Prevalence of Signs and Symptoms of Temporomandibular Disorders and Their Association with Emotional Factors and Waking-State Oral Behaviors on University Students: A Cross-Sectional Study

Abstract

Background/Objective: This cross-sectional study assessed the prevalence of temporomandibular disorders (TMD) among Italian university students and their association with emotional factors and parafunctional behaviors. Methods: A total of 321 students participated in this study. TMD signs and symptoms were evaluated using the DC/TMD criteria through clinical examinations and self-report questionnaires: physical (Symptom Questionnaire), psycho-emotional (PHQ-9, PHQ-15, PHQ-4, and GAD-7), and wake-state oral behaviors (Oral Behavior Checklist, OBC). The Mann-Whitney U test assessed associations between TMD, sociodemographic data, oral behaviors, and psychological vulnerability (p < 0.05). Results: Pain-related symptoms were present in 37% of students (male/female ratio 1:2.7; p < 0.001), and joint dysfunction in 28%, with no gender differences. The median score of PHQ-9 (2.0; interquartile range IQR 5.0), PHQ-15 (2.0; IQR 5.0), PHQ-4 (3.0; IQR 6.0), and GAD-7 (3.00; IQR 6.0) suggested negligible severity of anxious mood, depressed mood, and somatic symptoms among the university students. However, all scores were noticeably higher in students with pain-related TMD compared to pain-free ones (p < 0.05). OBC scores were significantly related to PHQ (p < 0.001), GAD-7 (p < 0.001), and pain symptoms (p < 0.001). Science faculty students (S) showed higher OBC scores than humanities ones (H; S: 20.0; IQR 13.0 vs. H: 16.0; IQR 14.0; p < 0.001), and an H/S ratio of 1:2 was found in pain prevalence (p < 0.05). Conclusions: This study found a high prevalence of TMD signs and symptoms, particularly pain-related, among university students, strongly linked to emotional factors and oral behaviors.

Keywords: TMD; anxiety; depression; epidemiology; stress; temporomandibular disorders.