Psychosocial determinants of pain laterality in myogenous temporomandibular disorders: A DC/TMD-based study
Related Experiment Video
Updated: Oct 31, 2026
Temporomandibular Joint Pain Measurement by Bite Force and Von Frey Filament Assays in Mice
Published on: September 13, 2024
1Sami Erkan Ünal Specialist in Oral and Maxillofacial Surgery Denizli Oral and Dental Health Hospital Denizli, Türkiye samierkanunal@gmail.com.
Background:
Pain laterality in myogenous temporomandibular disorders may reflect psychosocial and behavioral modulation rather than structural craniofacial factors. This study investigated the association between pain laterality and psychosocial and behavioral factors assessed using DC/TMD Axis II instruments in patients diagnosed with myalgia. A secondary exploratory analysis evaluated whether craniofacial morphology contributes to pain laterality.
Materials And Methods:
This retrospective cross-sectional study included 102 patients diagnosed with myalgia according to DC/TMD Axis I criteria and evaluated between January 2023 and July 2024. Pain laterality (right-sided, left-sided, or bilateral) was determined using standardized DC/TMD clinical examination and pain drawings. Psychosocial and behavioral factors were assessed using the Graded Chronic Pain Scale, Patient Health Questionnaire (PHQ-4/9/15), Generalized Anxiety Disorder scale (GAD-7), Jaw Functional Limitation Scale (JFLS-8/20), and Oral Behaviors Checklist (OBC). Lateral cephalometric measurements were obtained from orthodontic records and analyzed using WebCeph® software. Multiple testing across cephalometric variables was controlled using the Benjamini-Hochberg false discovery rate correction.
Results:
Pain was bilateral in 56.9% of patients, right-sided in 27.5%, and left-sided in 15.7%. No cephalometric parameter showed a significant association with pain laterality after FDR correction. In contrast, anxiety (GAD-7, p = 0.030) and oral parafunctional behaviors (OBC, p = 0.024) differed significantly across pain laterality groups, with higher scores observed in patients with unilateral (particularly right-sided) pain.
Conclusions:
In DC/TMD-defined myalgia, pain laterality was associated with psychosocial and behavioral factors while craniofacial morphology did not contribute meaningfully to pain laterality.
Clinical Relevance:
Pain laterality in myogenous temporomandibular disorders appears to be more closely related to psychosocial and behavioral factors than to craniofacial morphology, supporting routine psychosocial screening and individualized behavioral management strategies.
