Evaluation of Family and Behavioral Factors Associated with Intra-Articular Temporo-Mandibular Disorders in Children and Adolescents: An Observational Cross-Sectional Study

Abstract

Purpose: To investigate the role of behavioral, familial, and psychosocial factors in the etiology of temporomandibular disorders (TMD) in children and adolescents. Methods: A cross-sectional observational study was conducted with 139 participants (70 TMD patients, 69 healthy controls) aged nine to 18 years and their parents. TMD diagnosis was made using the Diagnostic Criteria for TMD (DC/TMD). Psychosocial, behavioral, and familial status were evaluated using Patient Health Questionnaire-4 (PHQ-4), Oral Behavior Checklist (OBC), Child Behavior Check-list/4-18 (CBCL/4-18), Family Assessment Device (FAD), and Visual Analog Scale (VAS). Statistical analyses employed the Mann-Whitney U test, Pearson's chi-square test, and Spearman's rho correlation with a significance level of P<0.05. Results: TMD patients exhibited significantly higher PHQ-4, OBC, and CBCL/4-18 scores compared to controls (P<0.001). Social withdrawal and introversion problems, such as anxiety and depression, as well as extraversion scores, such as criminal and aggressive behaviors, and diligent control scores, were higher in the TMD group. FAD scores did not differ significantly between groups (P=0.31 5). A statistically significant positive correlation was observed between OBC and VAS scores (r equals 0.390, P=0.001). Conclusion: These findings suggest that psychosocial and behavioral factors may play an important role in the clinical profile of temporomandibular disorders and should be considered in their assessment and management.