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 Table of Contents  
Year : 2021  |  Volume : 16  |  Issue : 1  |  Page : 47-51

Prevalence of temporomandibular disorders among medical students of Wardha district: A cross-sectional study

1 Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
2 Trauma Care Center, Government Medical College, Nagpur, Maharashtra, India
3 MDS Conservative Dentistry and Endodontics, Mumbai, Maharashtra, India

Date of Submission19-Dec-2019
Date of Decision08-Jan-2021
Date of Acceptance19-Jan-2021
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Sharayu Nimonkar
New SBI Colony Nisargnagri Nagpur Road, Wardha - 442 001, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-4534.322613

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Context: Temporomandibular disorder (TMD) has reached a foremost role within the context of oral health care because of its high prevalence. Although its etiology cannot be exactly interpreted, it is considered to be multifactorial. Aims: The study aimed at evaluating the prevalence of TMD among Medical students with the help of Helkimo's index. Settings and Design: This study was based a cross-sectional in vivo study design. Materials and Methods: Hundred and ten students studying in medical college were evaluated with the help of the Helkimo's index. Anamnestic component of Helkimo was analyzed using the questionnaire and was scaled. Clinical dysfunction component of the Helkimo's index was clinical assessment and was scored. Results: Descriptive statistical analysis was done. The questionnaire answered showed sounds in the temporomandibular joint pain (TMJ) area by 89%, jaw rigidity by 8%, fatigue of the jaw by 2%, and pain in TMJ by 23%. On clinical examination, 17% had mild difficulty in mouth opening, 11% showed mild mandibular deviation, 69% showed clicking sound in TMJ, 18% had mild pain in the TMJ region, and only 8% had muscle pain on palpation. Conclusion: Signs and symptoms of TMD to a varied extent were present among Medical students. Although prevalence was high, the severity was mild. Initial diagnosis may decrease the worsening of the condition in them.

Keywords: Helkimo index, stress, temporomandibular joint disorders

How to cite this article:
Shyamsukha B, Nimonkar S, Belkhode V, Nimonkar P, Pol A. Prevalence of temporomandibular disorders among medical students of Wardha district: A cross-sectional study. J Datta Meghe Inst Med Sci Univ 2021;16:47-51

How to cite this URL:
Shyamsukha B, Nimonkar S, Belkhode V, Nimonkar P, Pol A. Prevalence of temporomandibular disorders among medical students of Wardha district: A cross-sectional study. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Sep 16];16:47-51. Available from: http://www.journaldmims.com/text.asp?2021/16/1/47/322613

  Introduction Top

Temporomandibular disorder (TMD) is a comprehensive term used for the structural and functional disorders of temporomandibular joint or masticatory muscles or both. TMDs are mainly recognized by pain in the temporomandibular joint pain (TMJ) region, restricted mandibular movements, muscle tenderness, and joint sounds.[1]

The etiology of TMD is multifactorial, and to date, the exact variable that contributes to the development of TMD is mysterious. However, some variables that are considered to contribute to the TMD are occlusion, faulty prosthesis, trauma to TMJ, psychological factors, masticatory muscular dysfunction, postural deviation, internal and external changes in TMJ structures, etc.[2]

Indices help to evaluate the prevalence and the severity of TMD.[3] Helkimo was a pioneer who evolved an index to measure the severity and pain in patients with TMD. Helkimo's index comprises anamnesis and clinical and occlusal dysfunction components. It had both questionnaire and the clinical evaluation that made it more objective than being mere subjective, unlike other indices that gave more accurate results toward TMD diagnosis.[4]

The rationale of this study was early detection of the signs and symptoms of TMD among medical students of the Wardha district to prevent the worsening of the condition.

  Materials and Methods Top

A cross-sectional study was undertaken in a period of 6 months from June 2019 to December 2019 at Jawaharlal Nehru Medical College, Wardha after the ethical clearance from the institutional ethical committee (Spdc/IEC/Jun-2019/8126). Hundred and ten subjects were randomly selected for the study. The sample size was determined using the sample size formula with the desired error of margin. The subjects were informed about the study design and after their approval, informed consent was signed before starting the study.

Inclusive criteria were the healthy cooperative subjects from both the genders with an age group ranging between 18 and 26 years and with all permanent teeth. The subjects who are or who had undergone orthodontic treatment and those with diagnosed and treated cases of TMD were excluded from the study.

Helkimo's index was used to evaluate the prevalence of TMD among the medical students of Jawaharlal Nehru Medical College, Wardha. Anamnestic component of the Helkimo's index was evaluated using a questionnaire with the answer in the form of “Yes” or “No” and was scaled.

This questionnaire was evaluated and further was categorized for the severity of symptoms as follows:

  1. 0: No symptoms
  2. I: Mild symptoms

    1. Jaw fatigue
    2. Jaw stiffness
    3. TMJ sounds (clicking or crepitus).

      1. II: Severe symptoms included one or more of the following:

      1. Difficulty in the mouth opening
      2. Jaw locking
      3. Mandible dislocation and its painful movement
      4. Painful TMJ region and/or masticatory muscles.

The clinical dysfunction component of the Helkimo's index was clinically evaluated and was scored.

Scoring was done as follows:

  1. Mandibular opening – Subjects were asked to open the mouth wide and with the help of Vernier caliper, the distance between the upper and lower incisal edge of the central incisor was recorded.

    • Score 0 – >40 mm
    • Score 1–30 – 39 mm
    • Score 5 – if <40 mm.

  2. Mandibular deviation – Subjects were asked to gently open the mouth and deviation from the facial midline was calculated with the divider and a ruler.

    • Score 0– <2 mm
    • Score 1-2–5 mm
    • Score 5– >5 mm.

  3. TMJ dysfunction (clicking, locking, and luxation) was checked by palpating over TMJ and by asking the subjects to open their mouth gently

    • Score 0 – No impairment
    • Score 1 – Palpable clicking
    • Score 5 – Evident clicking, locking, and luxation.

  4. TMJ pain: By palpating in the region of TMJ

    • Score 0– No pain
    • Score 1– Palpable pain
    • Score 5– Palpebral reflex.

  5. Muscle pain: Bilateral examination was done for muscles of mastication

    • Score 0– No pain
    • Score 1– Palpable pain
    • Score 5 – Palpebral reflex.

The score obtained by each subject for clinical dysfunction was added and the total was further categorized as:

  1. 0 – No dysfunction (<1 point)
  2. I – Mild dysfunction (1–4 points)
  3. II – Moderate dysfunction (5–9 points)
  4. III – Sever dysfunction (9–25 points).

Ethical clearance

The Institutional Ethics Committee of DMIMSDU has approved the Research work proposed to be carried out at Sharad Pawar Dental College & Hospital, Sawangi(M), Wardha. Date : 21st June 2019 with Reference no Spdc/IEC/Jun-2019/8126.

  Results Top

All 110 subjects responded to the questionnaire as well as to the clinical evaluation. Analysis of anamnesis component of Helkimo's index revealed that out of 110, 98 (89.09%) had the clicking or crepitation sound in the area of TMJ, 8 (7.27%) had Jaw rigidity, 2 (1.82%) had fatigue in jaw area, 2 (1.82%) has difficulty while opening mouth, 8 (7.27%) had locking of the mandible during opening the mouth, 23 (20.91%) had pain in TMJ in the area of masticatory muscle, 13 (11.82%) had pain during the movement of the mandible, and 7 (6.36%) had luxation of the mandible [Table 1] and [Graph 1].
Table 1: Analysis of anamnesis component of Helkimo's index (questionnaire)

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On grading the severity, 8 (7.27%) showed no symptoms, 72 (65.45%) showed mild symptoms, and 30 (27.27%) showed severe symptoms as per the anamnesis component of Helkimo's index [Table 2] and [Graph 2].
Table 2: Severity of symptoms (anamnesis component of Helkimo's index)

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Evaluation of clinical dysfunction showed limited mouth opening with score 1 in 19 (17.27%) and score 5 in 6 (5.45%), deviation in opening mouth with score 1 in 11 (10%) and score 5 in 3 (2.73%), TMJ dysfunction with score 1 in 76 (69.09%) and score 5 in 3 (2.73%), TMJ pain with score 1 in 20 (18.18%) and score 5 in 1 (0.91%), and muscle pain with score 1 in 8 (7.27%) and score 5 in 0 (0%) [Table 3],[Table 4],[Table 5],[Table 6],[Table 7] and [Graph 3], [Graph 4], [Graph 5], [Graph 6], [Graph 7].
Table 3: Distribution of patients according to the opening range

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Table 4: Distribution of patients according to the mandibular deviation

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Table 5: Distribution of patients according to the temporomandibular joint dysfunction

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Table 6: Distribution of patients according to the temporomandibular joint pain

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Table 7: Distribution of patients according to the muscle pain

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On grading the severity, 18 (16.03%) showed no symptoms, 86 (78.81%) showed mild symptoms, 3 (0.27%) showed moderate symptoms, and 3 (0.27%) showed severe symptoms as per the clinical dysfunction component of Helkimo's index [Table 8] and [Graph 8].
Table 8: Severity of dysfunction (clinical dysfunction component of Helkimo's index)

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  Discussion Top

The present study aimed at evaluating the prevalence of TMD among medical students. Of 110 students, 65.45% showed mild symptoms when analyzed with the questionnaire and 78.81% showed mild dysfunction when examined physically. Many Studies are documented in literature, evaluating prevalence of TMD.[5],[6],[7],[8] Schiffman et al. evaluated TMD among nursing students with the help of index and reported prevalences of TMD in 69% of students.[9] Solberg et al. found 65% prevalence among college students, Otuyemi found 46% prevalence of TMD among university students, and Pedroni found 68% prevalence among dental students.[10],[11],[12] A study by Vojdani et al. showed 71% prevalence of TMD among university students of Shiraz.[13] Modi et al. showed 45.16% of students with mild symptoms of TMD.[14]

The finding of our study is in agreement with the results of the above-mentioned studies. It has been found that despite being at high risk for TMD, students were unaware of this disorder.

TMD is a multifactorial condition and is broadly categorized as psychosocial, psychological, and physical factors.[15] Dahlstrom and Carlsson did a systematic review and found that TMD had a high impact on oral health-related quality of life (OHRQoL).[16]

It is considered that the psychosocial component has a major role in TMD. Stress level is high among medical students which is a contributing factor for TMD. This stress results in clenching and grinding that eventually leads to overuse of muscles resulting in their fatigue and pain.[17]

It is a fact the 25% of the general population suffers from TMD and only 2% of them obtain treatment.[18] The main reason behind this is the ignorance on the part of the patient and public health-care providers who fail to diagnose TMD in its initial phase. TMD must be diagnosed at the earliest to prevent its severity and further complications.

In the present study, clicking was the most common TMJ dysfunction (69.09%) followed by TMJ pain (18.18%) and symptom of sounds in TMJ (89%) followed by pain in TMJ (20%). The results of this study were in accordance with the study done by Rani et al.[17]

A small sample size comprising only medical students from one region and exclusion of the occlusal disharmony component from the Helkimo's index is a limitation of this study. Since more girls are enrolling in the medical field, the gender prediction cannot be determined. Longitudinal studies should be undertaken to investigate the correlation of medical and dental history with the TMD targeting a massive population in different regions.[18],[19],[20],[21],[22]

  Conclusion Top

TMD has become a considerable source of nondental pain in the orofacial region. The prevalence of TMD in healthy asymptomatic medical students was 86% which was mild in severity. The most common finding was clicking or crepitation sound in the area of TMJ. Timely diagnosis and the treatment of this condition may prove helpful in improving the quality of life in such patients.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Okeson JP, editor. Etiology of functional disturbances in the masticatory system. In: Management of Temporomandibular Disorders and Occlusion. 7th ed. Rio de Janeiro: Elsevier; 2013.  Back to cited text no. 1
De Leeuw R, Klasser G, editors. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. 5th ed. Chicago: Quintessence Publishing Co., Inc.; 2013.  Back to cited text no. 2
Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301-55.  Back to cited text no. 3
Helkimo M. Studies on function and dysfunction of the masticatory system. II. Index for anamnestic and clinical dysfunction and occlusal state. Sven Tandlak Tidskr 1974;67:101-21.  Back to cited text no. 4
Mutlu N, Herken H, Guray E, Oz F, Kalayaci A. Evaluation of the prevalence of temporomandibular joint disorder syndrome in dental school students with psychometric analysis. Turk J Med Sci 2002;32:345-50.  Back to cited text no. 5
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Solberg WK, Woo MW, Houston JB. Prevalence of mandibular dysfunction in young adults. J Am Dent Assoc 1979;98:25-34.  Back to cited text no. 10
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Vojdani M, Bahrani F, Ghadiri P. The study of relationship between reported temporomandibular symptoms and clinical dysfunction index among university students in Shiraz. Dent Res J (Isfahan) 2012;9:221-5.  Back to cited text no. 13
Modi P, Shaikh SS, Munde A. A cross sectional study of prevalence of temporomandibular disorders in university students. Int J Sci Res Publ 2012;2:1-3.  Back to cited text no. 14
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Rani S, Pawah S, Gola S, Bakshi M. Analysis of Helkimo index for temporomandibular disorder diagnosis in the dental students of Faridabad city: A cross - sectional study. J Indian Prosthodont Soc 2017;17:48-52.  Back to cited text no. 17
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Rawlani SM, Bhowate, S. Kashikar, M. Khubchandani, S. Rawlani, and R. Chandak. Morphological Evaluation of Temporo-Mandibular Joint in Indian Population [Avaliação Morfológica Da Articulação Temporo-Mandibular Em Indianos]. Braz Dent Sci 2018;21:44-53. Available from: https://doi.org/10.14295/bds.2018.v21i1.1488. [Last accessed on 2020 Mar 16].  Back to cited text no. 20
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]


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