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

BACKGROUND: 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. OBJECTIVE: To explore associations of TMD pain with sex, life stress, anxiety, depression and oral mucosal pain and identify independent psychosocial correlates. METHODS: 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. RESULTS: 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. CONCLUSION: 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.