Beyond the jaw: vocal, oropharyngeal and cognitive-linguistic biomarkers for precision pain phenotyping in TMD

Temporomandibular disorders (TMDs) represent a group of conditions affecting the temporomandibular joint and its associated musculature. TMD is the leading cause of chronic orofacial pain. Current assessment relies heavily on patient-reported outcomes, which capture pain intensity and its impact but provide limited mechanistic or functional insight. This narrative conceptual review proposes a framework for investigating vocal, oropharyngeal, and cognitive-linguistic (VOCL) features as candidate behavioral biomarkers for precision pain phenotyping in TMD. We synthesize the literature from TMD and related neurological and chronic pain conditions to examine how alterations in neuromuscular control, autonomic regulation, and cognitive burden could plausibly manifest as changes in acoustic voice metrics, motor speech performance, swallowing function, and cognitive-linguistic tasks. Given the limited TMD-specific empirical evidence available to date, we outline a staged validation roadmap that specifies TMD subgroups, study designs, confounder control strategies, and reliability considerations necessary before clinical application. While promising, VOCL features should be regarded as investigational constructs requiring rigorous validation. Establishing standardized protocols and integrating VOCL measures with psychological and physiological domains may clarify the potential role of VOCL in TMD phenotyping and monitoring.

Temporomandibular disorders; Vocal biomarkers; Speech acoustics; Swallowing; Cognitive function; Pain phenotyping

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