# Temporomandibular disorders in a tertiary clinic: associations with pain, chronicity, sleep versus awake bruxism, and psychological factors—a retrospective study

## TL;DR

This study explores how pain, chronicity, bruxism, and psychological factors are linked in patients with temporomandibular disorders in a Thai clinic.

## Contribution

The study identifies awake bruxism as a potential clinical indicator of psychological factors in TMD patients.

## Key findings

- Higher pain severity is significantly associated with depression, anxiety, and stress in TMD patients.
- Awake bruxism is strongly linked to psychological factors like depression, anxiety, and stress.
- Chronic TMD symptoms are associated with higher odds of depression, anxiety, and stress.

## Abstract

Background: Temporomandibular disorders (TMD) are prevalent orofacial
pain conditions; however, the interrelationships among clinical, psychological,
and behavioral factors remain insufficiently explored, particularly within the
Thai population. This single-center retrospective study aimed to examine the
associations among clinical characteristics, pain, bruxism, and psychological
factors in patients with TMD. Methods: The medical records of 222 adult
patients diagnosed with TMD at the Orofacial Pain Clinic between January and
December 2024 were reviewed. The primary outcomes were the associations of pain
severity and symptom duration with psychological factors, and the secondary
outcomes were the relationships of sleep and awake bruxism with psychological
factors and related variables. Statistical analyses included nonparametric tests,
chi-square tests, and logistic regression. Results: Among the 222
patients (75.7% female; mean age 35.83 ± 17.08 years), 56.8% presented
with chronic symptoms, 36.0% reported sleep bruxism, and 37.8% reported awake
bruxism. Higher pain severity was significantly associated with depression
(p = 0.004), anxiety (p = 0.001), and stress (p =
0.045). Chronic symptoms (>3 months) were associated with depression, anxiety,
and stress (p < 0.001). Awake bruxism demonstrated significant
associations with all three psychological factors (p < 0.001), whereas
sleep bruxism did not show such associations. In multivariable analyses, patients
with acute symptoms (≤3 months) had lower odds of sleep bruxism compared
with those with chronic symptoms (odds ratio (OR) = 0.37, p = 0.003),
and higher stress levels were associated with awake bruxism (OR = 1.15,
p < 0.001). Conclusions: The findings highlight the burden of
psychological factors among TMD patients, particularly those with higher pain
intensity, chronic symptoms, and awake bruxism. Awake bruxism may serve as a
clinical indicator of psychological factors, underscoring the importance of
psychological screening and biopsychosocially oriented management. Nonetheless,
the results should be interpreted with caution given the retrospective design and
the single-center setting.