Correlation between Temporomandibular Joint Disorders, Sleep Quality and Stress among Dental Students: A Cross-sectional Study

Abstract

Introduction: Dental students are subjected to high levels of stress during their academic performance. The quality of sleep could also be affected in those with increased stress levels. Stress and sleep quality could be considered as risk factors in Temporomandibular Joint Disorders (TMD). Identification of the risk factors in TMD at the initial stages can lead to minimising the long term effects. Aim: To investigate the relationship between TMD symptoms, sleep quality and stress among dental students. Materials and Methods: A cross-sectional questionnairebased survey was conducted in the Department of Oral Medicine and Radiology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India, from November 2021 to December 2021 among 255 dental students. Fonseca Anamnestic Index (FAI) questionnaire was used for evaluation of TMD, while Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess stress scores and sleep quality, respectively. The students were surveyed to categorise them, if they were showing any symptoms of mild, moderate or severe TMD. Similarly the sleep quality and stress scores were assessed. The relationship between TMD with stress and sleep quality was also evaluated. Data analysis was done using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) version 26.0. Comparison of frequencies of scores of PSS, PSQI and FAI within groups was done using Chi-square test. Bivariate correlation between PSS/PSQI, PSS/ FAI ad FAI/PSQI was assessed using correlation coefficient. Results: Out of 255 participants, 182 were females and 73 were males. It was observed that 221 (86.7%) students reported moderate stress levels, 21 (8.2%) students showed mild and 13 (5.1%) subjects showed high stress levels. Temporomandibular symptoms were reported as mild, moderate and severe in 130 (51%), 21 (8.2%) and 9 (3.5%) students, respectively. A total of 229 (89.8%) students showed poor sleep quality and 26 (10.2%) students showed good sleep quality. Moderate stress was correlated with poor sleep quality and mild TMD. Conclusion: The stress levels were significantly correlated with sleep quality and TMD symptoms. Thus, increased stress and poor sleep may be considered as risk factors of TMD. However, longitudinal studies in large samples are required to determine the cause and effect relationships between sleep quality, stress levels and TMD.