JIAOMR
10.5005/jp-journals-10011-1310
Prevalence of Temporomandibular Joint Disorders in Outpatients at Al-Badar Dental College and Hospital
RESEARCH ARTICLE
Prevalence of Temporomandibular Joint Disorders in
Outpatients at Al-Badar Dental College and Hospital
and Its Relationship to Age, Gender, Occlusion
and Psychological Factors
Raheel Ahmed Syed, Arshiya Ara Syeda, Girish Katti, Vini Arora
ABSTRACT
Background: Temporomandibular disorder (TMD) is a
collective term that encompasses many clinical problems
involving the masticatory muscles, temporomandibular joints
(TMJ) and associated structures and it has high prevalence
among populations.
Aims and objectives: To determine the prevalence of TMD
and its relationship to age, gender, occlusion and psychological
factors and to evaluate which age group, gender, malocclusion
parameters and psychological factors contribute to the
prevalence of TMD.
Materials and methods: The study includes a sample of 250
young adults (134 girls and 116 boys) with age ranging from 18
to 25 years, the presence and severity of TMD was determined
using a self-administered anamnestic questionnaire composed
of 10 questions regarding common TMD symptoms.
Morphologic occlusion was evaluated according to Angle’s
classification (molar classes I, II, III) and to evaluate the
psychological factors, The hospital anxiety and depression scale
(HADS) developed by Zigmond and Snaith was used.
Results: Data were computerized and the SPSS package
(version 11.2) was used and nonparametric test of Chi-square
for data analysis and unpaired t-test was also used for statistical
data analysis. Anamnestic index (AI) showed that the percentage
of women (55.22%) had higher degree of TMD symptoms than
compared with men (50.86%), comparing the age of men and
women free TMD and with TMD, the statistical difference was
not significant as (t = 1.35, p > 0.5), distribution of the cases
among Angle’s class I, II, III occlusion the difference was not
statistically significant as (p > 0.5), the degree of anxiety and
TMD degree among men and women patients, women had
higher anxiety levels as compared to men and no statistical
difference was found between the cases of men and women in
the depression levels.
Conclusion: Prevalence of TMD symptoms in our sample of
250 patients was high for women. Morphologic occlusion was
not associated with the presence of TMD symptoms. By
considering the psychological factors we found anxiety but not
depression associated with TMD symptoms.
Keywords: Temporomandibular disorders, The hospital anxiety
and depression scale, Anxiety and depression.
How to cite this article: Syed RA, Syeda AA, Katti G, Arora V.
Prevalence of Temporomandibular Joint Disorders in
Outpatients at Al-Badar Dental College and Hospital and Its
Relationship to Age, Gender, Occlusion and Psychological
Factors. J Indian Aca Oral Med Radiol 2012;24(4):261-268.
Source of support: Nil
Conflict of interest: None declared
Journal of Indian Academy of Oral Medicine and Radiology, October-December 2012;24(4):261-268
INTRODUCTION
According to the American Academy of Temporomandibular
Disorders, ‘temporomandibular disorders or dysfunctions
(TMD) is a collective term that encompasses many clinical
problems involving the masticatory muscles, the temporo-
mandibular joint (TMJ) and associated structures or both’.1,2
The etiology of TMD remains controversial and is
generally viewed as multifactorial. Nevertheless, a number
of studies have implicated occlusal inferences and psycho-
logical factors as more important than other variables in
providing explanation for TMD that are still under discussion.3,5
Signs and symptoms of TMD were found in all age
groups in epidemiological studies that may be as high as 88
and 55% respectively with prevalence being low in small
children and increasing with age in adolescence up to young
adulthood.4,5
The role of gender in TMD has also been extensively
discussed in the literature. TMD is considered to be 1.5 to
2 times more prevalent in women than in men and 80% of
patients treated for the disorder are women.4,5
Malocclusion has been associated with TMD, when it
is believed that the alteration of form might cause alteration
in the stomatognathic system function. With the intention
of elucidating this relation, several authors have studied
class I, II, III malocclusion, posterior crossbite anterior open
bite, horizontal overlap and vertical overlap, suggesting that
these alterations are responsible for the onset of TMD
symptoms.5,6
Evidence has been accumulating since 1950s that
psychological factors are of concern in certain subgroups
of patients with TMD. Investigators using various
psychological and behavioral assessments have reported
depression, anxiety, oral habits, chronic pain and
compromised coping skills in a certain percentage of TMD
patients. Anxiety has been proposed as an etiological factor
through oral habits and increased muscle tension.5,7,8
AIMS AND OBJECTIVES
1. To determine the prevalence of TMD and its relationship
to age, gender, occlusion and psychological factors.
2. To evaluate which age group and gender shows most
prevalent TMD.
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Raheel Ahmed Syed et al

3. To evaluate which malocclusion parameters contributes After the patient has answered the following 10 questions
to the prevalence of TMD. the questionnaire was interpreted for TMD presence and
4. To evaluate the association of psychological factors to the scores were given as:1
the prevalence of TMD. For each ‘yes’ answer, a score of ‘2’ was assigned,
‘sometimes’ had a score of ‘1’; and ‘no’, a score of ‘0’. For
MATERIALS AND METHODS questions 6 and 7, if the symptoms were bilateral, ‘1’ more
The study includes a sample of 250 young adults as inclusion point was added to the total value. Also for question 4, ‘1’
criteria (134 girls and 116 boys) with age ranging from more point was added when pain, besides frequent, was
18 to 25 years, randomly selected from the outpatients also intense.2
attending the Department of Oral Medicine and Radiology The scores were calculated and were distributed for the
at Al-Badar Rural Dental College and Hospital, Gulbarga, presence or absence of the symptoms:
Karnataka. The ethical committee of Al-Badar Rural Dental • A score of ‘0’ indicates the absence of symptoms.
College and Hospital had approved the conduct for this • A score of ‘1’ indicates the occasional occurrence.
research. • A score of ‘2’ indicates the presence of dysfunction.
Exclusion criteria for our study include: • A score of ‘3’ indicates severe pain or bilateral
1. Patients with trauma to the TMJ. symptoms.
2. Patients with congenital abnormalities related to TMJ. After summing up the scores we grouped the patients of
3. Patients following odontogenic infections like abscess, our study into four categories:2,5,10
cyst or any other periapical pathological swellings in • Score 0-3: TMD free.
relation to TMJ. • Score 4-8: Mild TMD.
4. Any pre- or postsurgical complications in relation to • Score 9-14: Moderate TMD.
the TMJ. • Score 15-23: Severe TMD.
5. Any metastatic tumors, cysts or carcinomas of the oral
cavity in relation to the TMJ. OCCLUSION EXAMINATION
Morphologic occlusion was evaluated according to Angle’s
Anamnestic Questionnaire classification (molar classes I, II, III).5
For data capture regarding to our study we used a self-
applicable history questionnaire, without the interference Hospital Anxiety and Depression Scale
of the researcher, aiming at detecting TMD. The presence The level of anxiety and depression was self-rated using
and severity of TMD was determined using a self- ‘The hospital anxiety and depression scale’ (HADS)
administered anamnestic questionnaire composed of developed by Zigmond and Snaith in 1983, as this scale
10 questions regarding common TMD symptoms. This provides an acceptable, reliable, valid and easy to use
questionnaire is a modified version of Helkimo’s anamnestic practical tool for identifying and quantifying depression and
index (AI) and has been previously used by Fonseca et al anxiety.5,10
and Conti et al. It has demonstrated a high efficiency in The HADS used in our study contained 14 questions
obtaining a diagnosis and was easy to apply.5,9 with equally distributed questions for anxiety and
Ten questions of AI proposed by Da Fonseca et al used depression.10
in our study:1,5,9
• Do you have difficulty in opening your mouth? Yes/no Seven questions for anxiety Seven questions for depression
• Do you have difficulty in moving or using your jaw? • I feel tense or ‘wound up’ • I still enjoy the things I used
Yes/no to enjoy
• I get a sort of frightened • I can laugh and see the funny
• Do you have tenderness or muscular pain when
feeling side of things
chewing? Yes/no • Worrying thoughts go • I feel cheerful
• Do you have frequent headaches? Yes/no through my mind
• I can sit at ease and • I feel as if I am slowed down
• Do you have neck aches or shoulder pain? Yes/no feel relaxed
• Do you have pain in or about the ears? Yes/no • I get a sort of frightened • I have lost interest in my
• Are you aware of noises in the jaw joints? Yes/no feeling like ‘butterflies’ appearance
in the stomach
• Do you consider your bite ‘normal’? Yes/no • I feel restless as if I have • I look forward with enjoyment
• Do you use only one side of your mouth when chewing? to be on the move to things
Yes/no • I get sudden feeling • I can enjoy a good book or
of panic radio or TV program
• Do you have morning facial pain? Yes/no
262

Prevalence of Temporomandibular Joint Disorders in Outpatients at Al-Badar Dental College and Hospital
The patients were asked to mark the options which were
rated as 0 to 3 below the questions and were calculated to
get the possible scores ranging from 0 to 21 for anxiety and
0 to 21 for depression.5,10
The scoring system for HADS is as follows:
• Score 0 to 7—normal.
• Score 8 to 10—mild.
• Score 11 to 14—moderate.
• Score 15 to 21—severe disorders.
STATISTICAL ANALYSIS
Data were computerized and the SPSS package (version
11.2) was used for the analysis. The percentages of the
subjects with TMD (of different grades of severity),
malocclusion, anxiety and depression in both genders were
calculated. The association between TMD degree and
occlusion, HADSa and HADSd was done using
nonparametric test of Chi-square for data analysis and
unpaired t-test was also used for statistical data analysis.
RESULTS
The results obtained in our study from the anamnestic index
showed that the percentage of women (55.22%) with TMD
symptoms were higher as compared to men (50.86%)
(Table 1 and Graph 1). The percentage of men (35.34%)
associated with mild TMD degree were equivalent as
compared with women (35.07%). The percentage of women
(16.42%) associated with moderate TMD degree were
higher as compared to men (10.34%). The percentage of
men (5.19%) associated with severe TMD degree were
higher as compared to women (3.73%). The overall TMD
percentage was 53.20% but this difference was not
statistically significant (Chi-square: χ2 = 1.32, p > 0.05)
(Table 2 and Graph 2).
The patients with TMD cases among men and women,
women had higher TMD symptoms (55.22%) as compared
Graph 1: Men and women with TMD degree and free TMD
Journal of Indian Academy of Oral Medicine and Radiology, October-December 2012;24(4):261-268
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to men (50.86%) and when the comparison was done for
free TMD cases, men (49.14%) had higher free of TMD
symptoms than women (44.78%) but this difference was
not statistically significant (Chi-square: χ2 = 1.32, p > 0.05).
The mean age of women free of TMD was 20.47 and
with TMD was 20.29 (t = 0.45, p > 0.05) and the mean age
of men free of TMD was 20.72 and with TMD was 21.81
(t = 1.27, p > 0.50). The mean age of men with TMD was
greater as compared to women but overall comparing the
age of men and women free TMD and with TMD, the
statistical difference was not significant as (t = 1.34, p > 0.5)
(Table 3 and Graph 3).
The majority of the patients irrespective of men and
women associated with TMD levels exhibited class I
occlusion. No significant association between morphologic
occlusion and TMD levels was found (Chi-square: χ2 = 0.27,
p > 0.5) (Table 4, Graphs 4A and B).
The percentage of the degree of anxiety with TMD
degree among men and women, women (66%) had high
anxiety levels with TMD degree as compared to men (34%)
and when we compared men and women free anxiety levels
with TMD degree, men were high (54.60%) followed by
women (45.30%).
The percentage of women (67.20%) with mild anxiety
associated with TMD degree was high as compared to men
(32.80%). In moderate level of anxiety associated with TMD
degree the percentage of women (61.80%) was high
followed by men (38%). In severe level of anxiety associated
with TMD degree women showed 100% anxiety levels
(Table 5 and Graph 5).
This shows that the difference was highly statistically
significant among men and women for the degree of
anxiety associated with TMD degree (Chi-square: χ2 =
10.39, p < 0.01).
The percentage of the degree of depression with TMD
degree among men and women, women (53.24%) had high
depression levels with TMD degree as compared to men
Graph 2: Severity of patients with TMD degree
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Raheel Ahmed Syed et al

(46.75%) and when we compared men and women free

depression levels with TMD degree, women were high
(53.75%) followed by men (46.20%).
The percentage of women (56.90%) with mild
depression associated with TMD degree was high as
compared to men (43.10%). In moderate level of depression
associated with TMD degree the percentage of men
(61.11%) were high followed by women (38.99%). In severe
levels depression associated with TMD degree women
showed 100% depression levels (Table 6 and Graph 6).

DISCUSSION
Our research was focused to find the prevalence of signs
and symptoms of TMD on a sample of outpatients attending
Graph 3: Age among men and women with free TMD and
with TMD Al-Badar Rural Dental College and Hospital, Gulbarga, and
its association to age, gender, morphologic occlusion and
psychological factors. Data collection was carried out by
means of a self-applied questionnaire.
The anamnestic index used to measure TMD degree
provided a substantial amount of information in a short
period of time and was sensitive and useful for identifying
the TMD degree in the studied population.5,11,12
In our study, we observed that (55.22%) women had a
higher degree of TMD signs and symptoms than that of
A
men (50.87%). These values are in agreement with the
studies done by Bonjardim et al in a sample of 196 patients,
women (57.43%) had a higher prevalence of TMD signs
and symptoms when compared to men (42.11%). Garcia et
al (1997) in a sample of 122 students (61%) had some degree
of TMD signs and symptoms out of which 84 (68.85%) of
them were women. Similar results were found with Conti
et al (68%) as both the authors used the same questionnaire
to evaluate the TMD. This was also in agreement with other
B
studies done by Widmalm et al, Sonmez and Yap et al.5,8,12-16
Graphs 4A and B: Association of malocclusion with TMD degree
(A) Angle’s class I malocclusion with TMD degree, (B) Angle’s class II Our study revealed that out of 116 men, 49.13% were
malocclusion with TMD degree free of TMD, 35.34% were mild, 10.34% were moderate

Graph 5: Anxiety associated with TMD degree Graph 6: Depression associated with TMD degree

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Prevalence of Temporomandibular Joint Disorders in Outpatients at Al-Badar Dental College and Hospital

and 5.19% showed severe signs and symptoms and out of Our results were in a close match with the studies done
134 women, 44.78% were free of TMD, 35.07% were mild, by Conti et al which comprised 310 students (51.61%
16.42% were moderate and 3.73% showed severe signs and females and 48.39% males) with a mean age of 19.79 years.
symptoms of TMD. The overall TMD percentage was The anamnestic questionnaire in the study done by Conti et
53.20% but this difference was not statistically significant al revealed that 58.71% of subjects were asymptomatic,
(Chi-square: χ2 = 1.32, p > 0.05). 34.84% had mild TMD signs and symptoms, 5.81% had
Our results were in agreement with the study done by moderate and only 0.65% had severe TMD signs and
Bonjardim et al in a sample of 196 patients, when compared symptoms.12
TMD degree among men and women, 42.57% of women Our results were in agreement with the study done by
were free of TMD signs and symptoms, 46.53% had mild Pedroni et al (2003) who evaluated 50 Brazilian college
students. The anamnestic questionnaire in the study done
TMD, 7.92% had moderate and 2.98% had severe TMD
by Pedroni et al revealed that 68% of the volunteers had
signs and symptoms. Among men 57.89% were free of TMD
some degree of TMD. Among them 15.62% females were
signs and symptoms, 34.74% had mild TMD, 6.32% had
TMD free, 46.87% had mild TMD signs and symptoms,
moderate TMD and 1.05% had severe TMD signs and
20% had moderate and 9.37% had severe signs and
symptoms.
symptoms of TMD. Among men, 61.11% were TMD free,
33.33% had mild TMD signs and symptoms and 5.55% had
Table 1: Men and women with TMD and free of TMD moderate signs and symptoms of TMD.17
Gender Patients with Patients free Total (n) In our study, mild TMD degree was the most prevalent
TMD (n) of TMD (n)
category for female and male patients, this was also in
Men 59 (50.86%) 57 (49.14%) 116 (100%) agreement with the studies done by Dekon et al (2002),
Women 74 (55.22%) 60 (44.78%) 134 (100%)
Pedroni et al (2003), Oliveira AS (2006) and Bonjardim
Total 133 (53.20%) 117 (46.80%) 250 (100%)
et al (2007) who also found similar results using the Fonseca

Table 2: Severity of patients with TMD degree Table 4: Association of malocclusion with TMD degree
TMD degree Men (n) Women (n) Total Molar Free TMD Mild TMD Moderate Severe
class TMD TMD
Free of TMD 57 (49.13%) 60 (44.78%) 117 (46.80%)
Mild 41 (35.34%) 47 (35.07%) 88 (35.20%) I 110 84 34 09
Moderate 12 (10.34%) 22 (16.42%) 34 (13.60%) II 07 04 – 02
Severe 6 (5.19%) 5 (03.73%) 11 (04.40%) III – – – –
Total 116 (100%) 134 (100%) 250 (100%) Chi-square: χ2 = 0.27, p > 0.05
Chi-square: χ2 = 1.32, p > 0.05, not significant

Table 3: Age among men and women with free TMD and with TMD
Sex Age free of TMD Age with TMD t-value Significant p-value
Female Mean ± SD (59) Mean ± SD (75) 0.45 >0.05
20.47 ± 2.21 20.29 ± 2.14
Male Mean ± SD (57) Mean ± SD (59) 1.27 >0.05
20.72 ± 1.94 21.18 ± 2.03
Total 20.59 ± 2.14 20.68 ± 2.31 1.34 >0.05

Table 5: Anxiety associated with TMD degree

TMD degree Free of Mild Moderate Severe Total Grand
anxiety (M/F) anxiety (M/F) anxiety (M/F) anxiety (M/F) (M/F) total
Free TMD 45/43 11/14 02/02 – 58/59 117
Mild TMD 28/19 06/19 06/10 – 40/48 88
Moderate TMD 08/05 03/09 02/06 00/01 13/21 34
Severe TMD 01/01 01/01 03/03 00/01 05/06 11
Total 82 (54.60%)/ 21 (32.80%)/ 13 (38.20%)/ 00/02 (100%) 116 (34%)/ 250
68 (45.33%) 43 (67.20%) 21 (61.80%) 134 (66%)
Grand total 150 64 34 02 250 250
Chi-square: χ = 10.39, p < 0.01
2

Journal of Indian Academy of Oral Medicine and Radiology, October-December 2012;24(4):261-268 265
Raheel Ahmed Syed et al
Table 6: Depression associated with TMD degree
TMD degree Free of Mild
depression (M/F) depression (M/F)
Free TMD 39/47 12/14
Mild TMD 31/32 08/11
Moderate TMD 09/13 04/07
Severe TMD 01/01 01/01
Total 80 (46.20%)/ 25 (43.10%)/
93 (53.75%) 33 (56.90%)
Grand total 173 58
Chi-square: χ = 0.94, p > 0.05
2
questionnaire to evaluate the prevalence of TMD signs and
symptoms.12,17,18
Although the difference in TMD prevalence between
males and females are not yet confirmed, but some theories
have been proposed for female predominance. According
to the theory, Smith et al suggested female seek treatment
more frequently than men because they maintain a healthier
relationship and close contact with the health professional.
Weinberg and Sandstron et al believed that males can easily
handle stress factors than females. More recently Lewitt
and Mikinney et al found females with TMD compared to
males with TMD and reported a higher level of severity of
all physical and psychological symptoms. Also the presence
of estrogen receptors in the TMJ and the possible role of
exogenous hormones have been suggested to be important
for gender difference. Despite these theories, the true reason
for why females present with higher signs and symptoms
of TMD and present frequently for treatment remains
unknown and warrant additional studies.19-21
In our study, we found that the mean age of women free
of TMD and with TMD was (20.47) and (20.29) respectively
and the mean age of men free of TMD and with TMD was
(20.72) and (21.18) respectively but there was no statistical
correlation found between the age group of men and women
(t = 1.34, p > 0.05). This was in agreement with the several
studies which showed that the severity of TMD symptoms
varies with age. The increase of signs and symptoms during
childhood and adolescence has been taken by some that
TMD is progressive, at any rate in women, while the large
fluctuation of signs and symptoms, where spontaneous
remission is very common, has been interpreted by others
that TMD is a self-limiting disorder. In women the
symptoms generally increase after puberty, to peak at the
reproductive age group (between 20-40 years).5
The increase in TMD symptoms between age 15 and
age 25 observed at the 10-year follow-up in a study done
by Magnusson et al (1999) seemed to have leveled out, and
in general no significant increase was found up to the age
of 35 years. On the other hand, fluctuation in TMD
symptoms was evident also during the last 10-year period.
266
Moderate Severe Total Grand
depression (M/F) depression (M/F) (M/F) total
03/02 – 54/63 117
03/03 – 42/46 88
00/01 – 13/21 34
05/01 00/01 01/07 11
11 (61.11%)/ 116 (46.75%)/
07 (38.99%) 00/01 (100%) 134 (53.24%) 250
18 01 250 250
Continuing development into more serious conditions was
rare, e.g. clicking did not develop into locking in any subject,
and the prevalence of frequent TMD symptoms was about
the same (10-12%) at both 25 and 35 years of age.22
The role of occlusion in TMD has been extensively
studied for a long time. Although occlusal factors have been
considered as an important predisposing and initiating factor
in the past, recent publications suggest no scientific evidence
for positive relationship between occlusion factor and TMD.
This was in agreement with our findings in which the
majority of the patients (94.2%) irrespective of men and
women associated with TMD levels exhibited class I
occlusion with (5.2%) exhibited class II occlusion.
No significant association between morphologic
occlusion and TMD levels was found (Chi-square: χ2 = 0.27,
p > 0.05). Our findings were in agreement with Mohlin et
al who found no association between any single
malocclusion and the severity of clinical signs. Jenni et al
did not find any significant connection between occlusal
interferences and the degree of clinical dysfunction. Gesch
et al, reported a weak association between malocclusion
and the functional and clinical parameters of occlusion as
well as subjective TMD.22-24
Henrikson, Ekberg and Nilner (1997) concluded that
normal occlusions has a lower chance of presenting signs
and symptoms of TMD, while some occlusal characteristics,
such as posterior condylar displacement with consequent
typical changes in the condylar form and more frequently
found in the individuals with class II malocclusion, increase
the chances of signs and symptoms of TMD. These
characteristics influence the muscular activity and
consequently the mandibular movement with predisposition
to TMD.17
The relationship between TMD and psychological
disturbances has been extensively studied. The percentage
of sample in our study, irrespective of the gender with mild
anxiety associated with TMD degree was 25.60%.
In moderate level of anxiety associated with TMD degree
the percentage was 13.60% and in severe level of anxiety
associated with TMD degree the percentage was 0.80%.

Prevalence of Temporomandibular Joint Disorders in Outpatients at Al-Badar Dental College and Hospital
In our study, it was found that comparing the percentage
of the degree of anxiety with TMD degree among men and
women, women (66%) had high anxiety levels with TMD
degree as compared to men (34%) and when we compared
men and women free anxiety levels with TMD degree, men
were high (54.60%) followed by women (45.30%).
The percentage of women (67.20%) with mild anxiety
associated with TMD degree was high as compared to men
(32.80%). In moderate level of anxiety associated with TMD
degree the percentage of women (61.80%) was high
followed by men (38%). In severe level of anxiety associated
with TMD degree women showed 100% anxiety levels.
This shows that the difference was highly statistically
significant among men and women for the degree of anxiety
associated with TMD degree (Chi-square: χ2 = 10.39, p < 0.01).
The percentage of sample irrespective of gender with
mild depression associated with TMD degree was 23.20%.
In moderate level of depression associated with TMD degree
the percentage was 7.20% and in severe levels depression
associated with TMD degree was 0.40%.
The percentage of the degree of depression with TMD
degree among men and women, women (53.24%) had high
depression levels with TMD degree as compared to men
(46.75%) and when we compared men and women free
depression levels with TMD degree, women were high
(53.75%) followed by men (46.20%).
The percentage of women (56.90%) with mild
depression associated with TMD degree was high as
compared to men (43.10%). In moderate level of depression
associated with TMD degree the percentage of men
(61.11%) were high followed by women (38.99%). In severe
levels depression associated with TMD degree women
showed 100% depression levels.
Out of 250 patients, depression cases associated with
TMD degree were only 45.70%, hence there was no
statistical difference found among men and women for the
degree of depression associated with TMD degree (Chi-
square: χ2 = 0.94, p > 0.01).
Our results for anxiety and depression were high as we
compared with the study done by Bonjardim et al5 in a
sample of 101 girls and 95 boys with age ranging from
18 to 25 years, the majority of the participants irrespective
of gender were free from anxiety (65.81%) and depression
(95.39%) symptoms according to HADS. With mild
(23.98%), moderate (4.61%) and severe (0.52%) anxiety
levels and (4.61%) mild depression respectively.
Our study was in agreement with Bonjardim et al8 as he
found a statistically significant association between TMD
degree and HADSa (15.20%) and 1.38% of subjects
presented with mild and moderate/severe anxiety symptoms
but not between TMD degree and HADSd (9.67%)
Journal of Indian Academy of Oral Medicine and Radiology, October-December 2012;24(4):261-268
JIAOMR
moderate/severe depression symptoms. Subjects free of
anxiety and depression comprised the majority of the sample.
Mazzetto et al asserted that anxiety plays an important
role in TMD, acting as a predisposing or aggravating factor.
Furthermore, anxiety may be an important factor in the
perception of pain, with anxious subjects paying more
attention to pain. This possibility has been confirmed by
other studies, which indicate that anxiety is related to
increased pain reports in clinical settings.25
Beaton et al and Niemi et al found higher level of stress
symptoms among the TMD patients when compared to
healthy subjects. Thus, considering that stress is associated
with psychological disturbances, such as anxiety and
depression. Thus, we can say that there appears to be a
relationship between stress and degree of TMD in our study
as well.26,27
CONCLUSION
The exact role of occlusion and psychological factors in
contributing to TMD and the reason why females constitute
the majority of patients are still unknown. It seems equally
important to suggest that further research is needed to
explore how differences in culture, ethnicity and related
variations in health care provision are possible factors
influencing the differential expression of TMD in patients
around the world.16
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ABOUT THE AUTHORS
Raheel Ahmed Syed (Corresponding Author)
Postgraduate Student (3rd Year), Department of Oral Medicine
and Radiology, Al-Badar Rural Dental College and Hospital, Gulbarga
Karnataka, India, e-mail: rahil1484@gmail.com
Arshiya Ara Syeda
Professor, Department of Oral Medicine and Radiology, Al-Badar
Rural Dental College and Hospital, Gulbarga, Karnataka, India
Girish Katti
Professor and Head, Department of Oral Medicine and Radiology
Al-Badar Rural Dental College and Hospital, Gulbarga, Karnataka
India
Vini Arora
Postgraduate Student (2nd Year), Department of Oral Medicine
and Radiology, Al-Badar Dental College and Hospital, Gulbarga
Karnataka, India