Prevalence of Temporomandibular Disorders and its Correlation with Stress and Salivary Cortisol Levels among Students


  • Swapna Bettanapalya Venkatesh
  • Smitha Sammith Shetty
  • Vignesh Kamath


Hydrocortisone, Saliva, Temporomandibular Joint Dysfunction Syndrome


Objective: To evaluate the prevalence of temporomandibular disorders (TMD) in students and to evaluate if any relationship existed between the stress levels, salivary cortisol levels, and TMD. Material and Methods: A total of 348 students, 187 female, and 161 male students, participated in this cross-sectional study. Students were evaluated based on the Research Diagnostic Criteria for TMD. The stress levels were evaluated using the Perceived Stress Scale. The students were divided into the control and TMD groups. Salivary cortisol levels in the salivary samples were analyzed. Results: The prevalence rate of TMDs was 30.7% in the study population. Of the female students, 61% had TMD compared with 46% of male students. Muscle disorders were the most predominant disorder in 14.2% of the students with TMD. The TMD group showed significantly higher salivary cortisol and stress levels than the control group. The TMD group also showed a moderate positive correlation between cortisol and stress levels (p=0.01). Conclusion: The study showed a strong association between salivary cortisol levels, stress, and temporomandibular disorders. Salivary cortisol could be used as a prognostic biomarker for stress while assessing the severity of TMJ problems in stressed individuals.


McNeill C. Management of temporomandibular disorders: concepts and controversies. J Prosthet Dent 1997; 77(5):510-22.

Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112(4):453-62.

Hongxing L, Astrom AN, List T, Nilsson IM, Johansson A. Prevalence of temporomandibular disorder pain in Chinese adolescents compared to an age-matched Swedish population. J Oral Rehabil 2016; 43(4):241-8.

Kobayashi FY, Gavião MBD, Marquezin MCS, Fonseca FLA, Montes ABM, Barbosa TS, et al. Salivary stress biomarkers and anxiety symptoms in children with and without temporomandibular disorders. Braz Oral Res 2017; 31:e78.

Schiffman EL, Fricton JR, Haley DP, Shapiro BL. The prevalence and treatment needs of subjects with temporomandibular disorders. J Am Dent Assoc 1990; 120(3):295-303.

Carlson GE, Magnusson T. Management of Temporomandibular Disorders in the General Dental Practice. London: Quintessence Publishing Co. Inc.; 1990.

Carlsson GE. Epidemiology and treatment need for temporomandibular disorders. J Orofac Pain 1999;13(4):232-7.

Solberg WK, Woo MW, Houston JB. Prevalence of mandibular dysfunction in young adults. J Am Dent Assoc 1979; 98(1):25-34.

Pedroni CR, De Oliveira AS, Guaratini MI. Prevalence study of signs and symptoms of temporomandibular disorders in university students. J Oral Rehabil 2003; 30(3):283-9.

Zulqarnain BJ, Khan N, Khattab S. Self-reported symptoms of temporomandibular dysfunction in a female university student population in Saudi Arabia. J Oral Rehabil 1998; 25(12):946-53.

Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992; 6(4):301-55.

Campos JADB, Goncalves DAG, Camparis CM, Speciali JG. Reliability of a form for diagnosing the severity of temporomandibular disorder. Rev Bras Fisioter 2009; 13(1):38-43.

Schmitter M, Ohlmann B, John MT, Hirsch C, Rammelsberg P. Research diagnostic criteria for temporomandibular disorders: a calibration and reliability study. Cranio 2005; 23(3):212-8.

John MT, Dworkin SF, Mancl LA. Reliability of clinical temporomandibular disorder diagnoses. Pain 2005; 118(1-2):61-9.

List T, John MT, Dworkin SF, Svensson P. Recalibration improves inter-examiner reliability of TMD examination. Acta Odontol Scand 2006; 64(3):146-52.

Greenberg MS, Glick M. Burket's Oral Medicine Diagnosis & Treatment. 10th ed. Hamilton: BC Decker; 2003.

Wu G, Chen L, Zhu G, Su, Y, Chen Y, Sun J, et al. Psychological stress induces alterations in temporomandibular joint ultrastructure in a rat model of temporomandibular disorder. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112(6): e106-e112.

Miller GE, Chen E, Zhou ES. If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull 2007; 133(1):25-45.

Laccio KJD, Colato AS, Dorneles G, Peres A. Assessment of levels of salivary cortisol and stress in patients with signs and symptoms of temporomandibular joint disorders. Int J Health Sci 2014; 2(4):59-72.

Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint (TMJ) disorders. Cochrane Database Syst Rev 2010; (7):CD006541.

Vining RF, McGinley RA. The measurement of hormones in saliva: possibilities and pitfalls. J Steroid Biochem 1987; 27(1-3):81-94.

Weibel L. Methodological guidelines for the use of salivary cortisol as biological marker of stress. Presse Med 2003; 32(18):845‑51.

Ahmed LI, Abuaffan AH. Prevalence of temporomandibular joint disorders among Sudanese university students. J Oral Hyg Health 2016; 4(2):200.

Okano K, Kaczmarzyk JR, Dave N, Gabrieli JDE, Grossman JC. Sleep quality, duration, and consistency are associated with better academic performance in college students. NPJ Sci Learn 2019; 4:16.

Oliveira AS, Dias EM, Contato RG, Berzin F. Prevalence study of signs and symptoms of temporomandibular disorder in Brazilian college students. Braz Oral Res 2006; 20(1):3-7.

Karthik R, Hafila MIF, Saravanan C, Vivek N, Priyadarsini P, Ashwath B. Assessing prevalence of temporomandibular disorders among university students: a questionnaire study. J Int Soc Prev Community Dent 2017; 7(Suppl 1):S24-S29.

Salameh E, Alshaarani F, Hamed HA, Nassar JA. Investigation of the relationship between psychosocial stress and temporomandibular disorder in adults by measuring salivary cortisol concentration: a case-control study. J Indian Prosthodont Soc 2015; 15(2):148-52.

Progiante PS, Pattussi MP, Lawrence HP, Goya S, Grossi PK, Grossi ML. Prevalence of temporomandibular disorders in an adult brazilian community population using the Research Diagnostic Criteria (Axes I and II) for Temporomandibular Disorders (The Maringá Study). Int J Prosthodont 2015; 28(6):600-9.

Barros VM, Seraidarian PI, Côrtes MI, de Paula LV. The impact of orofacial pain on the quality of life of patients with temporomandibular disorder. J Orofac Pain 2009; 23(1):28-37.

Nilsson AM, Dahlström L. Perceived symptoms of psychological distress and salivary cortisol levels in young women with muscular or disk-related temporomandibular disorders. Acta Odontol Scand 2010; 68(5):284-8.

Ali QS, Hadi R. Assessment of cortisol as salivary psychological stress marker in relation to temporomandibular disorders among a sample of dental students. JBCD 2015; 27(2):86-92.




How to Cite

Venkatesh, S. B. ., Shetty, S. S. ., & Kamath, V. . (2021). Prevalence of Temporomandibular Disorders and its Correlation with Stress and Salivary Cortisol Levels among Students. Pesquisa Brasileira Em Odontopediatria E Clínica Integrada, 21, e0120. Retrieved from



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