Sex and Psychosocial Correlates of TMD-Related Pain: A Cross-Sectional Study

Previous studies have linked sex, stress, anxiety and depression to temporomandibular disorders (TMD) and orofacial pain, yet their independent associations with pain remain poorly defined.

To explore associations of TMD pain with sex, life stress, anxiety, depression and oral mucosal pain and identify independent psychosocial correlates.

This cross-sectional study enrolled 179 participants. Data on demographics, TMD-related pain, oral mucosal pain, 6-month stressful life events, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores were collected. TMD-related pain was defined as pain score > 0. Spearman correlation, intergroup comparison, stratified stress analysis and multivariate logistic regression were performed.

Overall, 46.9% had TMD-related pain and 31.3% had oral mucosal pain. Females showed a higher prevalence of TMD-related pain. TMD-related pain severity was positively correlated with stress, SAS, SDS and oral mucosal pain. TMD-related pain prevalence increased progressively across stress levels, and each higher stress category was associated with increased odds of TMD-related pain. In the fully adjusted model, female sex and anxiety remained independently associated with TMD-related pain, whereas stress and depression were no longer independently associated.

The associations of sex and psychosocial factors with TMD-related pain observed in this study are consistent with previous evidence. After simultaneous adjustment, anxiety was the only psychological dimension that remained independently associated with TMD-related pain, while stress burden showed a graded association with pain likelihood. These findings are compatible with a biopsychosocial approach to TMD assessment and highlight the potential value of incorporating psychosocial evaluation into routine clinical assessment.