Professional Documents
Culture Documents
Sectional Study
ID: 451200494
The aim of this cross-sectional research will be to examine the severity and frequency of
temporomandibular disorders among first-time adult patients seeking orthodontic treatment and
adolescents, and this persists into adulthood (Bilgiç & Gelgör, 2018; Emes et al., 2020).
Christidis et al. (2019) asserted that there are increasing concerns about temporomandibular
disorders among adult patients seeking orthodontics, most likely dating to their teenage years.
Failure to assess and screen for temporomandibular disorders before initiating orthodontic
therapy has been associated with treatment complications (Diab et al., 2023; Jain et al., 2018),
resulting in medical negligence and medical-legal suits (Yap et al., 2021). While its prevalence
ranges from 15-45%, few studies have examined the frequency and severity of
temporomandibular disorders among adults seeking orthodontic treatment for the first time. The
patients seeking orthodontic treatment for the first time. Implications of these findings will
emphasise the importance of screening patients’ masticatory systems before starting orthodontic
Introduction
(Lai et al., 2020). Patients with TMJ problems may exhibit pain or function-related symptoms.
Although up to 40% of adults may be affected, the prevalence may be higher in teenagers,
ranging from 7% to 55%. (Karaman et al., 2022). A study by Natu et al. (2018) reported that
patients with temporomandibular disorders reported higher concerns about reduced quality of life
than oral diseases like oral cancer, cavities, and periodontal disease. Specifically,
temporomandibular disorders have been associated with occlusal conditions like maxillary
overjet, anterior open bite, and posterior cross-bite (Paço et al., 2021). Some scholars observe
that the various cases of malocclusions might be due to the result of temporomandibular
that progresses to adulthood, there are arguments that dentists need to screen for their pre-
existence before commencing orthodontic therapy (Bilgiç & Gelgör, 2018; Emes et al., 2020).
Failure to screen for temporomandibular disorders may result in poor orthodontic treatment and
patient outcomes (Christidis et al., 2019; Natu et al., 2018). Complications, repeated clinic visits,
high cost of care, and reduced patient quality of life have been noted to result during orthodontic
Literature Review
Orthodontic scholars and practitioners have researched over thirty different types of
temporomandibular disorders. There is a large consensus that these disorders contribute to pain
and jaw dysfunction, impairing joints and muscles that control jawbone movement (Pastore et
al., 2018; Paunonen et al., 2019; Yap et al., 2021). Some common painful orofacial conditions
that have been associated with temporomandibular disorders include articular clicking, limited
mandible motion, masticatory muscle fatigue (Tesic et al., 2020), and painful
temporomandibular joints (Yap et al., 2023). Assessment of the scholarly literature further
reveals that temporomandibular disorders are considered to have multifactorial impact, such as
changes in the structure of the temporomandibular joints, abnormal functions of the masticatory
Diab et al. (2023) found that causes of temporomandibular disorders could be attributed
to postural changes, malocclusion, and local interferences due to occlusion. Paunonen et al.
(2019) reported that other aetiologies like neoplasm, immunological disorders, and traumatic
injury have been reported to trigger temporomandibular disorders. Mechanical stress, change in
jaw position, and loading have been noted to be standard treatment responses that trigger
adaptive capacity (Karaman & Buyuk, 2022; Paço et al., 2021). Despite these findings, there is
study by Macrì et al. (2022) reported few studies on the relationship between patients seeking
disorders are associated with malocclusion complexity. Therefore, it is crucial to determine the
management. Such an approach can aid us in enhancing therapy planning and assessing the
aspects that can intensify or alleviate the symptoms. While examining the ongoing controversy
between temporomandibular disorders and malocclusion, Aboalnaga et al. (2019) found that a
precise diagnosis needs to be made before commencing orthodontic treatment. Robust medical
assessments are needed since functional and static dental malocclusion are not always predictors
of temporomandibular disorders.
Research Design
The question that will be investigated in this cross-sectional study relates to determining
the prevalence and severity of temporomandibular disorders among adults seeking orthodontic
treatment. The null hypotheses are (1) the prevalence of temporomandibular disorders in
potential orthodontic patients is low, and (2) there is no association between the presence of
of observational study (Nicolau et al., 2023), will collect data to test the formulated hypotheses.
According to Tabatabaei and Tayebi (2023), researchers measure both the exposure and the
outcome simultaneously when conducting a cross-sectional study. This study will use clinical
data and surveys to examine correlations between the prevalence and severity of
2023). The independent variables will be the severity and prevalence of temporomandibular
Methodology
Before conducting the study, approvals will be obtained from the Institutional Review
Board and Ethics Research Committee regarding the use of human subjects (Pastore et al., 2018).
The target population for this study will be limited to patients seeking orthodontic treatment. The
sample size will include 55 prospective orthodontic patients, aged 18 to 40 years, who present at
the Riyadh Elm University dental clinics. Assuming a confidence level of 95%, a margin of error
of 5%, and the estimated target population of 64 first-time patients seeking orthodontic treatment
at a local dental clinic, a sample size of 55 patients will be enough for the study. The sample size
Predetermined inclusion and exclusion criteria were used to recruit (1) persons 18 years
and above, (2) prospective orthodontic patients who have existing temporomandibular disorders,
and (3) first-time visitors to the Riyadh Elm University dental clinics. Participants will be
excluded on the following grounds: (1) have severe psychiatric conditions, (2) unable to
autonomously understand the questionnaire, (3) received prior orthodontic treatment, (4)
therapy, and (6) has cranial facial syndrome. The Fonseca Anamnestic Index (FAI) will be used
to assess the severity and presence of temporomandibular disorders. In contrast, the Peer
Assessment Rating (PAR) index will be used to identify the severity of malocclusion (Zhang et
al., 2020).
The Oral Health Impact Profile–14 (OHIP-14) and the FAI with demographic
information will be administered at the initial visit. Models for the study will then be obtained
and analysed using the Ortho Analyzer to determine patients’ PAR index scores before matching
the data with individuals’ FAI data (Pastore et al., 2018). OHIP-14 (Appendix 1) includes 14
questions with responses ranked on a 5-point Likert scale (from 1 = never to 5 = very often). The
responses help identify the different problems patients have experienced in the past 12 months
regarding their oral health. The total score is obtained by summing all responses to 14 items with
using headache, neck pain, masticatory muscle, and temporomandibular joints [TMJ]). The FAI
survey also includes emotional stress, temporomandibular disorder risk factors and symptoms
(poor bite or malocclusion, teeth clenching), and functional issues (jaw movement problems,
openings, and TMJ sound). A 3-point scale scores points on the ten FAI items with No = 0,
Sometimes = 5, and Yes = 10. Patients with “No TMDs” score ≤15 points, while individuals
with “With TMDs” score ≥20 points. Severe TMDs will include patients with a score of 70-100
points, moderate TMDs will consist of scores of 45-69 points, and those with mild TMD will
The collected data will be analysed using the Statistical Package for Social Sciences
(SPSS) version 26. The significance level will be set to 0.05, with all p-values ≥0.05 considered
statistically significant. The data from OHIP-14 and FAI will not be normally distributed; the
Shapiro–Wilk test will be used to test for normality. Nonparametric tests (Mann-Whitney U and
Kruskal–Wallis tests) will compare means from the sampled populations. The tests will be used
to compare median OHIP-14 scores. At the same time, Spearman’s rho correlation (rs) will be
applied in assessing correlations between FAI and OHIP-14 scores to determine the frequency
and severity of temporomandibular disorders. Appendices 3 and 4 present the proposed study’s
Diab, A., Elkhashab, M. and Aziz, E. (2023) “Prevalence and severity of temporomandibular
disorders among Egyptian postgraduate students: A cross-sectional study,” Advanced Dental
Journal, 5(1), pp. 166–173. doi: 10.21608/adjc.2023.180496.1218.
Emes, Y. et al. (2020) “Evaluation of occlusion types, pain severity, and onset of complaints in
127 patients with temporomandibular disorders: A retrospective study,” Cranio: the journal of
craniomandibular practice, 38(3), pp. 168–173. doi: 10.1080/08869634.2018.1509824.
Jain, S., Chourse, S. and Jain, D. (2018) “Prevalence and severity of temporomandibular
disorders among the orthodontic patients using Fonseca’s questionnaire,” Contemporary clinical
dentistry, 9(1), pp. 31–34. doi: 10.4103/ccd.ccd_689_17.
Karaman, A., DDS, MSc and Buyuk, S. K. (2022) “Evaluation of temporomandibular disorder
symptoms and oral health-related quality of life in adolescent orthodontic patients with different
dental malocclusions,” Cranio: the journal of craniomandibular practice, 40(1), pp. 55–63. doi:
10.1080/08869634.2019.1694756.
Macrì, M. et al. (2022) “Prevalence of temporomandibular disorders and its association with
malocclusion in children: A transversal study,” Frontiers in public health, 10, p. 860833. doi:
10.3389/fpubh.2022.860833.
Natu, V. P. et al. (2018) “Temporomandibular disorder symptoms and their association with
quality of life, emotional states and sleep quality in South‐East Asian youths,” Journal of oral
rehabilitation, 45(10), pp. 756–763. doi: 10.1111/joor.12692.
Nicolau, B. et al. (2023) “How to use mixed methods in oral health research,” Community
dentistry and oral epidemiology, 51(1), pp. 71–74. doi: 10.1111/cdoe.12801.
Paço, M., Duarte, J. A. and Pinho, T. (2021) “Orthodontic treatment and craniocervical posture
in patients with temporomandibular disorders: An observational study,” International journal of
environmental research and public health, 18(6), p. 3295. doi: 10.3390/ijerph18063295.
Pastore, G. P. et al. (2018) “Comparison of instruments used to select and classify patients with
temporomandibular disorder,” Acta odontologica latinoamericana: AOL, 31(1), pp. 16–22.
Tabatabaei, F. and Tayebi, L. (2023) Research methods in dentistry. 1st ed. Cham, Switzerland:
Springer Nature.
Tesic, M. et al. (2020) “Validation of the oral health impact profile - 14 in patients with head and
neck cancer,” Medicina oral, patologia oral y cirugia bucal, pp. e739–e744. doi:
10.4317/medoral.23765.
Yap, A. U., Ho, H. C. W. and Lai, Y. C. (2023) “Analysing the psychosocial construct of
temporomandibular disorders: Implications for orthodontics,” Seminars in orthodontics. doi:
10.1053/j.sodo.2023.11.006.
Zhang, M.-J. et al. (2020) “Psychometric evaluation of the Chinese version of the Fonseca
anamnestic index for temporomandibular disorders,” Journal of oral rehabilitation, 47(3), pp.
313–318. doi: 10.1111/joor.12893.