Prevalence of Temporomandibular Disorders and Its Association With Oral Parafunctions, Neck Pain and Function
Prevalence of Temporomandibular Disorders and Its Association With Oral Parafunctions, Neck Pain and Function
Purpose: To determine the prevalence of temporomandibular disorders (TMD) in female
 healthcare students and to assess its association with oral parafunctions, neck pain and
 function.

 Methods: Female medical students will be included in the study on a voluntary basis using
 stratified sampling method according to the department they were being educated. The presence
 and severity of TMD will be assessed with the Fonseca's Anamnestic Index (FAI). The oral
 parafunctions will be self-reported with the Oral Behavior Checklist (OBC). The neck pain and
 function will be recorded with the Core Outcome Measure Index (COMI). A Chi-square test and
 Spearman correlation analysis will used for statistical analysis.
Temporomandibular disorder (TMD) has a multifactorial etiology related to parafunctional
 habits, emotional and psychological factors, trauma, posture, other musculoskeletal, or
 rheumatic disorders (1). Symptoms of TMD may include temporomandibular joint pain and clicks,
 headache, myofascial pain, decreased mandibular range of motion, masticatory muscle fatigue,
 limitation of mouth opening, pain when chewing, tinnitus, neuralgias, and bruxism (1,2). The
 severity of symptoms is related to the age and gender of the patients. Women showed a higher
 prevalence of TMD symptoms, with proportions varying from two to six women for each man,
 usually with ages between 20 and 40 years3. The distribution of age and gender in TMD,
 suggests a possible link between its pathogenesis and the female sex hormone, the estrogen,
 or between TMD and the mechanisms of pain modulation, as women show more sensitivity to most
 of the pain modalities (3,4) Epidemiologic studies showed that TMD prevalence in the students
 ranges from 50% to 77% (5-7). Several studies reported that a higher prevalence of TMD ranges
 from 47% to 81% in the Turkish student population (8-13). However, in some cases especially
 in students, the presence of TMD is asymptomatic. Therefore, the diagnosis of early symptoms
 and signs of TMD is crucial in preventing or minimizing TMD signs and symptoms (9).

 Parafunctional habits such as bruxism, tooth clenching, gum chewing, biting foreign objects,
 and prolonged nail-biting might increase the risk of developing TMD (14). Even there are
 several studies examining the association of TMD and oral parafunctions in students (15-17);
 still, more studies are need to identify which oral behaviors cause TMD patients and healthy
 populations (18). Therefore, understanding the TMD symptoms in association with the oral
 parafunctions could provide different perspectives and an efficient treatment program (15).

 To our knowledge, there is no study about TMD prevalence in female healthcare students and
 its association with oral parafunctions, neck pain, and function. The aims of this
 cross-sectional study were: (1) to evaluate the prevalence of TMD in female healthcare
 students and (2) to determine the association of TMD severity with oral parafunctional
 habits, neck pain and function.
Inclusion Criteria:

 -  be Adnan Menderes University student

 -  female gender

 -  express consent to participate voluntarily in the study

 Exclusion Criteria:

 -  with recent trauma to head and face,

 -  history of systematic diseases and neurological disorders

 -  currently an ongoing orthodontic treatment