Risk Factors for Temporomandibular Joint Disorders in Young Adults in Khyber Pakhtunkhwa
Keywords:
Anxiety; Case-Control Studies; Orofacial Pain; Parafunctional Habits; Sleep Bruxism; Temporomandibular Joint Disorders; Young AdultsAbstract
Background:
Temporomandibular joint disorders (TMD) are among the most prevalent causes of non-odontogenic orofacial pain, yet their multifactorial etiology remains insufficiently characterized in young adults from developing regions. Psychosocial stress, sleep disturbance, and oral parafunctions have been identified as potential contributors, but population-specific evidence from Pakistan is limited.
Objective:
To identify and quantify behavioral, psychosocial, and anatomical risk factors associated with TMD among young adults in Khyber Pakhtunkhwa through a case–control analysis.
Methods:
A hospital-based case–control study was conducted in private hospitals across Peshawar, Mardan, and Abbottabad between May and October 2025. A total of 236 participants (118 clinically diagnosed TMD cases, 118 matched controls aged 18–35 years) were assessed. Diagnosis was based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Data on sociodemographic, behavioral, and psychosocial factors were collected using validated instrumentsthe Oral Behaviors Checklist (OBC), Pittsburgh Sleep Quality Index (PSQI), and Patient Health Questionnaire-4 (PHQ-4). Logistic regression analyses identified independent predictors of TMD, with significance set at p < 0.05.
Results:
Sleep bruxism (37.3% vs 15.3%; p < 0.001), awake parafunction (39.8% vs 17.8%; p < 0.001), poor sleep quality (51.7% vs 22.0%; p < 0.001), and elevated anxiety/depression (29.7% vs 12.7%; p = 0.003) were significantly more common among cases. In multivariate analysis, sleep bruxism (aOR = 2.94; 95% CI: 1.53–5.68), poor sleep quality (aOR = 3.21; 95% CI: 1.72–5.99), and awake parafunction (aOR = 2.78; 95% CI: 1.49–5.18) remained independent predictors of TMD.
Conclusion:
Behavioral and psychosocial factorsparticularly sleep bruxism, parafunctional activity, and poor sleep qualityare major risk determinants for TMD in young adults. Addressing these modifiable variables through early screening and behavioral interventions may help reduce TMD prevalence in this population.
Keywords: Anxiety; Case-Control Studies; Orofacial Pain; Parafunctional Habits; Sleep Bruxism; Temporomandibular Joint Disorders; Young Adults
