70
INCIDENCE RATE OF TEMPORO MANDIBULAR DISORDERS
71 INTRODUCTION
National Health Research (RISKESDAS) of the province of South Kalimantan in 2007 mentioned that the type of treatments that received by people who had dental-oral health problems in the province of South Kalimantan were dental care (81,2%), restoration/tooth extraction/dental surgical (42,3%), and counseling care/dental hygiene (12,5%). People who used removable or fixed dentures were around 0,6% - 10,8%, the highest age was over than 65 years old. In Banjarmasin, the percentage of people who did restoration/tooth extraction/dental surgical were 49,6%, while people who used removable or fixed denture were only 3,0%. This suggests that many cases of tooth loss are not equal with the rehabilitation treatment (Prostodontia).
The lack of public awareness can be seen from the old paradigm which assumedthat extracting the tooth without replacing it with denture would solve the problem.It can also be proved by the statement of Ketua Ikatan Profesi Kesehatan Gigi Masyarakat Indonesia, drg.
Armasastra Bahar, stated that the current ratio between restoration and tooth extraction in Indonesia is one to seven (1:7).
The loss of mandibular first permanent molar has the highest prevalence. This is because the mandibular first permanent molar is the first permanent tooth to erupt around 6-7 years in the period of mixed dentition. The first permanent molar is the largest and strongest of all the teeth. It plays an important role in mastication and guiding eruption of other posterior teeth into proper occlusion.
Tooth loss due to extraction could be a serious problem because it may cause dysfunction of mastication, while when lots of tooth missing in a long time may cause temporomandibular disorder and also has impact in speaking and psychological aspect such as aesthetic even in certain jobs that required a great dental health.
The function of dental arch will decrease by 10% and this decline will increase by 30% in the loss of a teeth especially mandibular first permanent molar if the next step, which is to replace the missing teeth is not immediately be done. Misalignment of pressure or imbalance between the left jaw and right jaw caused by one side of chewingdue to the loss of mandibular first permanent molar may causing disruption on one side of the joint. Therefore, researcher feels that need to do some research on the incidence rate of temporomandibular disorder (TMD) due to the loss of mandibular first permanent molar.
72 MATERIALS AND METHODS
This research was using analitic survey method with cross-sectional approach.
Population in this research were patients who came to the Poli Gigi RSUD Ulin Banjarmasin.
Samples were taken with purposive sampling technique to those who came to the Poli Gigi RSUD Ulin Banjarmasin with inclusion criteria: there are symptoms of TMD, missing of mandibular first permanent molar, and willingly to be as a respondent. The initial preparation of this research is to determined the samples with Anamnestic index and Dysfunction index according to the inclusion criteria. Then explained the purposes and goals of the research and gave the informed consent to the patient as an approval.
RESULTS
Table 1. Cross tabulation of gender by Di classification.
Di (Disfunction Index)
Total
Gender Mild Moderate Severe
Men 19 11 2 32
59,4% 34,3% 6,3% 100.0%
Women 20 20 5 45
44,4% 44,4% 11,2% 100.0%
Total 39 31 7 77
50.6% 40,3% 9,1% 100,0%
Table 2. Cross tabulation of age by Di classification DI
Total
Age Mild Moderate Severe
<31 years old
13 9 3 25
52,0% 36,0% 12,0% 100.0%
31-45 years old
21 10 2 33
63,6% 30,3% 6,1% 100.0%
>45 years old
5 12 2 19
26,3% 63,2% 10,5% 100.0%
Total 39 31 7 77
50.6% 40,3% 9,1% 100,0%
73 Table 3. Cross tabulation of missing molar by Di classification
Di classification
Total Missing
molar Mild Moderate Severe
36 23 8 1 32
71,9% 25,0% 3,1% 100.0%
46 10 5 3 18
55,6% 27,7% 16,7% 100.0%
36 and 46
6 18 3 27
22,2% 66,7% 11,1% 100.0%
Total 39 31 7 77
50.6% 40,3% 9,1% 100,0%
DISCUSSION
From table 1 above its known that women has bigger frequency of TMJ dysfunction than men. It can be described in the table above that as many as 19 men having mild Di, while there are 20 women, as well as there are 20 women having moderate Di, and only 11 people in men group. This thing can happen in severe Di, which are 2 men having severe TMJ dysfunction, while there are 5 women that having severe TMJ dysfunction. This can supported by the opinion from Achir YA which is said that women around 35 years old and men around 45 years old, have reach their peak bone mass. After that fase, more bone is lost than its formed. Generally women have narrow bone and less compact than men, that’s why women tend from suffering osteoporosis.24
Table 2 above showing that the most group that suffering mild Di found at range age 31-45 years old which is 63,6% compared to other age groups. It caused that those age are classified as working age, so they are having more concern about their oral health.25
From classification of moderate TMJ dysfunction, this research show that the group above 45 years old are suffer from moderate TMJ disfunction at the most compared to other age groups, which is 63,2%. This can be confirmed according to Jubhari EH and Akhmadi which said that aging, make retrogression many function of body. For example, TMJ function for mastication, it causing the food intake reduce as a source of nutrition for body. So that good nutrition is very necessary and sufficient for elderly. It is also done with the consideration that the elderly need adequate nutrition to support and maintain their health. 23.
74 Meanwhile severe TMJ dysfunction in this research show that the age group under 31 years is greater than the other age groups, which is 12%. This is probably the subject in this research having bad habit that not been researched such as chewing on one side of which has been carried out. The subject in this research probably having malrelation that causing malocclusion thus aggravating TMJ function.
From table 7 above explain that in subjects in this research which are missing its 36 having greater frequency suffering mild TMJ dysfunction, which are 71,9%. This can be confirmed according to Janjua OS, dkk which said that percentage of left lower first molar extraction are 32,1% and percentage of right lower first molar extraction are 30,6%.
Meanwhile the greatest frequency of TMJ dysfunction categories are shown in subjects who had lost both of its molar, both 36 and 46 which are 66,7%.
Classification of severe TMJ function disorder showed in subjects on this research that missing 46 and subjects that missing both its molar, 36 and 46. This is probably that the condition of missing posterior teeth more that one are causing its vertical dimention missing.
This neuromascular disorder will be followed by occlusion changing. Deviation of the mandible as the result of tilting, migration and extrusion of teeth is the impact of posterior tooth loss cases. The teeth are tipping will increase pressure on the anterior teeth and will be followed by an open contact on anterior teeth and will reduce the vertical dimension. Effects of missing lower molar will also causing the reaction that is far from its located in some of arch segments, this will be result limitations on the movement of the mandible in mandibular functional movements.
CONCLUSION
1. 39 patients were having Di mild (50,6%), 31 patients were having Di moderate (40,3%), while 7 patients were having Di severe (9,1%).
2. Women had the frequence of having more TMJ dysfunction than men.
3. Age range of 31-45 years old were the most who getting Di mild in the amount of 63,6%.
Moderate TMJ dysfunction of this research showed that the age of group over 45 years old had the biggest result than the other age group in the amount of 63,2%. Meanwhile, severe TMJ dysfunction of this research showed that the age of group under 31 years old had the biggest result than the other age group in the amount of 12%.
4. Missing its 36 element having greater frequency from suffering mild TMJ dysfunction, which are 71,9%.The greatest frequency of TMJ dysfunction categories are shown in
75 subjects who had lost both of its molar, both 36 and 46 which are 66,7%. Classification of severe TMJ function disorder showed in subjects on this research that missing 46 and subjects that missing both its molar, 36 and 46.
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