Ortodontik Tedavi Görmek İsteyen Bireylerde Kaygı Düzeyleri, Temporomandibular Eklem Disfonksiyonu Skorları ve Ortodontik Maloklüzyon Arasındaki İlişkinin Değerlendirilmesi

Yıl 2022, , 186 - 193, 31.08.2022

Kevser Kurt Demirsoy , S. Kutalmış Büyük , Nursu Becet

https://doi.org/10.29058/mjwbs.1114749

Öz

Amaç: Ortodontik tedavi görme isteğiyle başvuran genç yetişkin bireylerde Beck Anksiyete İndeksi (BAI)
ile belirlenen kaygı düzeyleri ve Fonseca Anamnestik İndeksi (FAI) ile belirlenen Temporomandibular
Eklem Disfonksiyonu (TMD) prevalansı ile Sınıf I, Sınıf II ve Sınıf III ortodontik maloklüzyonlar arasındaki
ilişkinin değerlendirilmesidir.
Gereç ve Yöntemler: Maloklüzyonlarının düzeltilmesi için ardışık olarak başvuran, 14-24 yaş arası
genç yetişkinlerden oluşan 120 katılımcı çalışmamızın gerecini oluşturmuştur. Yapılan klinik muayene
sonucunda dental maloklüzyonlarına göre bireyler Angle Sınıf I, II ve III olarak 3 gruba ayrılmıştır. Her
grup kendi içinde kadın ve erkek bireyler olarak iki alt gruba ayrılmış ve sonuçta her bir grupta 20 birey
olacak şekilde 6 grup oluşturulmuştur. Hastalara rutin ortodontik muayenenin yanı sıra TMD prevalansı
ve şiddetini değerlendirmek amacıyla FAI ve kaygı düzeylerini belirlemek amacıyla da Beck Anksiyete
BAI uygulanmıştır. Verilerin istatistiksel değerlendirmesi için Fischer’s Exact, Mann-Whitney U ve
Kruskal Wallis testleri kullanılmıştır. BAI ve FAI arasındaki ilişkiyi değerlendirmek için Kendall Tau-b
korelasyon testi kullanılmıştır. Anlamlılık düzeyi p<0,05 olarak kabul edilmiştir.
Bulgular: Çalışmaya katılan bireylerin cinsiyet, sayı ve yaş bakımından benzer dağılım gösterdiği belirlenmiştir.
FAI’e göre TMD semptomu bulunan kadın bireylerin erkek bireylerden daha fazla olduğu
ve şiddetli TMD semptomu gösteren bireylerin tamamının kadın olduğu görülmüştür. Dental maloklüzyon
gruplarına göre FAI-TMD skorlarının dağılımı açısından anlamlı bir fark olmadığı belirlenmiştir
(p=0,093). BAI skorlarının kadın bireylerde erkek bireylere göre daha yüksek olduğu ve bu farkın istatistiksel
olarak da anlamlı olduğu görülmüştür (p<0,05). Toplam anksiyete skorları açısından Sınıf I, Sınıf
II ve Sınıf III grupları arasında istatistiksel olarak anlamlı farklılık bulunmazken, en yüksek ortalama
anksiyete skorunun dental Sınıf III maloklüzyonda olduğu tespit edilmiştir. FAI skorları ile BAI skorları
arasında her iki cinsiyette de pozitif korelasyon gözlenirken; kadın hastalarda korelasyon değerinin erkek
hastalara göre daha yüksek olduğu bulunmuştur (Kadın r=0,537; p<0,01), Erkek r=0,319; p<0,01).
FAI skorları ile BAI skorları arasında tüm maloklüzyon grupları için pozitif korelasyon bulunmaktadır.
Sonuç: Farklı maloklüzyon tiplerine sahip ortodontik tedavi görmek isteyen bireylerin kişilik ve
psikososyal durumlarındaki farklılıkların, farklı maloklüzyon tiplerine ve TMD bulgularına yansıdığı
ve bu özelliklerin cinsiyet faktöründen de etkilendiği görülmektedir. Ortodontik tedavi yaklaşımları
ve tedavi alternatifleri belirlenirken farklı maloklüzyonlara sahip bireyler psikososyal bir perspektif ile
değerlendirilmelidir.

Anahtar Kelimeler

Malokluzyon, Kaygı, Temporomandibular Hastalık, Beck Anksiyete İndeksi, Fonseca Anamnestik İndeks.

Evaluation of the Relationship between Anxiety Levels, Temporomandibular Joint Dysfunction Scores and Orthodontic Malocclusion in Individuals who Seeking Orthodontic Treatment

Öz

Aim: To evaluate the relationship between anxiety levels determined by Beck Anxiety Index (BAI) and Temporomandibular Joint Dysfunction
(TMD) prevalence determined by Fonseca Anamnestic Index (FAI) and Class I, Class II and Class III orthodontic malocclusions in young
adults who apply with the desire to receive orthodontic treatment.
Material and Methods: 120 participants, consisting of young adults aged 14-24, who consecutively applied for the correction of malocclusions,
constitute the material of our study. As a result of the clinical examination, individuals were divided into 3 groups as Angle Class I, II and
III according to their dental malocclusions. Each group is divided into two subgroups as male and female individuals. As a result, 6 groups
were formed with 20 individuals in each group. In addition to routine orthodontic examination, FAI was applied to evaluate the prevalence
and severity of TMD, and BAI was applied to determine their anxiety levels. Fischer’s Exact test, Mann-Whitney U test and Kruskal Wallis
test were used to evaluate the data. Kendall Tau-b correlation test was used to evaluate the relationship between BAI and FAI. Significance
level was accepted as p<0.05.
Results: It was determined that the individuals participating in the study showed a similar distribution in terms of gender, number and
age. According to the FAI, it was observed that female individuals with TMD symptoms were more common than male individuals, and all
individuals with severe TMD symptoms were female. It was determined that there was no significant difference in terms of distribution of
FAI TMD scores according to dental malocclusion groups (P=0.093). BAI scores were found to be higher in females than in males, and this
difference was statistically significant (P<0.05). While there was no statistically significant difference between Class I, Class II and Class III
groups in terms of total anxiety scores, it was determined that the highest mean anxiety score was in dental Class III malocclusion. While
a positive correlation was observed between FAI scores and BAI scores in both genders, it was found that the correlation value was higher
in female patients than in male patients (Female r=0.537, p<0.010; Male r=0.319, p<0.010). There was a positive correlation between FAI
scores and BAI scores for all malocclusion groups.
Conclusion: It is seen that the differences in personality and psychosocial status of individuals who want to receive orthodontic treatment
with different malocclusion types are reflected in different malocclusion types and TMD findings, and these characteristics are also affected
by the gender factor. While determining orthodontic treatment approaches and treatment alternatives, individuals with different malocclusions
should be evaluated from a biopsychosocial perspective.

Anahtar Kelimeler

Malocclusion, Anxiety, Temporomandibular Disease, Beck Anxiety Index, Fonseca Anamnestic Index.

Kaynakça

• 1. Sardenberg F, Martins MT, Bendo CB, Pordeus IA, Paiva SM, Auad SM, Vale MP. Malocclusion and oral health-related quality of life in Brazilian school children: A population-based study. Angle Orthod. 2013; 83(1), 83-89.
• 2. Jha K, Saha S, Gv J, Narang R, Biswas G, Sood P, Garg A, Narayan M. Prevalence of Malocclusion and its Psycho-Social Impact among 12 To 15-Year-old School Children in Lucknow City. J Clin Diagn Res. 2014; 8(10):ZC36-9.
• 3. Jain S, Chourse S, Jain D. Prevalence and severity of temporomandibular disorders among the orthodontic patients using fonseca's questionnaire. Contemp Clin Dent. 2018;9:31-4.
• 4. De Santis TO, Motta LJ, Biasotto‑Gonzalez DA, Mesquita‑Ferrari RA, Fernandes KP, de Godoy CH, et al. Accuracy study of the main screening tools for temporomandibular disorder in children and adolescents. J Bodyw Mov Ther 2014;18:87‑91.
• 5. Ohrbach R, Slade GD, Bair E, Rathnayaka N, Diatchenko L, Greenspan JD, Maixner W, Fillingim RB. Premorbid and concurrent predictors of TMD onset and persistence. Eur J Pain. 2020;24(1):145–158.
• 6. Wu J, Huang Z, Chen Y, Chen Y, Pan Z, Gu Y. Temporomandibular disorders among medical students in China: prevalence, biological and psychological risk factors. BMC Oral Health. 2021;21(1):549.
• 7. Khayat N, Winocur E, Emodi Perelman A, Friedman-Rubin P, Gafni Y, Shpack N. The prevalence of posterior crossbite, deep bite, and sleep or awake bruxism in temporomandibular disorder (TMD) patients compared to a non-TMD population: a retrospective study. Cranio. 2021;39(5):398–404.
• 8. Giray B, Sadry S. Modifications in Class I and Class II Div. 1 malocclusion during orthodontic treatment and their association with TMD problems. Cranio. 2021;39(1):65–73.
• 9. Sójka A, Stelcer B, Roy M, Mojs E, Pryliński M. Is there a relationship between psychological factors and TMD? Brain Behav. 2019;9(9):e01360.
• 10. Simoen L, Van den Berghe L, Jacquet W, Marks L. Depression and anxiety levels in patients with temporomandibular disorders: comparison with the general population. Clin Oral Investig. 2020;24(11):3939–3945.
• 11. Fonseca DM, Bonfante G, Valle AL, de Freitas SFT. Diagnósticopela anamnese da disfunc¸ão craniomandibular. Rev Gauch deOdontol. 1994;4(1):23-32.
• 12. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893-7.
• 13. Ulusoy M, Şahin N, Erkman H. Turkish Version of The Beck Anxiety Inventory: psychometric Properties. J Cognitive Psychotherapy: Int Quaterly. 1998;12:28-35.
• 14. Phillips C, Bailey L, Kiyak HA, Bloomquist D. Effects of a computerized treatment simulation on patient expectations for orthognathic surgery. Int J Adult Orthodon Orthognath Surg. 2001;16:87–98.
• 15. Karaağaç E, Küçükeşmen Ç. Malokluzyonun Psikososyal Etkileri ve Çocuklarda Ortodontik Tedavi Görme İsteği. SDU Journal of Health Science, 2017, 8(2), 40-44.
• 16. Perillo L, Esposito M, Caprioglio A, Attanasio S, Santini AC, Carotenuto M. Orthodontic treatment need for adolescents in the Campania region: the malocclusion impact on self-concept. Patient Prefer Adherence. 2014; 8: 353-359.
• 17. Nayak UA, Winnier J, Rupesh S. The relationship of dental aesthetic ındex with dental appearance, smile and desire for orthodontic correction. Int J Clin Pediatr Dent. 2009; 2(2): 6-12.
• 18. Sharma S, Gupta DS, Pal US, Jurel SK. Etiological factors of temporomandibular joint disorders. Natl J Maxillofac Surg.2011;2(2):116-119.
• 19. Rodrigues-Bigaton D, de Castro EM, Pires PF. Factor and Rasch analysis of the Fonseca anamnestic index for the diagnosis of myogenous temporomandibular disorder. Braz J Phys Ther. 2017;21(2), 120-126.
• 20. Nascimento MM, Vasconcelos BC, Porto GG, Fernanda G,Nogueira CM, Raimundo RC. Physical therapy and anesthetic blockage for treating temporomandibular disorders: a clinical trial. Med Oral Patol Oral Cir Bucal. 2013;18(1):81-85.
• 21. Berni KCS, Dibai-Filho AV, Rodrigues-Bigaton D. Accuracy ofthe Fonseca anamnestic index in the identification of myoge-nous temporomandibular disorder in female community cases. J Body Mov Ther. 2015;19(3):404-409.
• 22. Bevilaqua-Grossi D, Caves TC, Oliveira AS, Monteiro-Pedro V.Anamnestic index severity and signs and symptoms of temporo-mandibular disorders. Cranio. 2006;24(2):1-7.
• 23. Lobezzo F, Lavigne GJ. Do bruxism and temporomandibular dis-orders have a cause-and-effect relationship? J Orofac Pain. 1997;11(1):15-23.
• 24. Alahmary AW. Association of temporomandibular disorder symptoms with anxiety and depression in Saudi dental students. Open Access Maced J Med Sci. 2019; 7(23), 4116-4119.
• 25. Al Hayek SO, Al‐Thunayan M, AlGhaihab AM, AlReshaid RM, Omair A. Assessing stress associated with temporomandibular joint disorder through Fonseca's anamnestic index among the Saudi physicians. Clin Exp Dent Res. 2019, 5(1), 52-58.
• 26. Minghelli B, Morgado M, Caro T. Association of temporomandibular disorder symptoms with anxiety and depression in Portuguese college students. J Oral Sci. 2014; 56:127-33.
• 27. Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008; 359:2693-705.
• 28. Thilander B, Rubio G, Pena L, de Mayorga C. Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: An epidemiologic study related to specified stages of dental development. Angle Orthod. 2002;72:146‑54.
• 29. Vučić L, Glišić B, Vučić U, Drulović J, Pekmezović T. Quality of Life Assessment in Patients with Malocclusion Undergoing Orthodontic and Orthognathic Treatment. Zdr Varst. 2020;25;59(3):137-145.
• 30. Ferreira CLP, Silva MAMRD, Felício CMD. Signs and symptoms of temporomandibular disorders in women and men. In Codas. 2016; 28(1), 17‐21.
• 31. LeResche L, Mancl LA, Drangsholt MT, Saunders K, Von Korff M. Relationship of pain and symptoms to pubertal development in adolescents. Pain 2005; 118(1–2), 201–209.
• 32. Oliveira LK, Almeida Gde A, Lelis ÉR, Tavares M, Fernandes Neto AJ. Temporomandibular disorder and anxiety, quality of sleep, and quality of life in nursing professionals. Braz Oral Res. 2015;29:1-7.
• 33. Gameiro GH, Nouer DF, Andrade AS, Veiga MCFA. How may stressful experiences contribute to the development of temporomandibular disorders? Clin Oral Investig. 2006;10(4):261-8.
• 34. Pesqueira AA, Zuim PR, Monteiro DR, Ribeiro PP, Garcia AR. Relationship between psychological factores and symptoms of TDM in university undergraduate students. Acta Odontol Latinoam. 2010 23(3):182-7.
• 35. Pizolato RA, Freitas-Fernandes FS, Gavião MB. Anxiety/depression and orofacial myofacial disorders as factors associated with TMD in children. Braz Oral Res. 2013;27(2):156-62.
• 36. Kiyak HA. Does orthodontic treatment affect patients' quality of life? J Dent Educ. 2008; (72): 886-894.