Temporomandibular disorders in a tertiary clinic: associations with pain, chronicity, sleep versus awake bruxism, and psychological factors—a retrospective study

Background: Temporomandibular disorders (TMD) are prevalent orofacial pain con-ditions; however, the interrelationships among clinical, psychological, and behavioral factors remain insufficiently explored, particularly within the Thai population. This single-center retrospective study aimed to examine the associations among clinical characteristics, pain, bruxism, and psychological factors in patients with TMD. Methods: The medical records of 222 adult patients diagnosed with TMD at the Orofacial Pain Clinic between January and December 2024 were reviewed. The primary outcomes were the associations of pain severity and symptom duration with psychological factors, and the secondary outcomes were the relationships of sleep and awake bruxism with psychological factors and related variables. Statistical analyses included nonparametric tests, chi-square tests, and logistic regression. Results: Among the 222 patients (75.7% female; mean age 35.83 ± 17.08 years), 56.8% presented with chronic symptoms, 36.0% reported sleep bruxism, and 37.8% reported awake bruxism. Higher pain severity was significantly associated with depression (p = 0.004), anxiety (p = 0.001), and stress (p = 0.045). Chronic symptoms (>3 months) were associated with depression, anxiety, and stress (p < 0.001). Awake bruxism demonstrated significant associations with all three psychological factors (p < 0.001), whereas sleep bruxism did not show such associations. In multivariable analyses, patients with acute symptoms (≤3 months) had lower odds of sleep bruxism compared with those with chronic symptoms (odds ratio (OR) = 0.37, p = 0.003), and higher stress levels were associated with awake bruxism (OR = 1.15, p < 0.001). Conclusions: The findings highlight the burden of psychological factors among TMD patients, particularly those with higher pain intensity, chronic symptoms, and awake bruxism. Awake bruxism may serve as a clinical indicator of psychological factors, underscoring the importance of psychological screening and biopsychosocially oriented management. Nonetheless, the results should be interpreted with caution given the retrospective design and the single-center setting.

Temporomandibular disorders; Orofacial pain; Bruxism; Psychological factors; Clinical characteristics; Retrospective study

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