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Year : 2020  |  Volume : 23  |  Issue : 4  |  Page : 476-480

Evaluation of the possible relationship between obesity and temporomandibular joint disorders

1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, 07058, Antalya, Turkey

Date of Submission10-Sep-2019
Date of Acceptance20-Dec-2019
Date of Web Publication4-Apr-2020

Correspondence Address:
Dr. H Tercanli Alkis
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, 07058, Antalya
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_489_19

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Objectives: The objective of this study is to question the existence of a possible relationship between obesity and temporomandibular joint disorders. Subjects and Methods: A total of 256 healthy subjects were included in the study. While the body mass index was used for the detection of obesity, Fonseca anamnestic index was used for the detection of temporomandibular joint disorders. The relationship between body mass index and temporomandibular joint disorders frequency was investigated. Values of P< 0.05 were considered statistically significant. Results: There were 136 female (53.1%) and 120 male (46.9%) subjects. The mean age was 39.02 ± 10.62. 41.4% of the subjects were in normal weight, 32.4% were overweight and 26.1% were obese. The prevalence of temporomandibular joint disorders was 73.8%.
Conclusions: There was no statistically significant difference between body mass index and temporomandibular joint disorders frequency, but further larger studies will give more accurate outcomes.

Keywords: Body mass index, obesity, temporomandibular joint disorders

How to cite this article:
Yilmaz S G, Alkis H T. Evaluation of the possible relationship between obesity and temporomandibular joint disorders. Niger J Clin Pract 2020;23:476-80

How to cite this URL:
Yilmaz S G, Alkis H T. Evaluation of the possible relationship between obesity and temporomandibular joint disorders. Niger J Clin Pract [serial online] 2020 [cited 2021 Sep 22];23:476-80. Available from:

   Introduction Top

Temporomandibular joint (TMJ) carries out activities such as opening and closing the mouth, speaking, swallowing, chewing, and stretching during the day.[1] The frequency of temporomandibular joint disorder (TMJD) is reported as 5–50% in various studies in the general population,[2],[3],[4],[5] and is seen more frequently in females than in males. TMJDs are more common in the age group of 20–40 years.[6],[7]

Organic and nonorganic factors (emotional stress, sleep, etc.) are influential in etiology.[4],[5] Organic pathologies may arise from intra-articular tissues, periarticular muscles and ligaments, and systemic inflammatory diseases that affect TMJ. Symptoms in TMJD are often a pain in TMJ and chewing muscles, limitation in right and left anteroposterior movements of the jaw, mouth opening, and clicking in the joint.[7],[8],[9],[10],[11]

Obesity and overweight are one of the serious health problems of our age and affect individuals from almost every age group.[12] There are many methods to measure obesity. One of the easiest ways to measure obesity is to calculate body mass index (BMI).[13]

Obesity is known as a risk factor for many health problems.[14],[15] The fact that obesity is a risk factor for TMJD is associated with an increased inflammatory mechanism triggered by obesity, changes in eating patterns, and joint problems it causes.[16],[17],[18],[19]

A number of forms have been set up to detect TMJD and attempts have been made to determine the frequency in different populations. The questionnaire developed by Fonseca et al.[20] is frequently used to determine TMJD.

It is known that the factors related to habits are effective in the causes of obesity and various types of pain.[21] In light of this information, the aim of this study is to question the existence of a possible relationship between obesity and TMJD.

   Material and Methods Top

Study design

This study was designed as a cross-sectional clinical research. Ethics approval (70904504/36) was obtained from the Presidency of Clinical Research Ethics Committee of Akdeniz University and the study follows the principles of the Declaration of Helsinki. A study group was created from patients who applied to Akdeniz University Faculty of Dentistry for a routine dental examination or various treatments. A total of 256 healthy subjects were included in the study. All participants were between 19-67 years of age. In this study, individuals without the following conditions were included: (I) presence of systemic diseases, bone mineral diseases, malignant diseases, psychiatric disorder, congenital anomalies, mental retardation, (II) presence of a history of trauma in the ora-facial region, (III) presence of parafunctional habits such as bruxism, tooth grind, nail-finger eating, (IV) presence of TMJ dysfunction, (V) presence of history of orthodontic treatment, (VI) presence of a malocclusion, (VII) pregnancy, and (VIII) smoking.

Calculation of the BMI

The BMI of all patients in the study population was calculated using the formula as follows:

BMI = kg/m2 where kg is a person's weight in kilograms and m2 is their height in meters squared.

18.5–24.9 is accepted as normal weight, 25–29.9 is accepted as overweight, 30–39.9 is accepted as obesity and, >40 is accepted as morbid obesity.[13]

Fonseca Anamnestic Index (FAI)

Demographic data of patients were obtained by scanning electronic patient files. The Fonseca et al. Questionnaire,[20] which is widely used, was used to assess the severity and frequency of TMJD [Table 1]. Participants in the study responded to the questions on the questionnaire on a voluntary basis without any time limit.
Table 1: Temporomandibular joint disorders questionnaire

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The questionnaire consists of 10 questions, and the answers to the questions are evaluated as “yes, sometimes, no.” In these 10 questions, the following were assessed: mouth opening, the right-left movement of the jaw, pain in the jaw muscles, joint and ear pain, head and neck pain, joint click noise, malocclusion, and emotional stress during chewing [Table 1]. The questionnaire was rated as yes: 10 points, sometimes: 5 points, no: 0 points, and the total score showed the severity of TMJD.

TMJD severity was classified as; without dysfunction (score between 0 and 15), mild dysfunction (score between 20 and 40), medium dysfunction (score between 45 and 65), and severe dysfunction (score between 70 and 100).

Statistical analyses

Statistical analyses were performed using SPSS version 22.0 for Windows (SPSS Inc., Chicago, IL). Data are presented as mean ± standard deviation (SD). The test of normality was evaluated using the Kolmogorov-Smirnov correlation analysis. The differences of the TMJD scores and BMI scores according to genders were tested with the Chi-square test. The relationship between BMI and TMJD was evaluated through logistic regression analysis and correlation (Pearson's r coefficient), as well as Spearman's rank correlation coefficient. A P value less than 0.05 was considered statistically significant.

   Results Top

All the individuals included in the study were 256. There were 136 females (53.1%) and 120 males (46.9%). The distribution of the participants was statistically insignificant in terms of gender (P = 0.093). The mean age was 39.02 ± 10.62. There was no significant relationship between TMJD and age.

41.4% of the subjects were in normal weight, 32.4% were overweight, and 26.1% were people with obesity. The distribution of BMI according to genders is shown in [Table 2]. The number of females with obesity was higher than males; the number of overweight males was higher than females, but there was no statistically significant difference between the genders (P = 0.059).
Table 2: Distribution of BMI status according to genders

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The prevalence of TMJD in this study was 73.8% in the whole group. 131 individuals had mild, 45 had moderate, 13 had severe TMJD, and 67 had no TMJD [Table 3].
Table 3: Prevalence of TMJDs for the whole group

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According to the data obtained from the Fonseca survey, the TMJD status of the study group was given in [Table 4] (P = 0.070). Half of both females and males had mild-grade joint problems. While the rate of males without TMJD was 31.7%, the rate of females was 21.3%; between the genders, there was no statistically significant difference in terms of the prevalence of TMJD (P = 0.059).
Table 4: Distribution of TMJDs status (with Fonseca anamnestic index) according to genders

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The presence and levels of TMJD for varying BMI ranges are given in [Table 5]. The rate of without TMJD was 46.3% in normal weight and this ratio decreased to 17.9% in subjects with overweight and obesity. Similarly, the rate of the mild stage, moderate, and severe TMJD increased with weight gain compared to normal subjects. When BMI groups were examined, TMJD prevalence was higher in normal and increasing weight, but according to these data, there was no statistically significant difference between BMI ranges in terms of TMJD presence and levels (P = 0.076).
Table 5: Relationship between BMI status and TMJD stage

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   Discussion Top

The prevalence of TMJD seen in the literature is 5–50%. LeResche et al.[3] showed that TMJD prevalence was seen in more than 10% of the population in their study, and Akhter et al.[2] found that this rate was around 30% in their Japanese university students. In the study by Badel et al., the incidence of TMJD was 79.82% in young adults and 87.10% in older adults.[22] In the current study, this rate was higher than other studies and the prevalence of TMJD was 73.2%. These differences may be due to the number of patients in the studies and inclusion/exclusion criteria. It is known that the frequency of factors such as abrasion, anxiety, myofascial pain in the teeth that are thought to cause TMJD with age increases while bruxism and mixed dentition period are effective in children and adolescents.[22]

In the literature, the increased prevalence of TMJD due to changing mental stress in women has previously been demonstrated. However, there was no statistically significant difference in the prevalence of males and females in our study. Similar to the current study, Wright et al.[21] did not find a significant difference between the genders in their study, while in most of the previous studies, the prevalence of TMJD was higher in females than males.[2],[3],[5],[7]

In the current study, the relationship between obesity and TMJD was not found to have any statistical significance, and the prevalence of TMJD did not change with age. Wright et al.[21] did not find the age factor statistically significant as similar to the current study. However, Rhim et al.[23] showed that the age variable in both males and females poses a risk for TMJD.

There are several studies evaluating the relationship between obesity and orofacial pain states, including TMJD. The relationship between obesity and TMJD has been tried to be expressed on different theories such as depression, changes in eating habits, and chronic inflammation in the previous literature but this is still unclear.[3],[21],[23],[24] Wright et al.[21] in their study of the distribution of various orofacial pain types found that TMJ and muscle pains were not significantly higher in individuals with overweight and obesity than normal-weight individuals. However, LeResche et al.[3] argued that obesity may cause TMJD by increasing the inflammatory mechanism in the body.

One of the most commonly used methods for the detection of obesity is the measurement of BMI.[25],[26] Individuals' weight status was evaluated by using BMI in the current study and there was no statistically significant difference between BMI and TMJD frequency. While this result was reported by Wright et al.,[21] De Santis et al.[27] found that the frequency of TMJD increased with decreasing BMI values in the pediatric population.

There are different methods and indexes used in the literature for the detection of TMJD. Fonseca anamnestic index (FAI) was used in the current study. Some previous studies have also used FAI. This questionnaire is easy to use and has been used for high sensitivity in identifying TMJD.[17],[28] Berni et al.[29] showed that the FAI can be employed for the identification of myogenous TMJD in female cases. Pires et al.[30] have shown that the short-form Fonseca anamnestic index can be used in the diagnosis of myogenous TMJD.

The current study has several limitations. First, similar to other studies in the literature, this is a cross-sectional study, so the cause-effect relationship between obesity and TMJD has not been clearly revealed. However, as previously reported in the literature, incorrect interpretation and diagnosis in cross-sectional studies are known to be fairly evenly distributed, therefore, the results are still significant.[31] Another limitation of this study is the absence of such a study conducted in the. population, according to our knowledge. With the extension of this study with a wider number of individuals with additional parameters, a general idea can be obtained.

   Conclusion Top

The prevalence of TMJD in individuals with obesity was not statistically different compared to individuals in normal weight and no difference was found between genders in the current study. However, in future with prospective studies, more comprehensive results will be obtained by increasing the number of individuals included in the study and by adding various parameters.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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