Paiva Bertoli et al., 2018). Temporomandibular disorders represent a genetic designation for subgroups of orofacial pain disorders (Ha ila et al., 2017). This will signi icantly have an effect on the quality of life (Al-Khotani et al., 2016). Temporomandibular disorders are taken into account to be a standard problem within the population, affecting people from adolescence to adulthood (AlWarawreh et al., 2018). The disorders of TMJ, masticatory muscles and associated structure sometimes occur throughout childhood and adolescence, however with less intensity than in the adult population. Throughout adolescence, TMJ presents with mild or moderate signs and symptoms (Sari and Sonmez, 2002). Common symptoms of temporomandibular disorders are pain (Kumar, 2017b;Abhinav et al., 2019b), headache, limitation of mouth opening and masticatory dif iculty (AlWarawreh et al., 2018).
The etiology of temporomandibular disorders is complex, the foremost normally cited factors are emotional tension, occlusal interference, genetics, teeth loss, postural deviation, masticatory dysfunction, internal and external changes in TMJ structure, either alone or both (Dworkin, 2010). Some studies also suggested that psychological disturbances, parafunctional habits like bruxism and trauma (Abhinav et al., 2019a) also contribute to the etiology of TMD (Agarwal et al., 2016). Intra Alveolar medication lessens pain, in lammation and infection and better wound healing in dry sockets where the pain mimics TMJ pain (Jesudasan et al., 2015;Marimuthu et al., 2018;Christabel et al., 2016).
The combination of psychological, structural and postural factors ends up in the derangement of the purposeful balance between 3 components of the stomatognathic system, namely dental occlusion, masticatory muscles and TMJ. Thus, it causes a spread of conditions and symptoms corresponding to pain within the muscle of mastication and TMJ, presence of noise and joint deviation, headache and hearing disorders. These characteristics vary from person to person, whose quality of life is negatively affected by their presence. The person's physiological and structural tolerance is the aspect which will con irm whether or not they will develop the disorder (de Lima Amarante et al., 2018).
The radiographic techniques used for diagnosis of the temporomandibular disorder are MRI, CBCT, high resolution ultrasonography and CT (Talmaceanu et al., 2018;Packiri, 2017). The commonly used treatments for TMD are pharmacotherapy (Rao and Kumar, 2018), occlusal splint therapy, TMJ arthrocentesis and TMJ surgery (Kumar and Sneha, 2016;Patil et al., 2017;Jain et al., 2019) depending upon the severity. A study suggests that botulinum toxin is more ef icacious and less invasive in the treatment of orofacial pain (Kumar, 2017c). This study aims to evaluate the incidence of temporomandibular disorders in patients referred to Saveetha Dental College.

MATERIALS AND METHODS
This retrospective study was done in Saveetha Dental College and Hospitals, Chennai. Data of patients who underwent treatment for TMD were collected from patients dental records. Sample collected was from June 2019 to March 2020. A total sample data of 77 patients were included in this study. All the case sheets were reviewed and cross veri ied with photographs. Both internal and external validity is available. Data collected are age, gender and the treatment undergone by the patient. Approval from the ethical committee was taken before the start of the study.
Both male and female patients were included. The patients who underwent treatment for temporomandibular disorders were included in the study. Incomplete and rejected data were excluded. All these dates were entered in Microsoft excel sheet and analysed by SPSS software using Chi-Square test.

RESULTS AND DISCUSSION
Out of these 77 patients, 51% were female and 49% were male. From the graph, it is evident that there is an increased number of female patients who underwent treatment for TMD Figure 1. The proportion of patients who underwent treatment for TMD was higher in females. About 72% of patients indicated for temporomandibular disorder underwent pharmacotherapy as treatment. From the graph, it is evident that most of the patients diagnosed with TMD underwent pharmacotherapy as treatment Figure 2. About 25% of patients underwent arthrocentesis and about 3% of patients who were diagnosed with temporomandibular disorder underwent surgery as management. Gender is not signi icantly associated with different treatment modalities for temporomandibular disorders (Chi-Square test; p-value 0.7not statistically signi icant) Figure 3. In recent times temporomandibular disorders have been identi ied as a frequent pathological disorder (Akhter, 2019). Temporomandibular disorder (TMD) is a collective term embracing a number of clinical conditions involving the temporomandibular joint (TMJ), masticatory muscles and/or associated structures (Thilander et al., 2002). Numerous studies Johansson et al. (2003); Pow et al. (2001); Goulet et al. (1995) have been reported about the incidence of signs and symptoms of patients with temporomandibular disorders. Most studies reported that the patients with temporomandibular disorders presented with symptoms of Pain from TMJ, Joint sounds, Dif iculty opening jaw, Bruxism, Sensitive teeth, Burning mouth and Chewing dif iculty.
A study by Johansson et al. (2003) stated that women reported more often than men from the TMJ sounds, bruxism, sensitive teeth and burning mouth symptoms. Our study indings stated that females are more prevalent than Male. The results of our study were in concordance with this literature. A study by Wright and North (2009) stated that about 2.5% of patients underwent TMJ surgery as the management of temporomandibular disorders. The results obtained by our study is that only 3% of patients underwent surgery as management. The result of our study is comparable with the results of this literature.
A study by Gauer and Semidey (2015) stated that about 50-90% of patients had undergone pharmacotherapy as a management measure for TMD. Our study indings (pharmacotherapy was undergone by 72% of patients) were comparable with the literature.  Lai et al. (2020) stating that females are more prevalent than Male. There is a higher incidence of female patients with temporomandibular disorders than Male. Our study indings revealed that 51% of patients with temporomandibular disorders with females. Our study indings are similar with the literature. Female reproductive hormones are well-known to be related to an enhanced risk of TMD pain (LeResche et al., 2005). Likewise, pubertal development is more related to pain than age because the presence of reproductive hormones will increase the risk of developing pain. TMD pain prevalence ought to increase throughout puberty in girls (LeResche et al., 1997). If gender is expounded to TMD onset, this factor could begin to play a role throughout the adolescent period (Pereira et al., 2009).

Numerous studies
The importance and complete knowledge and awareness about TMD should be emphasised to the practitioners (Patturaja and Pradeep, 2016;Kumar and Rahman, 2017;Kumar, 2017a).

Limitations
The incidence of patients who underwent treatment for TMD is observed with the fact that the subjects examined represent a selected population. Further studies can be done with a larger sample size.

CONCLUSION
Within the limitations of the study, the incidence of temporomandibular disorders in patients reported to Saveetha Dental College was observed. A detailed examination should be done for early diagnosis and better prognosis. Awareness to clinicians should be done on various other temporomandibular treatments. More importance should be given towards educating the patients as a patient's education is a key for successful TMD rehabilitation. Further investigations should be done to spot risk factors related to TMD so as to ascertain measures for prevention and treatment.

Funding Support
The authors declare that they have no funding support for this study.

Con lict of Interest
The authors declare that they have no con lict of interest for this study.