Pain-Affective Disorder Comorbidity in the Temporomandibular Disorders: From Mechanistic Insights to Clinical...

Temporomandibular disorders (TMDs) comprise a spectrum of conditions affecting the temporomandibular joint, masticatory musculature, dental occlusion, and even multiple systemic structures. Epidemiological data indicate that approximately 40% of patients with TMDs experience comorbid affective disorders, creating complex diagnostic and therapeutic challenges, further resulting in suboptimal management. This review summarizes the comorbidity spectrum of TMDs, especially focusing on the bidirectional relationship between TMD-related pain and affective disorders, with the aims of (1) elucidating shared neurobiological mechanisms involving central sensitization, maladaptive neuroplasticity, and neuro-endocrine-immune dysregulation in TMDs; (2) analyzing the role of psychosocial factors in perpetuating this comorbidity; and (3) evaluating evidence-based treatment strategies that address both somatic and psychological symptoms. This review concludes by highlighting emerging new technologies with the potential for improved risk assessment and advocates for personalized treatment paradigms in this complex patient population. Future research directions should prioritize longitudinal studies examining the trajectories of comorbidity as well as testing emerging intervention approaches.