UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4413
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4413
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Association between painful temporomandibular disorders and
psychosocial factors in dental students
Associação entre disfunções temporomandibulares dolorosas e fatores psicossociais em estudantes de odontologia
Fernando ORTIZ-CULCA1 , Patricia ASTUPINARO-CAPRISTAN1 , Doris SALCEDO-MONCADA1 , Martha PINEDA-MEJIA1 ,
Romel WATANABE-VELAZQUEZ1
1 - Universidad Nacional Mayor de San Marcos, Faculty of Dentistry, Rehabilitation Stomatology Department, Lima, Peru.
How to cite: Ortiz-Culca F, Astupinaro-Capristan P, Salcedo-Moncada D, Pineda-Mejia M, Watanabe-Velasquez R. Association between
painful temporomandibular disorders and psychosocial factors in dental students. Braz Dent Sci. 2024;27(4):e4413. https://doi.
org/10.4322/bds.2024.e4413
ABSTRACT
Objective: To establish the association between painful Temporomandibular Disorders (TMD) and psychosocial
factors in dental students, using the Diagnostic Criteria for TMD. Material and Methods: This cross-sectional
study included dental students of the Universidad Nacional Mayor de San Marcos from the third to tenth cycle.
Descriptive and inferential statistical tests were used, including the chi- square, Fisher’s, and t-tests, and multivariate
analysis to analyze the results. Results: This study was carried out on 203 students aged 17–48 years; 64.5%
were female. Using the TMD pain screener, we found 14.7% and 15.76% of painful TMD in the short and long
versions, respectively. Painful TMD was associated with chronic pain (odds ratio [OR: 34.506 and 9.205 for the
short and long versions, respectively), moderate depression (OR: 7.545 and 6.301 for the short and long versions,
respectively), severe depression (OR: 57.218 and 18.310 for the short and long versions, respectively), and oral
habits (OR: 3.146 for the long version). Conclusion: Psychosocial variables may increase the risk for the presence
of painful TMD. Moderate and severe depression and oral habits were signicantly associated with TMD pain.
KEYWORDS
Chronic pain; Cross-sectional studies; Dental students; Psychology; Temporomandibular joint disorders.
RESUMO
Objetivo: Estabelecer a associação entre as Disfunções Temporomandibulares (DTM) dolorosas e os fatores
psicossociais em estudantes de Odontologia, utilizando os Critérios de Diagnóstico para DTM. Material e Métodos: Este
estudo transversal incluiu estudantes de Odontologia da Universidade Nacional Maior de São Marcos, do 3º
ao 10º semestre. Para a análise dos resultados foram utilizados testes estatísticos descritivos e inferenciais,
nomeadamente os testes do qui-quadrado, de Fisher e t, e análise multivariada. Resultados: Participaram neste
estudo 203 estudantes com idades compreendidas entre os 17 e os 48 anos, sendo 64,5% do gênero feminino.
Utilizando o questionário de triagem de dor para DTM, encontramos 14,7% e 15,76% de DTM dolorosa nas
versões curta e longa, respetivamente. A DTM dolorosa foi associada à dor crônica (odds ratio [OR: 34,506 e 9,205
para as versões curta e longa, respetivamente), depressão moderada (OR: 7,545 e 6,301 para as versões curta e
longa, respetivamente), depressão grave (OR: 57,218 e 18,310 para as versões curta e longa, respetivamente)
e hábitos orais (OR: 3,146 para a versão longa). Conclusão: As variáveis psicossociais podem aumentar o risco
para a presença de DTM dolorosa. A depressão moderada e grave e os hábitos orais foram signicativamente
associados à dor na DTM.
PALAVRAS-CHAVE
Dor crônica; Estudos transversais; Estudantes de Odontologia; Psicologia; Distúrbios da articulação temporomandibular.
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Culca FO et al.
Association between painful temporomandibular disorders and psychosocial factors in dental students
Culca FO et al. Association between painful temporomandibular disorders and
psychosocial factors in dental students
INTRODUCTION
Temporomandibular disorders (TMD) are a
group of musculoskeletal and neuromuscular con-
ditions that compromise the temporomandibular
joints, masticatory muscles, and associated tis-
sues. The signs and symptoms may include dif-
culties in chewing, speech, and other functions
of the masticatory system [1].
TMD is a complex chronically painful
condition that occurs in both acute and chronic
forms and is the most important chronic orofacial
pain condition [2].
Diagnostic Criteria for TMD (DC/TMD) have
been proposed to standardize the diagnostic
system and classication for therapeutic purposes,
including clinical (Axis I) and psychosocial
aspects (Axis II) [3]; currently an ofcial Spanish
version is available [4].
The prevalence of TMD varies owing to
the various diagnostic systems used and the
presence of pain as a necessary condition for
treatment intervention. Huhtela et al., using self-
report pain questionnaires in Finnish university
students, found the prevalence of TMD pain to
be 20.6% [5]; Lung et al. found in Australian
university students that 77.2% reported at least
one TMD symptom [6]; in Peru, using the DC/
TMD screener, the individuals identied with
painful TMD were reported in 16.1% of dental
students [7]; and using the same self-report
instrument, Iodice et al. in Italy found 16.4% of
individuals with painful TMD [8].
The biopsychosocial model proposed by
Engel [9] included factors associated with
pain perception, as well as social and cultural
factors. In a study carried out in the USA with
208 risk factors, involving 2737 participants and
a follow-up period of 2.8 years, it was found that
in the appearance of TMD, which occurred in
260 individuals, one of the important risk factors
was the location of the city [10]. Associations
have been found between chronic pain and levels
of education and poverty [11], social class [12],
rural location, and poor general health [13,14].
The model proposed by Maixner et al. [15]
presents two intermediary phenotypes, psychological
distress and pain amplication, which contribute to
the appearance and persistence of TMD, with social
factors appearing as contributing factors.
The results of a prospective cohort
study (“Orofacial Pain Prospective and Risk
Assessment”) evaluated the contribution of
202 variables in 2,737 men and women from
the USA, and found an annual TMD incidence
of 3.5% in a period of 2.8 years [16]. Variables
related to the health status contributed greatly to
the incidence of TMD, followed by psychological
and clinical factors [17].
Some authors do not report the results of
Axis II and do not consider the heterogeneity of
psychosocial factors and their possible inuences on
various results of similar therapeutic interventions
in identical diagnoses on Axis I [18].
No correlation has been found between
a specic diagnosis of Axis I and the ndings
of Axis II; however, high levels of pain were
associated with severe depression and higher
somatization scores [19,20]. The prevalence of
severe depression and somatization was higher
in patients with TMD [21,22].
This study aimed to determine the association
between painful TMD and psychosocial
characteristics using standardized and validated
self-report questionnaires and screener included
in DC/TMD.
MATERIAL AND METHODS
A total of 281 students, enrolled in the
2022-2 semester at the dental school of the
Universidad Nacional Mayor de San Marcos
(UNMSM), Lima (Perú), were invited to
participate in this study by lling out the surveys
within the application of a web page (http://
essentia-ttmperu.com/encuesta/) containing the
triage instrument (Axis I) and Axis II instruments
of the DC/TMD. A total of 230 students responded
and authorized their participation with a digital
informed consent. This research was approved
by the General Directorate of Research and
Technological Transparency of the UNMSM (N.
º 000230-2022-DGITT-VRIP/UNMSM).
The exclusion criteria were the presence
of ongoing orthodontic treatment or chronic
systemic joint diseases.
To determine the study variables, the ofcial
Spanish version of the DC/TMD was used. These
criteria included the assessment of TMD in two
axes, Axis I, physical diagnosis, and Axis II, which
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Culca FO et al.
Association between painful temporomandibular disorders and psychosocial factors in dental students
Culca FO et al. Association between painful temporomandibular disorders and
psychosocial factors in dental students
measured the psychosocial state and disability
caused by pain [4].
Axis I included the TMD pain screener, which
is a six-item questionnaire, with two versions, a
short version of three items and a long version of
six items, which has a sensitivity and specicity
of 97% and 99%, respectively. The presence of a
painful TMD is established when the sum of the
scores obtained from their responses is greater
than 2 and 3 for the short and long versions,
respectively [23].
For the estimation of psychosocial factors,
we used Axis II; to estimate chronic pain, the
Graded Chronic Pain Scale version 2.0 was used,
the long form of Jaw Functional Limitation Scale
20-item was used; for anxiety, the Generalized
Anxiety Disorder Index GAD-7 was used; for
depression, the Patient Health Questionnaire
PHQ-9 was used; for somatization, the Patient
Health Questionnaire: Physical Symptoms PHQ-
15; and for waking-state oral behaviors, the
Oral Behaviors Checklist was used. All of these
instruments were found in the Spanish version
of the DC TMD [4].
For socioeconomic level, a variation of the
Peruvian Institute of Statistics and Informatics
scale adapted by the Peruvian Association of
Market Research Companies was used [24].
After signing the digital informed consent
form and according to the semester corresponding
to each participant, they were provided with
an access code to an internet application that
contained the DC/TMD in Spanish in the digital
version (http://essentia-ttmperu.com; Peruvian
National Institute for the Defense of Competition
and the Protection of Intellectual Property patent
Resolution No. 1271-2022/DDA-INDECOPI).
The application did not allow the completion of
the survey if it was not completely lled out or
completed at a single time. The indications for
completing the survey were provided at the time
of signing the digital informed consent form.
The survey was completed during the nal
week of the nal semester of 2022 academic year.
All instruments were self-responsive and did not
require examiner calibration.
Statistical analysis
All data were exported from the web
application to Excel (Microsoft Corp., Redmond,
WA, USA) to determine the corresponding
diagnoses according to the specications of each
instrument used, thus allowing verication of the
collected data.
The frequencies were obtained for each
variable. The associations between variables were
established using chi-square and Mann–Whitney
U tests.
The univariate and multivariate analyses
were used to calculate the odds ratio (OR) and
the corresponding 95% condence intervals to
estimate the association between painful TMD and
the various instruments used in the assessment of
Axis II of DC/TMD. A multivariate analysis was
performed using painful TMD as the dependent
variable. Age, sex, and psychosocial variables
were categorized as dichotomous (score “0”
representing absence and “≥1” denoting presence),
except for depression (absence, moderate, and
severe) and the Jaw Functional Limitation Scale
20-item (continuous). Socioeconomic levels were
grouped as low, medium, and high.
The data were analyzed using STATA
(StataCorp, College Station, TX, USA), and the
results were considered signicant with p <0.05.
RESULTS
Of the 230 students who responded,
1 was eliminated for presenting a diagnosis of
rheumatoid disease and 26 were eliminated for
having orthodontic treatment, thus resulting in
203 students. The age range of the participants
was 17–48 years, with an average of 22.03 (±
3.47 [standard deviation]) years; 131 (64.5%)
were women and 72 (35.5%) were men.
Using the TMD pain screener of the DC/
TMD, 14.78% of the students identified with
painful TMD using the short version (3 items), of
which 16.0% were women and 12.5% were men,
and using the long version (6 items) the estimate
was 15.76%, of which 17.6% were women and
12.5% were men.
No statistically signicant differences were
found between the positive results in terms of
sex using the distribution of TMD pain screener
(χ2= 0.459, p = 0.498 for the short version and
χ2 = 0.895, p = 0.344 for the long version)
(Table I).
A high socioeconomic status was found in
20 (9.85%) students, medium in 67 (33%), and
low in 116 (57.14%). No signicant difference
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Culca FO et al.
Association between painful temporomandibular disorders and psychosocial factors in dental students
Culca FO et al. Association between painful temporomandibular disorders and
psychosocial factors in dental students
was found between socioeconomic level and
positive results using the screener (χ2 = 2.796,
p = 0.247 for the short version and χ2 = 2.174,
p = 0.337 for the long version) (Table II).
Using the chi-square test with psychosocial
factors (Axis II), it was found that with the chronic
pain scale, 53.20% of the individuals (57.73%
women and 48.61% men) reported the presence
of chronic pain, 51.72% reported some degree
of anxiety (52.67% women and 50.0% men),
and 61.58% reported some degree of depression
(65.65% women and 54.17% men). In these
variables no significant difference was found
in relation with sex. Regarding somatization,
62.07% of the individuals presented some degree
of somatization (70.9% women and 45.83%
men), indicating a signicant relationship with
sex (p <0.05). Regarding the information on the
presence of parafunctions among the participants,
using the Oral Behaviors Checklist, it was found
that 18.23% of the individuals presented a
score >25 (high level); no signicant difference
was found in relation to sex (p = 0.420). All Axis
II instruments were signicantly associated with
the presence of painful TMD in both the versions.
(Table III).
The overall index of decreased mandibular
mobility was signicantly associated with both the
versions of the TMD pain screener (p <0.001),
using the Mann-Whitney U test.
Multivariable logistic regression analysis
showed that in both the versions of the TMD pain
screener, there was a signicant association with
the presence of chronic pain (OR: 34.603 and
9.205 for the short and long versions, respectively),
moderate depression (OR: 7.545 and 6.301 for
the short and long versions, respectively), severe
depression (OR: 57.218 and 18.31 for the
short and long versions, respectively), and
oral behavior (OR: 3.146 for the long version)
(Table IV, Table V).
DISCUSSION
The results of this cross-sectional study
conrmed the ndings of previous research on
the association between psychosocial factors
and the presence of painful TMD in university
students [25-27].
No statistically signicant association was
found between socioeconomic level and the
presence of painful TMD, similar to the results of
the study presented by Nogueira et al., who found
a higher percentage of low socioeconomic level
(48.5%) in university students from Brazil [28].
Using the TMD pain screener, we found the
presence of painful TMD in 14.78% and 15.76%
of the individuals in the short and long versions,
respectively. The presence of painful TMD
using this instrument was lower than those
Table I - Sample distribution according TMD pain screener by sex
n3-item version 6-item version
Negative Affirmative Negative Affirmative
Sex
Male 72 63 9 63 9
87.50% 12.50% 87.50% 12.50%
Female 131 110 21 108 23
84.00% 16.00% 82.40% 17.60%
Total 203 173 30 171 32
85.22% 14.78% 84.24% 15.76%
Table II - Percent of cases identified by socioeconomic level using the TMD Pain screener
Socioeconomic Level 3-item version 6-item version
Negative Affirmative Negative Affirmative
Low 96 (82.8%) 20 (17.2%) 95 (81.9%) 21 (18.1%)
Medium 61 (91.0%) 6 (9.0%) 60 (89.6%) 7 (10.4%)
High 16 (80.0%) 4 (20.0%) 16 (80.0%) 4 (20.0%)
Total 173 (85.22%) 30 (14.78%) 171 (84.24%) 32 (15.76%)
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Association between painful temporomandibular disorders and psychosocial factors in dental students
Culca FO et al. Association between painful temporomandibular disorders and
psychosocial factors in dental students
Table III - Comparison of prevalence of psychosocial factors and TMD pain
Prevalence 3-item version 6-item version
n % male female p value
(Chi squared)
p value
(Fisher test) p value Fisher
(pvalue)
Socioeconomic level
High 20 9.85% 8 (11.11%) 12 (9.16%) 0.247 0.337
Medium 67 33.00% 29 (40.28%) 38 (29.01%)
Low 116 57.14% 35 (48.61%) 81 (61.63%)
Chronic Pain
No pain 95 46.80% 37 (51.39%) 58 (44.27%) <0.001* <0.001*
Low intensity pain, without disability 79 38.92% 24 (33.33%) 55 (41.98%)
High intensity, without disability 11 5.42% 6 (8.33%) 5 (3.82%)
Moderately limiting 18 8.87% 5 (6.94%) 13 (9.92%)
Depression
No depression 78 38.42% 33 (45.83%) 45 (34.35%) 0.000* 0.001*
Mild 70 34.48% 25 (34.72%) 45 (34.35%)
Moderate 27 13.30% 6 (8.33%) 21 (16.03%)
Moderately severe 17 8.37% 5 (6.94%) 12 (9.16%)
Severe 11 5.42% 3 (4.17%) 8 (6.11%)
Anxiety
No anxiety 98 48.28% 62(47.33%) 36(50%) 0.003* 0.007*
Mild 67 33.00% 40(30.53%) 27(37.50%)
Moderate 25 13.32% 20(15.27%) 5(6.94%)
Severe 13 6.40% 9(6.87%) 4(5.56%)
Somatic symptoms
No symptoms 77 37.93% 39(54.17%) 38(19.02%) <0.001* 0.005*
Low intensity pain, without disability 70 34.48% 22(30.46%) 48(36.64%)
Medium 42 20.69% 5(6.94%) 37(28.24%)
High physical symptoms 14 6.90% 6(8.33%) 8(6.11%)
Oral Behaviour Cheklist
No risk 166 81.77% 61 (84.72%) 105(80.15%) 0.001* 0.001*
Risk 37 18.23% 11(15.28%) 26(19.85%)
* Significant difference p<0.05
Table IV- Multivariable logistic regression analysis assesing the association between psychosocial factors and TMD pain with 3-item version
Variable Category Presence/
Absent
version 3 (crude) version 3 (multivariable)
OR 95% IC p OR 95% IC p
Age Mean 21.93/22.04 0.99 0.881-1.112 0.869 0.898 0.736-1.096 0.294
Sex Male 9/63 1 reference 1 reference
Female 21/110 1.336 0.576-3.095 0.499 1.03 0.345-3.076 0.05
Socioeconomic level Low 20/96 1 reference 1 reference
high/medium 10/77 0.623 0.275-1.409 0.256 0.496 0.173-1.424 0.193
Graded Chronic Pain no pain 1/94 1 reference 1 reference
Scale Version 2.0 pain 29/79 34.506 4.596-
259.026 0.001* 34.603 4.144-288.90 0.001*
Anxiety (GAD - 7) no symptoms 10/88 1 reference 1 reference
with symptoms 20/85 2.07 0.916-4.680 0.08 0.173 0.415-0.729 0.017*
Depression (PHQ-9)
no depression 4/74 1 reference 1 reference
Moderate 13/84 2.863 0.894-9.164 0.07 7.545 1.587-35.855 0.011*
Severe 13/15 16.033 4.591-55.992 <0.001* 57.218 7.914-413.66 <0.001*
Somatization (PHQ-15) No somatization 5/72 1 reference 1 reference
With somatization 25/101 3.564 1.302-9.753 0.013* 1.42 0.367-5.489 0.611
Jaw Functional Limitation
Scale 8-item mean value 1.56 1.164-2.089 0.003* 1.27 0.873-1.849 0.21
Oral Behaviors Checklist no risk 18/148 1 reference 1 reference
Risk 12/25 3.946 1.696-9.182 0.001* 2.897 0.985-8.522 0.053
* p significative
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Association between painful temporomandibular disorders and psychosocial factors in dental students
Culca FO et al. Association between painful temporomandibular disorders and
psychosocial factors in dental students
reported by Khan et al. [29], who found 36.1%
of adolescents with painful TMD in a Brazilian
city, and Ortiz-Culca et al. [7], who found
19.4% and 16.1% of Peruvian dental students
with painful TMD with the short and long
versions, respectively. Iodice et al. [8] found
16.1% of adults in Italy with painful TMD using
the short version, whereas Nadershah [30]
found 35% of individuals in Saudi Arabia with
painful TMD, using the long version of the
instrument.
The DC/TMD offers a dual approach, with an
ofcially validated Spanish translation available
on the internet with a series of psychometric
instruments that allow their results to be compared
with publications made in other countries, owing
to their high levels of standardization, validity,
and reliability, and with an ofcial translation in
Spanish [4]. To the best of our knowledge, this is
the rst publication in Peru that uses the ofcial
translation of all instruments of Axis II.
Dental students are subjected to strong
levels of stress; reported up to 100% [31]. This
perception is due to the tendency of students
towards perfectionism, based on the excellence
that represents the norm in dentistry [32],
the natural demand for training [33], and the
curriculum changes developed in dentistry that
increase the levels of stress in the students [34].
Benassi et al. [35] reported higher levels
of anxiety in a sample of 90 dental students
and found no signicant association with sex,
which are similar to the results of this study.
Srivastava et al. [36] found a prevalence of
TMD to be 36.99% and signicant differences in
relation to sex (p = 0.004), similar to the study
by Ortiz-Culca (p <0.001) [7].
Disability due to chronic pain has been
proposed since the appearance of the Research
Diagnostic Criteria for TMD (RCD/TMD)
and various studies have found a significant
relationship between the presence of TMD and
severe depression and somatization [37].
Most investigations have evaluated the
distribution of Axis II in patient populations;
however, not in population samples.
The scores obtained on the chronic pain
scale (GCPS) and the duration of pain, followed
by psychological problems, are the main factors
that can affect the quality of life of patients with
TMD [38]. The psychosocial variables of Axis II
of the RCD/TMD were found to be more severe
in patients with TMD compared with the normal
population (p <0.001) [39].
According to the results of this study, a
significant relationship was found between
painful TMDs and the presence of moderate or
Table V - Multivariable logistic regression analysis assesing the association between psychosocial factors and TMD pain with 6-item version
Variable Category Presence/
Absent
version6 (crude) version 6 (multivariable)
OR 95% IC p OR 95% IC p
Age Mean 22.28/21.98 1.023 0.925-1.131 0.656 0.991 0.855-1.149 0.914
Sex Male 9/63 1 reference
Female 23/108 1.49 0.649-3.421 <0.001* 1.226 0.452-3.320 0.688
Socioeconomic level Low 21/95 1 reference 1 reference
high/medium 11/76 0.654 0.297-1.441 0.293 0.676 0.263-1.736 0.417
Graded Chronic Pain no pain 3/92 1 reference 1 reference
Scale Version 2.0 pain 29/79 11.257 3.303-38.364 <0.001* 9.205 2.447-34.62 0.001*
Anxiety (GAD - 7) no symptoms 11/87 1 reference 1 reference
with symptoms 21/84 1.977 0.898-4.351 0.09 0.335 0.958-1.176 0.088
Depression (PHQ-9)
no depression 5/73 1 reference 1 reference
Moderate 16/81 2.883 1.006-8.264 0.049* 6.301 1.524-26.051 0.011*
Severe 11/17 9.447 2.898-30.792 <0.001* 18.310 3.129-107.177 0.001*
Somatization (PHQ-15) No somatization 7/70 1 reference 1 reference
With somatization 25/101 2.475 1.014-6.038 0.046* 0.815 0.245-2.712 0.739
Jaw Functional
Limitation Scale 8-item mean value 1.641 1.226-2.198 0.001* 1.33 0.940-1.880 0.106
Oral Behaviors Checklist no risk 19/147 1 reference 1 reference
Risk 13/24 4.190 1.832-9.581 0.001* 3.146 1.172-8.443 0.023*
* p significative
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Association between painful temporomandibular disorders and psychosocial factors in dental students
Culca FO et al. Association between painful temporomandibular disorders and
psychosocial factors in dental students
severe depression, limited mandibular function,
and oral habits.
Depression, anxiety, and stress were found
in 55.9%, 66.8%, and 54.7% of dental students,
respectively, thus establishing a need to provide
support to dental students [40]. Lövgren et al.
reported that in dental students painful TMD
was significantly related to the chronic pain
scale (GCPS, p = 0.001) with respect to those
who presented with non-painful TMD, and
found no significant differences between the
presence of TMD and the severity of depression,
anxiety, or stress. However, they found signicant
differences with respect to the Jaw Functional
Limitation Scale (p <0.001) and for estimated
oral parafunctions with the Oral Behaviors
Checklist (p = 0.005) [27].
In some investigations carried out in patient
populations, it was found that moderate-to-
severe depression varied from 47.4% to 60.1%,
whereas moderate-to-severe somatization varied
from 62.8% to 76.6% [20,41], attributing these
variation to ethnic factors and socioeconomic
aspects that would merit future research [24].
Canales et al. [42] did not nd signicant
relationships between the various instruments
of Axis II of the RDC/TMD and TMD in patient
populations; however, found significant
relationships when comparing painful and
non-painful TMD, and found higher levels of
depression and moderate and severe somatization
(p <0.001).
No signicant differences were found in this
study in relation to oral habits with respect to sex,
results that disagree with other reports that found
higher in women (p <0.001) [43].
In this study, signicant differences were
found in relation to oral habits and TMD, similar
to the results of Srivastava et al. [36], and a
higher level of risk was found with respect to oral
habits in the female sex [44].
No signicant association was found between
anxiety and painful TMD on any version of the
TMD pain screener. Fernandes Azevedo et al. [45],
using the RDC/TMD, found 36.2% of individuals
with TMD and found no signicant relationship
between TMD and anxiety (p >0.05), which
was contrary to other studies carried out on
university students, where statistically signicant
relationships were found between anxiety and
TMD [46-51].
The ndings of Axis II, especially the GCPS,
expressed in terms of disability caused by pain,
can be established as the best predictors of
treatment outcomes and the best tools for better
therapeutic planning for TMD [20]. The clinical
relevance of psychosocial diagnosis may be more
important than physical evaluation for treatment
prognosis [52]. Ethnic, socio-demographic, and
cultural factors may have inuenced the presence
of painful TMD in more representative samples.
There are limitations on determining the
painful TMD only by the use of questionary,
we consider in the future to include clinical
examination to classify the TMD and to establish
their relationships with psychological factors in
time.
The results of this cross-sectional study
provide an overview of the psychosocial status of
dental students, and the need for a longitudinal
estimation of these variables must be established.
CONCLUSION
In this cross-sectional study, psychosocial
variables were found to increase the risk of painful
TMD. Moderate and severe depression, and oral
habits were signicantly associated with painful
TMD. Longitudinal studies must be conducted to
assess the probable risks of psychosocial variables
in dental students with TMD.
Acknowledgements
The authors would like to thank to dental
students from the Universidad Nacional Mayor
de San Marcos, Lima (Peru), for their voluntary
participation in the study.
Author’s Contributions
FOC, RWV: Conceptualization. FOC, PAC,
DSM, MPM, RWV: Methodology. FOC, PAC:
Data curating. FOC: Writing – Original Draft
Preparation. FOC, PAC, DSM, MPM, RWV: Writing
– Review & Editing. PAC, MPM: Resources. FOC,
RWV: Supervision.
Conict of interest
The authors declare that there are no
conicts of interest regarding the publication of
this paper.
8
Braz Dent Sci 2024 Oct/Dec;27 (4): e4413
Culca FO et al.
Association between painful temporomandibular disorders and psychosocial factors in dental students
Culca FO et al. Association between painful temporomandibular disorders and
psychosocial factors in dental students
Funding
This research did not receive any specic
grant from funding agencies in the public,
commercial, or not-for-prot sectors
Regulatory Statement
This study was conducted in accordance
with the General Directorate of Research and
Technological Transparency of the UNMSM (N.
º 000230-2022-DGITT-VRIP/UNMSM).
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Fernando Ortiz Culca
(Corresponding address)
Universidad Nacional Mayor de San Marcos, Faculty of Dentistry,
Rehabilitation Stomatology Department, Lima, Peru
Email: fortizc@unmsm.edu.pe
Date submitted: 2024 June 19
Accept submission: 2024 Oct 13
