Psychological Stress, Anxiety, and Temporomandibular Disorders: A Structured Narrative Review with Emphasis on Young Adults
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Abstract
Background: Temporomandibular disorders are multifactorial conditions involving the temporomandibular joints, masticatory muscles, and associated craniofacial structures. Psychological distress may contribute to symptom severity through behavioural, neuroendocrine, sleep-related, and pain-processing pathways. Objective: To synthesise evidence concerning the associations of psychological stress and anxiety with TMDs, with particular emphasis on young adults. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Web of Science, and Google Scholar. Eligible evidence included observational, prognostic, interventional, and review studies evaluating stress, anxiety, or related psychosocial factors in relation to TMD diagnosis, symptoms, pain, parafunctional behaviour, functional limitation, or quality of life. Findings were synthesised thematically because of heterogeneity in populations, diagnostic criteria, psychological measures, and outcomes. Results: Stress and anxiety were repeatedly associated with greater TMD-related pain, muscular tenderness, clenching, bruxism, sleep disturbance, functional limitation, and psychosocial impairment. Evidence was particularly frequent among university and dental students; one Pakistani study included 346 undergraduate BDS students and reported a significant stress–TMD association. Most primary evidence was cross-sectional, preventing determination of temporality or causality. Conclusion: Psychological distress is clinically relevant to TMD symptom burden, but the relationship is probably bidirectional and cannot be interpreted as independently causal. Psychosocial screening may complement structured TMD assessment, particularly in patients with persistent pain or functional impairment.
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