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ORIGINAL ARTICLE
Year : 2022  |  Volume : 13  |  Issue : 3  |  Page : 457-461  

A retrospective study on factors affecting the dropout rate among temporomandibular joint internal disc derangement patients in India - A single-institution experience


1 Department of Oral and Maxillofacial Surgery, Geetanjali Dental and Research Institute, Udaipur, Rajasthan, India
2 Department of Prosthodontics and Implantology, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India
3 Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India
4 Department of Dentistry, AIIMS, Bilaspur, Himachal Pradesh, India
5 Maxillofacial Consultant, SB Aesthetics, Gurgaon, Haryana, India
6 Department of Oral and Maxillofacial Surgery, NYU College of Dentistry, New York, USA

Date of Submission04-Feb-2021
Date of Acceptance25-May-2021
Date of Web Publication10-Dec-2022

Correspondence Address:
Shallu Bansal
Department of Oral and Maxillofacial Surgery, Geetanjali Dental and Research Institute, Hiranmagri Extension, Manwakhera NH-8 Bypass, Near Eklingpura, Chouraha, Udaipur, Rajasthan - 313 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njms.njms_314_21

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   Abstract 


Introduction: Patients suffering temporomandibular joint internal disc derangement (IDD) ignore appointments after the first examination or after the first or second sessions of initial treatment. The dropout rate for these patients varies from 36% to 78% as per literature. Unfortunately, very few studies have investigated the dropout rate of these patients. Hence, the present study was undertaken to find out the dropout rate among these kinds of patients.
Material and Methods: A retrospective study was done from June 2008 to December 2017 by collecting the records of the patients who were diagnosed to have IDD. Outcome variables included were age, sex, distance traveled, occupation, and education.
Results: Out of 1021 patients 766 patients were included in the study after fulfilling the inclusion and exclusion criteria. The data were analyzed using Chi-square test. The level of significance was set at <0.05. In this study, there is slight male predominance (52.8%) and 63.1% (21–40 years) were among young adults and the patients in the age group of 21–30 years had shown good compliance, Postgraduate has shown the highest follow-up rate when compared with graduates and school level and the difference was found to be statistically significant. People in the job had shown good compliance when compared with business class and retired people and the patients within 50 km had shown the maximum follow-up with a statistically significant difference (P < 0.01).
Conclusion: This study has shown that the dropout rate of treatment in temporomandibular joint disorder is affected by age, sex, distance traveled, occupation, and education.

Keywords: Dropout rate, factors, internal disc derangements, retrospective, temporomandibular joint


How to cite this article:
Bansal S, Bansal S, Aggarwal V, Verma DK, Pahari KC, Talib HS. A retrospective study on factors affecting the dropout rate among temporomandibular joint internal disc derangement patients in India - A single-institution experience. Natl J Maxillofac Surg 2022;13:457-61

How to cite this URL:
Bansal S, Bansal S, Aggarwal V, Verma DK, Pahari KC, Talib HS. A retrospective study on factors affecting the dropout rate among temporomandibular joint internal disc derangement patients in India - A single-institution experience. Natl J Maxillofac Surg [serial online] 2022 [cited 2023 Jan 26];13:457-61. Available from: https://www.njms.in/text.asp?2022/13/3/457/363066




   Introduction Top


Temporomandibular joint disorders (TMD's) are associated with a wide range of signs and symptoms of musculoskeletal and neuromuscular components with varying morphological and functional deformities.[1] Signs and symptoms of TMDs include varying degrees of joint sounds, restricted or deviating range of motion, and cranial and/or muscular pain.[2] Studies have shown that approximately 25%–41% of the population may experience one or the other symptoms of TMD during their lifetime. It is the third-most prevalent disease in dentistry, after tooth decay and periodontal diseases.[3],[4] It had been estimated that approximately 70% of TMD patients suffer from pathology or malpositioning of the temporomandibular joint (TMJ) disc known as “internal disc derangement” (IDD).

TMDs can occur at any age, but it is most prevalent among 20–50 years old persons.[3],[5],[6],[7],[8] It is two to eight times more common in females as compared to males.[9],[10] However, only a small percentage of these patients present themselves for any form of treatment. Carlsson and LeResche, Carlsson.[11],[12] in their study showed that even though it is found in 16%–59% of the population but only 3% to 7% of persons care for diagnosis and treatment. Most of the patients ignore appointments after one or two sessions of initial treatment. However, according to generally accepted standards treatment protocols, they are still in need of further treatment. Patient compliance is an important and critical factor in the success of any treatment. Many surgeons believe that compliance is weakly related to patient characteristics such as gender, age, race, and marital status.[13] Patient attitude and perception have a strong relationship with compliance. Most of the time during the initial visit dentists are taking a detailed history, perform a clinical exam and discuss the treatment plan. Many patients can have problem with the proposed treatment and many believe that physiotherapy will not be of any help.[14]

Many papers have been published in literature regarding the epidemiology, diagnosis, and management of TMJ disorders, but there is a paucity of literature regarding the compliance of these patients. The dropout rate among these patients is 36%–78%.[13] We have therefore undertaken this retrospective study to test the null hypothesis that to age, gender, distance traveled, occupation and education have no influence on follow-up of these patients. The aim of this study was to assess the dropout rate in the patients who were diagnosed to have TMJIDD and the objective of this study was to find out whether the noncompliance is related to age, gender, distance traveled, occupation, and education.


   Material and Methods Top


Design and data source

This Retrospective study was done after the approval of the institutional ethical committee of SDC&RI, reference no SDCRI/IEC/2017/023 dated 29/12/2017. The data for the study were collected by obtaining the records of all the patients diagnosed with TMJIDD, from the outpatient department registers of the Department of Oral and Maxillofacial Surgery, from June 2008 to December 2017 under the supervision of the Principal investigator.

Records of only those patients who were advised conservative therapy (pharmacological means (nonsteroidal anti-inflammatory drugs and muscle relaxant with or without antianxiety drugs), physiotherapy, transcutaneous electrical nerve stimulation therapy, appliance therapy, occlusion adjustment, or prosthetic rehabilitations) were considered for the study. Patients with varying degrees of IDD were included in the study after fulfilling the inclusion and exclusion criteria. Inclusion criteria of this study included the patients in between the age of 21 and 60 years irrespective of gender, who were diagnosed to have TMJIDD after thorough history, clinical and radiological examination, and patients who had traveled distance within the radius of 150 km. The patients who had traveled more than 150 km and with incomplete records were excluded from the study.

Sample size was estimated with α =0.05, β =0.1, confidence interval = 95% and coefficient of variation was 25%. Based on these, values required sample size were 625. A total of 1021 patients were found to have IDD, of which 766 patients were included in the study after fulfilling the inclusion and exclusion criteria, of which 405 were male and 361 were female. Descriptive characteristics such as age, sex, distance traveled, occupation, education, and duration of follow-up were considered for the study. The maximum follow-up period considered for this study was 3 months. Dropout in this study was defined as one who failed to attend the scheduled appointments against clinician advice after the diagnosis of TMJIDD.

The following variables were analyzed in this study:

  1. Patients' age at the time of presentation–age was further categorized into four groups, i.e., 21–30 years, 31–40 years, 41–50 years, and 51–60 years
  2. Gender
  3. Distance traveled for treatment–It was categorized into three groups, i.e., 0–50 km, 50–100 km, and 100–150 km
  4. Occupation-it was further divided into four categories: Student, doing business, in Job (homemakers are included in this category only), and retired persons
  5. Education of the patient–level of education was broadly categorized into three groups, i.e., school level (+2 or below), graduate-level, or postgraduate level
  6. The primary outcome variable was the duration of follow-up–it was further divided into four groups; i.e., at the 10th day, 1 month, 2nd month, and 3rd month.


Statistical analysis

Data were analyzed using IBM SPSS Statistics Windows, version 20.0 IBM Corp., (Armonk, NY, USA). Association between duration of follow-up and age, sex, distance traveled, occupation, and education was analyzed using Chi-square test with a level of significance set at <0.05.


   Results Top


The study variables included age, sex, distance traveled, occupation, and education. The primary outcome variable was compliance for the follow-up visits [Table 1].
Table 1: The outcome variables

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Gender

Males had shown a higher follow-up rate as compared to females at 10 days, 1 month, 2 months, and 3rd month and the difference was found to be statistically significant (P = 0.005).

Age

As per our study, maximum follow-up was shown by the patient in the age group of 21–30 years followed by 31–40 years, 41–50 years, and 51–60 years at every follow-up, but the difference was found to be statistically nonsignificant (P = 0.79).

Education

Postgraduates had shown higher follow-up followed by graduate and school level at 10 days, 1 month, 2 months, and 3rd month and the difference was found to be statistically significant (P < 0.01).

Occupation

Maximum followup was shown by people in salaried class followed by students and business class and minimum by retired people and the difference was found to be statistically significant (P < 0.01).

Distance traveled

Patients within 50 km had shown the maximum follow-up as compared to patient who traveled 100 km and 150 km for the treatment and again the difference was found to be statistically significant (P < 0.01).


   Discussion Top


Patients suffering from TMDs usually ignore their appointment after the initial visit. Not returning to the treatment as per protocol is a form of noncompliance and patient compliance is always a critical factor in the success and outcome of any treatment. Studies on the dropout rate are rare.[15],[16]

The dropout rates in various studies[13],[14] are usually affected by how one defines drop out and in our study the dropout was defined as one who did not turn up for follow-up against the therapist's advice. Studies have shown that dropping out of the treatment regimen is weakly related to the degree of pain and dysfunction at the initial visit and strongly relate to environmental obstacles, perceived improvement of illness, and dissatisfaction with services.[17] It would be interesting to know that whether compliance depends upon gender, age, distance traveled, level of education, and job portfolio as these reasons may reveal significant biasing. It is important to find out the reasons for patient attrition in TMJIDD patients; the present retrospective study was done to find whether gender, age, distance traveled, occupation, and education are related to the dropout rate of patients suffering from TMJIDD.

TMJIDD is more common among females and young adults.[9] In our study, there is slight male predominance (52.8%). In our study, 63.1% (21–40 years) of TMJIDD patients were young adults and this incidence is correlating with previous studies.

Funch and Gale[13] reported that 46% of patients failed to complete the treatment and the dropout rate in a study by Smith[18] was 35.3% in TMDs patients. De Boever et al.[17] reported a compliance rate of 10%. In this study, dropout rate was 48.31% at the 10th day which correlates with Funch and Gale[13] but is less than De Boever et al.[17] At the 3rd month, only 2.34% of patients returned for follow-up and this dropout rate was higher than the previous studies.

From the results of the previous studies, it is still unclear that whether compliance in TMDs is related to age and gender, but in our study, dropout rate was higher among females and the difference was found to be statistically significant (P = 0.005) at each subsequent follow-up visits. The reason might be that in India females are dependent on male members or other family members to bring them for treatment. The dropout rate was higher among old age (51–60 years followed by 41–50 years and so on) as compared to young adults. Although this difference is statistically nonsignificant in our study, the reason for noncompliance might be that old people may need the company to bring them for follow-up visits. As per our search, we were not able to found that whether compliance in TMDs is related to the job profile and education, but in the present study, education is directly related to the compliance of the patient.

People in the job had shown good compliance when compared with business class and retired people. The hypothesis behind that can be that people in the job are more health-conscious and retired people are in need of the company to come along.

In our study, we tried to correlate the compliance with distance traveled and patient with in 50 km had shown the maximum followed by with in 100 km and this difference was statistically significant at each subsequent visit. As per De Boever et al.[17] most of the patients want to travel for treatment which are close to their homes, we think this hypothesis can be correlated in the present study also.

The present study suffers from some drawbacks. It's a single institutional study. This study did not consider the patient satisfaction with the treatment and patient-doctor rapport and the expertise level of the treating doctor, all of which may affect the patient compliance.

Even though in the present study, we are closely related to the primary outcome criteria, larger studies with more variables are advised for evidence with higher strength.


   Conclusion Top


It may be concluded from the present study, that the dropout rate in TMJIDD patients is directly related to age, gender, education level, distance traveled, and job profile.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Yadav S, Yang Y, Dutra EH, Robinson JL, Wadhwa S. Temporomandibular joint disorders in older adults. J Am Geriatr Soc 2018;66:1213-7.  Back to cited text no. 1
    
2.
Laskin DM, Greenfield W, Gale E, Rugh J, Neff P, Alling C, et al., editors. The President's Conference on the Examination, Diagnosis, and Management of Temporomandibular Disorders. Chicago: American Dental Association; 1983.  Back to cited text no. 2
    
3.
Solberg WK, Woo MW, Houston JB. Prevalence of mandibular dysfunction in young adults. J Am Dent Assoc 1979;98:25-34.  Back to cited text no. 3
    
4.
Małgorzata P, Małgorzata KM, Karolina C, Gala A. Diagnostic of temporomandibular disorders and other facial pain conditions-narrative review and personal experience. Medicina (Kaunas) 2020;56:472.  Back to cited text no. 4
    
5.
Farrar WB, McCarty WL Jr. The TMJ dilemma. J Ala Dent Assoc 1979;63:19-26.  Back to cited text no. 5
    
6.
Martins-Júnior RL, Palma AJ, Marquardt EJ, Gondin TM, Kerber Fde C. Temporomandibular disorders: A report of 124 patients. J Contemp Dent Pract 2010;11:071-8.  Back to cited text no. 6
    
7.
Gonçalves DA, Dal Fabbro AL, Campos JA, Bigal ME, Speciali JG. Symptoms of temporomandibular disorders in the population: An epidemiological study. J Orofac Pain 2010;24:270-8.  Back to cited text no. 7
    
8.
Wilkes CH. Internal derangements of the temporomandibular joint. Pathological variations. Arch Otolaryngol Head Neck Surg 1989;115:469-77.  Back to cited text no. 8
    
9.
Warren MP, Fried JL. Temporomandibular disorders and hormones in women. Cells Tissues Organs 2001;169:187-92.  Back to cited text no. 9
    
10.
van Loon JP, de Bont LG, Stegenga B, Spijkervet FK, Verkerke GJ. Groningen temporomandibular joint prosthesis. Development and first clinical application. Int J Oral Maxillofac Surg 2002;31:44-52.  Back to cited text no. 10
    
11.
Carlsson GE, LeResche L. Epidemiology of temporomandibular disorders. In: Sessle BJ, Bryant P, Dionne R, editors. Temporomandibular Disorders and Related Pain Conditions. Seattle: IASP Press; 1995. p. 497-506.  Back to cited text no. 11
    
12.
Carlsson GE. Epidemiology and treatment need for temporomandibular disorders. J Orofac Pain 1999;13:232-7.  Back to cited text no. 12
    
13.
Funch DP, Gale EN. Predicting treatment completion in a behavioral therapy program for chronic temporomandibular pain. J Psychosom Res 1986;30:57-62.  Back to cited text no. 13
    
14.
Sluys EM. Patient Education in Physical Therapy (PhD thesis, Maastricht, The Netherlands: University of Limburg). Utrecht: NIVEL Bibliographies; 1991.  Back to cited text no. 14
    
15.
Tanaka E, Detamore MS, Mercuri LG. Degenerative disorders of the temporomandibular joint: Etiology, diagnosis, and treatment. J Dent Res 2008;87:296-307.  Back to cited text no. 15
    
16.
Stohler CS. Clinical perspectives on masticatory and related muscle disorders. In: Sessle BJ, Bryant PS, Dionne RA, editors. Temporomandibular Disorders and Related Pain Conditions, Progress in Pain Research and Management. Vol 4. Seattle: IASP Press; 1995. p. 3-29.  Back to cited text no. 16
    
17.
De Boever JA, Van Wormhoudt K, De Boever EH. Reasons that patients do not return for appointments in the initial phase of treatment of temporomandibular disorders. J Orofac Pain 1996;10:66-72.  Back to cited text no. 17
    
18.
Smith JP. Neglected patients in temporomandibular joint dysfunction reports. J Prosthet Dent 1988;59:78-80.  Back to cited text no. 18
    



 
 
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