Evaluation of temporomandibular disorders among dental students of Saudi Arabia using
      Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): a cross-sectional study

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Abstract

Background

Temporomandibular disorders (TMD) are a broad category of conditions arising from the various components of the temporomandibular joint complex. Bio-psychosocial model is the most accepted theory describing the etiopathogenesis of TMD. Dental students are vulnerable to psychological disorders, including anxiety, depression, and stress. Hence, the aim of the current study was to evaluate the prevalence and possible risk factors of TMD among dental students of various academic levels and explore the association of TMDs with demographic, academic, and psychosocial parameters.

Methods

A total of 246 students of a Saudi Arabia dental school were chosen for the study. After getting consent, all students were examined according to the Diagnostic Criteria for Temporomandibular Disorders, including Axis I and II components.

Results

The overall cross-sectional prevalence of TMD was found to be 36.99%. Pain arising from the jaw, temple, and the peri-auricular area were the most commonly reported symptoms and elicited signs during examination. Among the pain-related TMD, myalgia was the commonest diagnosed condition, whereas disc displacement with reduction was found prevalent in the intra-articular disorder category. Female (OR = 1.94; P = 0.004), married (OR = 1.74; P = 0.04), and students in clinical academic levels (OR = 1.65; P = 0.03) were found to have significantly increased risk of TMD. Among the psychosocial parameters, anxiety (OR = 1.55; P = 0.04) and parafunctional behaviours (OR = 2.10; P < 0.001) were shown to increase the risk of developing TMD. Students with any TMD reported to have significantly higher pain intensity levels (OR = 1.68; P = 0.01) and jaw functional limitations (OR = 1.45; P = 0.008).

Conclusion

Dental students, especially in clinical levels were shown to pose a higher risk of developing TMD, hence strategies such as academic counselling and objective evaluation via rubrics should be planned to modify the administration of the curriculum, training methods and evaluation process.

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Most cited references 57

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The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Erik von Elm, Douglas G. Altman, Matthias Egger … (2008)

Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalizability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover 3 main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors, to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to all 3 study designs and 4 are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available at http://www.annals.org and on the Web sites of PLoS Medicine and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.

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Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†.

Eric D Schiffman, Richard Ohrbach, Edmond L Truelove … (2014)

The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.

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Central sensitization: implications for the diagnosis and treatment of pain.

Clifford Woolf, John Jarrell (2011)

Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and post-surgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk in both developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the first discovery of activity-dependent synaptic plasticity in the spinal cord and the revelation that it occurs and produces pain hypersensitivity in patients. Nevertheless, discovering the genetic and environmental contributors to and objective biomarkers of central sensitization will be highly beneficial, as will additional treatment options to prevent or reduce this prevalent and promiscuous form of pain plasticity. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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Author and article information

Contributors

Kumar Chandan Srivastava:

ORCID: http://orcid.org/0000-0002-5969-6810

drkcs.omr@gmail.com

Journal

Journal ID (nlm-ta): BMC Oral Health

Journal ID (iso-abbrev): BMC Oral Health

Title: BMC Oral Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6831

Publication date (Electronic): 26 April 2021

Publication date PMC-release: 26 April 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 211

Affiliations

[1 ]GRID grid.440748.b, ISNI 0000 0004 1756 6705, Oral Medicine and Radiology, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, , Jouf University, ; Sakaka, 72345 Saudi Arabia

[2 ]GRID grid.440748.b, ISNI 0000 0004 1756 6705, Periodontics, Department of Preventive Dentistry, College of Dentistry, Jouf University, ; Sakaka, 72345 Saudi Arabia

[3 ]GRID grid.440748.b, ISNI 0000 0004 1756 6705, Oral Surgery, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, , Jouf University, ; Sakaka, 72345 Saudi Arabia

[4 ]GRID grid.440748.b, ISNI 0000 0004 1756 6705, Prosthetic Dental Sciences, College of Dentistry, , Jouf University, ; Sakaka, 72345 Saudi Arabia

[5 ]GRID grid.412125.1, ISNI 0000 0001 0619 1117, Department of Oral Diagnostic Sciences, Faculty of Dentistry, , King Abdulaziz University, ; Jeddah, Saudi Arabia

[6 ]GRID grid.440748.b, ISNI 0000 0004 1756 6705, Orthodontics, Department of Preventive Dentistry, College of Dentistry, , Jouf University, ; Sakaka, 72345 Saudi Arabia

Author information

Kumar Chandan Srivastava http://orcid.org/0000-0002-5969-6810

Deepti Shrivastava http://orcid.org/0000-0002-1073-9920

Mohammad Khursheed Alam http://orcid.org/0000-0001-7131-1752

Article

Publisher ID: 1578

DOI: 10.1186/s12903-021-01578-0

PMC ID: 8077893

PubMed ID: 33902543

SO-VID: fc2ec9cb-9267-46d6-84a2-f200d362f77d

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 22 January 2021

Date accepted : 15 April 2021

Custom metadata

ScienceOpen disciplines: Dentistry

Keywords: dc/tmd,anxiety,dental students,diagnostic criteria,parafunctional behaviours

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ScienceOpen disciplines: Dentistry

Keywords: dc/tmd, anxiety, dental students, diagnostic criteria, parafunctional behaviours

Evaluation of temporomandibular disorders among dental students of Saudi Arabia using Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): a cross-sectional study

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Arab Journal of Forensic Sciences & Forensic Medicine (AJFSFM)

Most cited references 57

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†.

Central sensitization: implications for the diagnosis and treatment of pain.

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