|Year : 2019 | Volume
| Issue : 2 | Page : 62-66
Prevalance of correlation between temporomandibular dysfunction and occupational stress in white collar professionals
Krutika D Gawade1, G Vardharajulu2
1 Faculty of Physiotherapy, Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharashtra, India
2 Dean of Krishna College of Physiotherapy, Department of Neurosciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharashtra, India
|Date of Submission||07-Mar-2019|
|Date of Acceptance||27-Apr-2019|
|Date of Web Publication||23-Jul-2019|
Dr. Krutika D Gawade
Faculty of Physiotherapy, Krishna Institute of Medical Sciences Deemed to be University, Karad - 415 110, Maharashtra
Source of Support: None, Conflict of Interest: None
Aims: Occupational stress (OS) is regarded as associated factor for causing temporomandibular joint temporomandibular dysfunction (TMD). However, there is little knowledge on the relationship between incremental OS and its role in causing TMD. The purpose of the study is to determine the relationship between OS and TMD. This study will help to provide the basic data to improve the conditions at the worksite and enhance the quality of life. Materials and Methods: A cross-sectional study was conducted among 100 white-collar professionals (WCPs) in Karad. To determine the prevalence of TMD, the scaled named Anamnestic Index by Fonseca was used. OS was assessed by the OS Index Scale. Data obtained from the outcome measures were analyzed using InStat, adopting a 5% significance level. Brief analysis was made, and the Pearson correlation test was used to find the correlation between TMD and OS. Results: The results obtained by OSI stated that majority of WCP experienced moderate stress (67%) highest among teachers. Fifty-three percent prevalence of TMD was noted, highest among teachers. The major correlation noted in moderate OS group (38%) majorly affecting teachers. The gender-wise findings noted females (53%) were more prone. Age-wise findings stated more prevalence among 31–40 years (56%). Conclusion: The results of this study show that a significant percentage of population had signs of TMDs, and there are high chances they may develop symptoms in the future. It is necessary to prevent the OS in WCP by improving working conditions, emotional stability, and frequent postural changes. Further studies are necessary for documentation of these preventive measures.
Keywords: Occupational stress, Parafunctional activities, Temporomandibular joint dysfunction, White-collar professionals
|How to cite this article:|
Gawade KD, Vardharajulu G. Prevalance of correlation between temporomandibular dysfunction and occupational stress in white collar professionals. J Health Res Rev 2019;6:62-6
|How to cite this URL:|
Gawade KD, Vardharajulu G. Prevalance of correlation between temporomandibular dysfunction and occupational stress in white collar professionals. J Health Res Rev [serial online] 2019 [cited 2019 Sep 15];6:62-6. Available from: http://www.jhrr.org/text.asp?2019/6/2/62/263239
| Introduction|| |
The temporomandibular joint (TMJ) derives its name from the two bones: the temporal bone and the mandible. It acts as a linkage between jaw and head bilaterally. It is an essential and complex synovial joint in the human body allowing to sustain basic activities of daily living, i.e., chewing, speech, communication, and emotional expression. It is the most frequently used joint in the human body.,, The joint is unique in some features implicated by its anatomical and internal designing., Two separate joints are present on either side functioning together in a synchronized closed chain pattern, yet on inspection varies impressively structurally and functionally. It has a synovial covering with the mere absence of hyaline cartilage in internal making. On the contrary, it is covered with dense, avascular collagenous cells; therefore, mimic being a fibrocartilage. This iniquity contributes to capacity of undergoing remodeling and adaptive changes.
Temporomandibular dysfunction (TMD) is the most common pathological condition experienced in association with TMJ affecting 50%–75% of population., Clinically, it is grouped as painful orofacial disorders, encompassing complaints of pain, fatigue, and tenderness in the craniocervical muscles. However, simply, it is an imbalance caused in TMJ or its surrounding structures. The occurrence of TMD is demarcated by pain and tenderness around the jaw, edema around the mandibular condyle, increased or decreased active or passive range, popping and clicking sounds, difficult functional activities such as eating and talking, and difficult parafunctional activities, i.e., clenching, bruxism. Secondary complications experienced in connotation are tension headaches, toothaches, neck aches, earaches, hearing problems, upper shoulder pain, and dizziness.
Causes of TMD are complex and multifactorial. Although numerous factors contribute; in some instances, a single factor may serve all the roles. Some contributing factors are occlusal abnormalities, orthodontic treatment, bruxism, orthopedic instability, macrotrauma, microtrauma, poor health, nutrition, joint laxity, exogenous estrogen, and psychological factors such as stress, tension, anxiety, and depression.
Personnel working in special environments are exposed to musculoskeletal disorders largely due to job stress is proved to be a contributing factor in causing dysfunction as mental stress causes jaw joint disorders, mainly affecting masticatory muscles and joint projections. Also in a study, quoted that TMD patients are restless, obsessive, dominating, and tend to express their nervousness through physical symptoms such as apprehension, anger and hostility, and fright. Parafunctional activities, i.e., chewing gums, biting pencil and nails, grinding teeth, and clenching helps release emotional tension. Parafunctional activities though help out relieve stress, initiates vicious cycle leading to morphological and functional impairments. The cycle triggers with deficient blood supply to muscle tissues with buildup of metabolic waste products in cells of the tissue; causing symptoms of pain, fatigue, and spasm. Although numerous etiologies do contribute in causing dysfunction, evidence focusing stress on increased muscle activity and causing pain around the joint area cannot be neglected. Augusto et al. in his study quoted that more than half experienced difficulty primarily due to chronic pain. Everyday activities demand high amount of adaptations from individual and therefore a detrimental source of stress. TMD affects multiple domains of life. It, therefore, interferes with daily activities and social life, having a deteriorating effect on individual's emotional and physical health along with academic and professional performance. However, the correlation between TMD and occupational stress (OS) is yet unclear and therefore investigating the prevalence in white-collar professionals (WCPs) might contribute preventive and rehabilitation strategies.
Learning about the facts gained, the objective of the study was to study the prevalence of TMD and its association with OS in WCP.
| Materials and Methods|| |
The presented study was a cross-sectional observational study. It was conducted in various institutions of Karad, Maharashtra. The samples selected were WCPs from who agreed to participate in the study after the approval by the Institutional Ethics Research Committee (Krishna Institute of Medical Sciences Deemed University, Karad) with protocol number 0221/2017–2018.
To determine the sample size, 5% significance level was adopted (with a confidence interval of 95%, Z (a/2) = 1.96 and Z − b = 0.84, resulting in required sample of minimum 66 participants to the estimated prevalence. 100 sample size was set according to the results obtained. The participants were selected according to simple random allocation method.
Individuals of age group 25–40 with WCPs including doctors, bankers, accountants, managers, teachers, clerical workers, engineers, and lawyers were included in the study.
Participants with existing TMJ dysfunction, malpositioning of teeth, malocclusion, molar defects, fixed dentures or with use of drugs antianxiety, antidepressant, and psychotics were excluded from the study.
To evaluate the WCPs, a standard format was used containing demographic data and specific instruments for evaluating OS and TMD.
To investigate the prevalence of TMD, Fonesca Anamnesis Index was used. This index is a functional assessment scale, which contains ten objective questions to assess whether the individual has TMD. Regarded as one of the few instruments that characterize the severity of symptoms of TMD, it allows the classification of the individual according to scoring: No TMD (0–15), mild TMD (20–40), moderate TMD (45–65), and severe TMD (70–100).
OS was measured by OS Index Scale developed by Srivastava and Singh (1984). The scale measures the extent of stress which employees perceive from various constituents and conditions of their job. The scale consists of 46 items. The scores range from minimum of 156 to maximum of 530. The scale classifies individual in three categories on basis of scoring as high stress (156–530), moderate stress (123–155), and low stress (46–122).
Data were analyzed using IN stat Version 3.06, adopting a 5% significance level. Descriptive analysis was made using frequency distribution. Pearson correlation test was used to verify associations between TMD and OS.
| Results|| |
The study was conducted with 100 participants. The gender distribution in the study was 50 males and 50 females. Two age criteria's were included: 25–30 and 31–40 years. WCPs from five respective professions were included as given in [Table 1]. The study analysis was done in three sections as mentioned further. Section 1 dealt with OS levels. The results obtained are as mentioned in [Table 2]. The results showed about 67% of WCP faced moderate stress. Teaching profession showed the highest prevalence of OS. Section 2 dealt with level of TMD. The results obtained are represented in [Table 3]. The results obtained showed that 47% had no TMD, 30% had mild TMD, 21% had moderate TMD, and 25 had severe TMD. The prevalence of TMD was found to be highest in teachers (14%). Section 3 dealt with the correlation between TMD and OS. [Table 4], [Table 5], [Table 6] show the presence of TMD in different stress groups. [Table 4] showed distribution of TMD in low stress group.
|Table 1: Sociodemographic data of the white-collar professionals working in various institutions of Karad, Maharashtra, India, 2017 (n=100)|
Click here to view
|Table 2: Analysis of Occupational Stress Index Scale in various professions|
Click here to view
|Table 3: Analysis of temporomandibular dysfunction according to Fonseca Questionnaire in various professions|
Click here to view
|Table 4: Distribution of temporomandibular dysfunction in low stress group|
Click here to view
|Table 5: Distribution of temporomandibular dysfunction in moderate stress group|
Click here to view
|Table 6: Distribution of temporomandibular dysfunction in severe stress group|
Click here to view
The results state that one individual had TMD with mild dysfunction in administrative sector. This states that only 1% had TMD with low stress. [Table 5] shows distribution of TMD in moderate stress group. [Table 6] shows distribution of TMD in severe stress group:
The results showed a prevalence of 16% dysfunction in individuals with severe stress group.
The results state that 20 individuals had mild TMD. It notes an overall prevalence of 38% TMD in individuals with moderate stress.
[Table 7] gives a representation about the relationship between different level of stress and level of TMD. The results obtained were maximum individuals faced moderate OS (67%). Furthermore, the prevalence of TMD was found to be highest in moderate TMD group individuals (38%). Total prevalence of dysfunction was noted as 55%. [Table 8] showed association of TMD and OS based on age, gender, and profession. It showed females had extremely significant correlation (P = 0.0048, r = 0.3929), whereas males showed no significant correlation (P = 0.1628, r = −0.2005). Age-wise distribution showed age group 31–40 had extremely significant correlation (P = 0.034, r = 0.2968), whereas age group 25–30 (P = 0.5906, r = 0.006) showed no significant correlation. The teaching profession showed a very significant correlation (P = 0.019, r = 0.6502).
|Table 7: Category-based correlation between occupational stress temporomandibular dysfunction|
Click here to view
|Table 8: Correlation rate between temporomandibular dysfunction and occupational stress-based on gender, age, and professions|
Click here to view
| Discussion|| |
The study was conducted to find if there exists any linkage between OS and TMD. TMD patients are nervous, obsessive, dominating, and express their anxiety through physical symptoms. In these individuals, worry, fear, and frustration are noted. Considering the fact, a group of 100 WCPs were selected as the study population. The results gained from the study emphasize on the hypothesis that there exists a linkage between TMD and OS. Results showed inconsistency with biological probability for its association. In a study by Al Shaban et al. stated that TMJ continues in its function unless disturbed by external influences that affect the functioning, such as mechanical, psychological, and occupational.
The distribution in the study showed the overall prevalence of TMD was 55%. Although more than half of the population showed TMD, the relationship between OS and TMD showed no major correlation (P = 0.2176, r = 0.1244). When further detailed analysis was made considering some parameters such as age, gender, and profession linkage were noted. Hence, it can be assumed that multiple other factors need to be focused when obtaining linkage. This assumption can be supported by previous studies inspecting about the factors causing TMD.
Although OS as whole did not show significant relation, some professions showed significant correlation. Teachers (r = 0.6502, P = 0.019) showed extremely significant correlation. Teaching profession majorly included female workers which would be again considered additional factor for linking OS and TMD in teachers significantly. Teaching similar findings were noted in various previous studies. The high prevalence of signs and symptoms of TMD (71.9%) confirms the results by a study by Oliveria et al. conducted with college students in Brazil, where the prevalence of TMD was 68.6%. However, also there are some studies stating TMD to be less common among college students, as the study by Minghelli et al., who estimated university students in the health area, stating TMD in only 37.3%. These differences may be related to the variability of courses, the lifestyle, and the academic position of the students during the survey period. Hence, it can be assumed that workplace conditions such as experience, type of work, working population, and timings also have a role to play in the inconsistency obtained.
Higher correlation was observed among women. This fact has been credited to the female hormones that hinder with pain threshold. According to Menezes, women's levels of estrogen cause higher laxity of joints, and thereby lowering ability to withheld functional stress., Teaching profession majorly included female workers which would be again considered a factor for linking OS and TMD. It was found that among the two age groups, the second group (31–40) showed extremely significant correlation (P = 0.034, r = 0.296) emphasizing age as a parameter responsible for the occurrence. A telephone survey of the French-speaking population reported pain around the TMJ which was found to be highest among 35–54 years old.
Further, the study purely focuses on a single factor highly neglecting the other causes. This may be a drawback accounting for negative correlation. Second, the inconsistency may be linked to the fluctuations in stress intensity. Finally, we observed more OS in severe TMD cases, and this proves OS might be a provoking cause for TMD. However, with this cross-sectional study, it is hard to find a sequential relationship between events, and therefore, hard to find a connecting relationship between them.
| Conclusion|| |
The results of this study state that OS and TMD correlate, but it is bit hard to learn the ultimate relationship between the events. Therefore, it is not clearly possible to state that OS is a cause of TMD among the participants, but the current correlation between these factors pays the way for preventive measures for WCPs, especially among those with moderate and severe signs of TMD. This is the first study to record the prevalence of TMDs in relation to OS and therefore suggest a requirement of few further studies which would surpass the limitations found in the present study. The limitations were mainly related to small sample size and study duration. However, further studies can be held taking into consideration of these limitations with a greater sample size, large study duration, different geographical area, inclusion of other professions, and also addition of work hours and work type would be a definite need as this study failed to encompass these domains.
The authors express their deep sense of gratitude to the management, Krishna Institute of Medical Sciences Deemed To Be University, Karad, Maharashtra.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sharma S, Gupta DS, Pal US, Jurel SK. Etiological factors of temporomandibular joint disorders. Natl J Maxillofac Surg 2011;2:116-9.
] [Full text]
Helland MM. Anatomy and function of the temporomandibular joint. J Orthop Sports Phys Ther 1980;1:145-52.
Augusto VG, Perina KC, Penha DS, Dos Santos DC, Oliveira VA. Temporomandibular dysfunction, stress and common mental disorder in university students. Acta Ortop Bras 2016;24:330-3.
AlShaban KK, Gul Abdul Waheed Z. Prevalence of TMJ disorders among the patients attending the dental clinic of Ajman University of science and technology-Fujairah Campus, UAE. Int J Dent 2018;2018:9861623.
Norkin CC, Levangie PK. Joint Structure and Function: A Comprehensive Analysis. 5th
ed. New Delhi: Jaypee Brothers Medical Publishers; 2011. p. 213-26.
David CM, Elavarasi P. Functional anatomy and biomechanics of temporomandibular joint and the far-reaching effects of its disorders. J Adv Clin Res Insights 2016;3:101-3.
Mottaghi A, Razavi SM, Pozveh EZ, Jahangirmoghaddam M. Assessment of the relationship between stress and temporomandibular joint disorder in female students before university entrance exam (Konkour exam). Dent Res J (Isfahan) 2011;8:S76-9.
Muthu Krishnan A, Sekar GS. Prevalence of temporomandibular disorders in Chennai population. J Indian Acad Oral Med Radiol 2015:27:508-15.
Nomura K, Vitti M, Oliveira AS, Chaves TC, Semprini M, Siéssere S, et al
. Use of the Fonseca's questionnaire to assess the prevalence and severity of temporomandibular disorders in Brazilian dental undergraduates. Braz Dent J 2007;18:163-7.
Jeong EY, Kim MR. Relationship between job-stress and Temporomandibular joint disorders in dental hygenists. J Korean Soc Dent Hyg 2014;14:381-90.
LeResche L, Saunders K, Von Korff MR, Barlow W, Dworkin SF. Use of exogenous hormones and risk of temporomandibular disorder pain. Pain 1997;69:153-60.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]