Skip to main content
Top
Published in: BMC Oral Health 1/2021

Open Access 01-12-2021 | Bruxism | Research

Temporomandibular disorders among medical students in China: prevalence, biological and psychological risk factors

Authors: Jing Wu, Zelun Huang, Yong Chen, Yifan Chen, Zhongqiang Pan, Yu Gu

Published in: BMC Oral Health | Issue 1/2021

Login to get access

Abstract

Background

The purpose of the present study is to evaluate the prevalence of temporomandibular disorders (TMD) and their associated biological and psychological factors in Chinese university students.

Methods

A total of 754 students were included from Zunyi Medical University, each participant completed questionnaires and clinical examinations according to the Diagnostic Criteria for Temporomandibular Disorders.

Results

The overall prevalence of TMD was 31.7% among medical students. Subjects with TMD had a high prevalence of bruxism, empty chewing, unilateral chewing, chewing gum, anterior teeth overbite, anterior teeth overjet, depression, anxiety, and sleep disturbance. Moreover, sleep bruxism, empty chewing, unilateral chewing, anterior teeth overbite, depression, and anxiety were the strongest risk factors for TMD.

Conclusions

Individuals with TMD have a high prevalence of psychological distress and oral parafunctional habits. Except for the psychological factors associated with TMD, bruxism, abnormal chewing, and malocclusion also shared similar risks for TMD.
Appendix
Available only for authorised users
Literature
1.
go back to reference Fernández-de-Las-Peñas C, Von Piekartz H. Clinical reasoning for the examination and physical therapy treatment of temporomandibular disorders (TMD): a narrative literature review. J Clin Med. 2020;9(11):3686.CrossRef Fernández-de-Las-Peñas C, Von Piekartz H. Clinical reasoning for the examination and physical therapy treatment of temporomandibular disorders (TMD): a narrative literature review. J Clin Med. 2020;9(11):3686.CrossRef
2.
go back to reference Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, Dubner R, Diatchenko L, Meloto CB, Smith S, et al. Painful temporomandibular disorder: decade of discovery from OPPERA studies. J Dent Res. 2016;95(10):1084–92.CrossRef Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, Dubner R, Diatchenko L, Meloto CB, Smith S, et al. Painful temporomandibular disorder: decade of discovery from OPPERA studies. J Dent Res. 2016;95(10):1084–92.CrossRef
3.
go back to reference List T, Jensen RH. Temporomandibular disorders: old ideas and new concepts. Cephalalgia. 2017;37(7):692–704.CrossRef List T, Jensen RH. Temporomandibular disorders: old ideas and new concepts. Cephalalgia. 2017;37(7):692–704.CrossRef
4.
go back to reference Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. J Dent Res. 2016;95(10):1093–101.CrossRef Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. J Dent Res. 2016;95(10):1093–101.CrossRef
5.
go back to reference Visscher CM, Baad-Hansen L, Durham J, Goulet J-P, Michelotti A, Roldán Barraza C, Häggman-Henrikson B, Ekberg E, Raphael KG. Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions. J Am Dent Assoc. 2018;149(6):422–31.CrossRef Visscher CM, Baad-Hansen L, Durham J, Goulet J-P, Michelotti A, Roldán Barraza C, Häggman-Henrikson B, Ekberg E, Raphael KG. Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions. J Am Dent Assoc. 2018;149(6):422–31.CrossRef
6.
go back to reference Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Diatchenko L, Dubner R, Bair E, Baraian C, Mack N, Slade GD, et al. Psychological factors associated with development of TMD: the OPPERA prospective cohort study. J Pain. 2013;14(12 Suppl):T75–90. Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Diatchenko L, Dubner R, Bair E, Baraian C, Mack N, Slade GD, et al. Psychological factors associated with development of TMD: the OPPERA prospective cohort study. J Pain. 2013;14(12 Suppl):T75–90.
7.
go back to reference Ohrbach R, Slade GD, Bair E, Rathnayaka N, Diatchenko L, Greenspan JD, Maixner W, Fillingim RB. Premorbid and concurrent predictors of TMD onset and persistence. Eur J Pain. 2020;24(1):145–58.CrossRef Ohrbach R, Slade GD, Bair E, Rathnayaka N, Diatchenko L, Greenspan JD, Maixner W, Fillingim RB. Premorbid and concurrent predictors of TMD onset and persistence. Eur J Pain. 2020;24(1):145–58.CrossRef
8.
go back to reference Jiménez-Silva A, Peña-Durán C, Tobar-Reyes J, Frugone-Zambra R. Sleep and awake bruxism in adults and its relationship with temporomandibular disorders: a systematic review from 2003 to 2014. Acta Odontol Scand. 2017;75(1):36–58.CrossRef Jiménez-Silva A, Peña-Durán C, Tobar-Reyes J, Frugone-Zambra R. Sleep and awake bruxism in adults and its relationship with temporomandibular disorders: a systematic review from 2003 to 2014. Acta Odontol Scand. 2017;75(1):36–58.CrossRef
9.
go back to reference Ohlmann B, Waldecker M, Leckel M, Bömicke W, Behnisch R, Rammelsberg P, Schmitter M. Correlations between sleep bruxism and temporomandibular disorders. J Clin Med. 2020;9(2):611.CrossRef Ohlmann B, Waldecker M, Leckel M, Bömicke W, Behnisch R, Rammelsberg P, Schmitter M. Correlations between sleep bruxism and temporomandibular disorders. J Clin Med. 2020;9(2):611.CrossRef
10.
go back to reference Shu J, Zhang Y, Chong DYR, Liu Z. Effects on loads in temporomandibular joints for patients with mandibular asymmetry before and after orthognathic surgeries under the unilateral molar clenching. Biomech Model Mechanobiol. 2020;19(2):533–41.CrossRef Shu J, Zhang Y, Chong DYR, Liu Z. Effects on loads in temporomandibular joints for patients with mandibular asymmetry before and after orthognathic surgeries under the unilateral molar clenching. Biomech Model Mechanobiol. 2020;19(2):533–41.CrossRef
11.
go back to reference Khayat N, Winocur E, Emodi Perelman A, Friedman-Rubin P, Gafni Y, Shpack N. The prevalence of posterior crossbite, deep bite, and sleep or awake bruxism in temporomandibular disorder (TMD) patients compared to a non-TMD population: a retrospective study. Cranio. 2021;39(5):398–404.CrossRef Khayat N, Winocur E, Emodi Perelman A, Friedman-Rubin P, Gafni Y, Shpack N. The prevalence of posterior crossbite, deep bite, and sleep or awake bruxism in temporomandibular disorder (TMD) patients compared to a non-TMD population: a retrospective study. Cranio. 2021;39(5):398–404.CrossRef
12.
go back to reference Giray B, Sadry S. Modifications in Class I and Class II Div. 1 malocclusion during orthodontic treatment and their association with TMD problems. Cranio. 2021;39(1):65–73.CrossRef Giray B, Sadry S. Modifications in Class I and Class II Div. 1 malocclusion during orthodontic treatment and their association with TMD problems. Cranio. 2021;39(1):65–73.CrossRef
13.
go back to reference Sójka A, Stelcer B, Roy M, Mojs E, Pryliński M. Is there a relationship between psychological factors and TMD? Brain Behav. 2019;9(9):e01360.CrossRef Sójka A, Stelcer B, Roy M, Mojs E, Pryliński M. Is there a relationship between psychological factors and TMD? Brain Behav. 2019;9(9):e01360.CrossRef
14.
go back to reference Canales GDLT, Guarda-Nardini L, Rizzatti-Barbosa CM, Conti PCR, Manfredini D. Distribution of depression, somatization and pain-related impairment in patients with chronic temporomandibular disorders. J Appl Oral Sci. 2019;27:e20180210.CrossRef Canales GDLT, Guarda-Nardini L, Rizzatti-Barbosa CM, Conti PCR, Manfredini D. Distribution of depression, somatization and pain-related impairment in patients with chronic temporomandibular disorders. J Appl Oral Sci. 2019;27:e20180210.CrossRef
15.
go back to reference Simoen L, Van den Berghe L, Jacquet W, Marks L. Depression and anxiety levels in patients with temporomandibular disorders: comparison with the general population. Clin Oral Investig. 2020;24(11):3939–45.CrossRef Simoen L, Van den Berghe L, Jacquet W, Marks L. Depression and anxiety levels in patients with temporomandibular disorders: comparison with the general population. Clin Oral Investig. 2020;24(11):3939–45.CrossRef
16.
go back to reference Dreweck FDS, Soares S, Duarte J, Conti PCR, De Luca Canto G, Luís Porporatti A. Association between painful temporomandibular disorders and sleep quality: a systematic review. J Oral Rehabil. 2020;47(8):1041–51.CrossRef Dreweck FDS, Soares S, Duarte J, Conti PCR, De Luca Canto G, Luís Porporatti A. Association between painful temporomandibular disorders and sleep quality: a systematic review. J Oral Rehabil. 2020;47(8):1041–51.CrossRef
17.
go back to reference Natu VP, Yap AUJ, Su MH, Irfan Ali NM, Ansari A. Temporomandibular disorder symptoms and their association with quality of life, emotional states and sleep quality in South-East Asian youths. J Oral Rehabil. 2018;45(10):756–63.CrossRef Natu VP, Yap AUJ, Su MH, Irfan Ali NM, Ansari A. Temporomandibular disorder symptoms and their association with quality of life, emotional states and sleep quality in South-East Asian youths. J Oral Rehabil. 2018;45(10):756–63.CrossRef
18.
go back to reference Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, List T, Svensson P, Gonzalez Y, Lobbezoo F, et al. 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†. J Oral Facial Pain Headache. 2014;28(1):6.CrossRef Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, List T, Svensson P, Gonzalez Y, Lobbezoo F, et al. 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. J Oral Facial Pain Headache. 2014;28(1):6.CrossRef
19.
go back to reference Levis B, Benedetti A, Thombs BD. Accuracy of patient health questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476.CrossRef Levis B, Benedetti A, Thombs BD. Accuracy of patient health questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476.CrossRef
20.
go back to reference Toussaint A, Hüsing P, Gumz A, Wingenfeld K, Härter M, Schramm E, Löwe B. Sensitivity to change and minimal clinically important difference of the 7-item generalized anxiety disorder questionnaire (GAD-7). J Affect Disord. 2020;265:395–401.CrossRef Toussaint A, Hüsing P, Gumz A, Wingenfeld K, Härter M, Schramm E, Löwe B. Sensitivity to change and minimal clinically important difference of the 7-item generalized anxiety disorder questionnaire (GAD-7). J Affect Disord. 2020;265:395–401.CrossRef
21.
go back to reference Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.CrossRef Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.CrossRef
22.
go back to reference Verdonck A, Takada K, Kitai N, Kuriama R, Yasuda Y, Carels C, Sakuda M. The prevalence of cardinal TMJ dysfunction symptoms and its relationship to occlusal factors in Japanese female adolescents. J Oral Rehabil. 1994;21(6):687–97.CrossRef Verdonck A, Takada K, Kitai N, Kuriama R, Yasuda Y, Carels C, Sakuda M. The prevalence of cardinal TMJ dysfunction symptoms and its relationship to occlusal factors in Japanese female adolescents. J Oral Rehabil. 1994;21(6):687–97.CrossRef
23.
go back to reference Deng YM, Fu MK, Hägg U. Prevalence of temporomandibular joint dysfunction (TMJD) in Chinese children and adolescents. A cross-sectional epidemiological study. Eur J Orthod. 1995;17(4):305–9.CrossRef Deng YM, Fu MK, Hägg U. Prevalence of temporomandibular joint dysfunction (TMJD) in Chinese children and adolescents. A cross-sectional epidemiological study. Eur J Orthod. 1995;17(4):305–9.CrossRef
24.
go back to reference Al-Khotani A, Naimi-Akbar A, Gjelset M, Albadawi E, Bello L, Hedenberg-Magnusson B, Christidis N. The associations between psychosocial aspects and TMD-pain related aspects in children and adolescents. J Headache Pain. 2016;17:30.CrossRef Al-Khotani A, Naimi-Akbar A, Gjelset M, Albadawi E, Bello L, Hedenberg-Magnusson B, Christidis N. The associations between psychosocial aspects and TMD-pain related aspects in children and adolescents. J Headache Pain. 2016;17:30.CrossRef
25.
go back to reference Karibe H, Shimazu K, Okamoto A, Kawakami T, Kato Y, Warita-Naoi S. Prevalence and association of self-reported anxiety, pain, and oral parafunctional habits with temporomandibular disorders in Japanese children and adolescents: a cross-sectional survey. BMC Oral Health. 2015;15:8.CrossRef Karibe H, Shimazu K, Okamoto A, Kawakami T, Kato Y, Warita-Naoi S. Prevalence and association of self-reported anxiety, pain, and oral parafunctional habits with temporomandibular disorders in Japanese children and adolescents: a cross-sectional survey. BMC Oral Health. 2015;15:8.CrossRef
26.
go back to reference de Paiva Bertoli FM, Bruzamolin CD, de Almeida Kranz GO, Losso EM, Brancher JA, de Souza JF. Anxiety and malocclusion are associated with temporomandibular disorders in adolescents diagnosed by RDC/TMD. A cross-sectional study. J Oral Rehabil. 2018, 45(10):747–55.CrossRef de Paiva Bertoli FM, Bruzamolin CD, de Almeida Kranz GO, Losso EM, Brancher JA, de Souza JF. Anxiety and malocclusion are associated with temporomandibular disorders in adolescents diagnosed by RDC/TMD. A cross-sectional study. J Oral Rehabil. 2018, 45(10):747–55.CrossRef
27.
go back to reference Lei J, Fu J, Yap AUJ, Fu K-Y. Temporomandibular disorders symptoms in Asian adolescents and their association with sleep quality and psychological distress. Cranio. 2016;34(4):242–9.CrossRef Lei J, Fu J, Yap AUJ, Fu K-Y. Temporomandibular disorders symptoms in Asian adolescents and their association with sleep quality and psychological distress. Cranio. 2016;34(4):242–9.CrossRef
28.
go back to reference Rener-Sitar K, John MT, Pusalavidyasagar SS, Bandyopadhyay D, Schiffman EL. Sleep quality in temporomandibular disorder cases. Sleep Med. 2016;25:105–12.CrossRef Rener-Sitar K, John MT, Pusalavidyasagar SS, Bandyopadhyay D, Schiffman EL. Sleep quality in temporomandibular disorder cases. Sleep Med. 2016;25:105–12.CrossRef
29.
go back to reference Paulino MR, Moreira VG, Lemos GA, Silva PLP, Bonan PRF, Batista AUD. Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life. Cien Saude Colet. 2018;23(1):173–86.CrossRef Paulino MR, Moreira VG, Lemos GA, Silva PLP, Bonan PRF, Batista AUD. Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life. Cien Saude Colet. 2018;23(1):173–86.CrossRef
30.
go back to reference Naeije M, Te Veldhuis AH, Te Veldhuis EC, Visscher CM, Lobbezoo F. Disc displacement within the human temporomandibular joint: a systematic review of a ‘noisy annoyance’. J Oral Rehabil. 2013;40(2):139–58.CrossRef Naeije M, Te Veldhuis AH, Te Veldhuis EC, Visscher CM, Lobbezoo F. Disc displacement within the human temporomandibular joint: a systematic review of a ‘noisy annoyance’. J Oral Rehabil. 2013;40(2):139–58.CrossRef
31.
go back to reference Yalçın Yeler D, Yılmaz N, Koraltan M, Aydın E. A survey on the potential relationships between TMD, possible sleep bruxism, unilateral chewing, and occlusal factors in Turkish university students. Cranio. 2017;35(5):308–14.CrossRef Yalçın Yeler D, Yılmaz N, Koraltan M, Aydın E. A survey on the potential relationships between TMD, possible sleep bruxism, unilateral chewing, and occlusal factors in Turkish university students. Cranio. 2017;35(5):308–14.CrossRef
32.
go back to reference Fassicollo CE, Garcia DM, Machado BCZ, de Felício CM. Changes in jaw and neck muscle coactivation and coordination in patients with chronic painful TMD disk displacement with reduction during chewing. Physiol Behav. 2021;230:113267.CrossRef Fassicollo CE, Garcia DM, Machado BCZ, de Felício CM. Changes in jaw and neck muscle coactivation and coordination in patients with chronic painful TMD disk displacement with reduction during chewing. Physiol Behav. 2021;230:113267.CrossRef
33.
go back to reference Thilander B, Rubio G, Pena L, de Mayorga C. Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development. Angle Orthod. 2002;72(2):146–54.PubMed Thilander B, Rubio G, Pena L, de Mayorga C. Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development. Angle Orthod. 2002;72(2):146–54.PubMed
34.
go back to reference Al-Ani Z. Occlusion and temporomandibular disorders: a long-standing controversy in dentistry. Prim Dent J. 2020;9(1):43–8.CrossRef Al-Ani Z. Occlusion and temporomandibular disorders: a long-standing controversy in dentistry. Prim Dent J. 2020;9(1):43–8.CrossRef
35.
go back to reference Špalj S, Šlaj M, Athanasiou AE, Žak I, Šimunović M, Šlaj M. Temporomandibular disorders and orthodontic treatment need in orthodontically untreated children and adolescents. Coll Antropol. 2015;39(1):151–8.PubMed Špalj S, Šlaj M, Athanasiou AE, Žak I, Šimunović M, Šlaj M. Temporomandibular disorders and orthodontic treatment need in orthodontically untreated children and adolescents. Coll Antropol. 2015;39(1):151–8.PubMed
Metadata
Title
Temporomandibular disorders among medical students in China: prevalence, biological and psychological risk factors
Authors
Jing Wu
Zelun Huang
Yong Chen
Yifan Chen
Zhongqiang Pan
Yu Gu
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-021-01916-2

Other articles of this Issue 1/2021

BMC Oral Health 1/2021 Go to the issue