Association between psychological distress and self-reported temporomandibular disorder symptoms among clinical-year medical and dental students: a cross-sectional study

Abstract

Temporomandibular disorder (TMD)-related symptoms and psychological distress are common concerns among university students, particularly those in demanding healthcare education. This study aimed to evaluate the association between self-reported TMD symptom severity and psychological distress among a combined cohort of clinical-year medical and dental students. An anonymous cross-sectional survey was conducted among fourth- and fifth-year medical and dental students using self-report questionnaires: the Fonseca Anamnestic Index (FAI) for self-reported TMD symptom severity, the Generalized Anxiety Disorder Scale (GAD-7) for anxiety symptoms, the Patient Health Questionnaire (PHQ-9) for depressive symptoms, and the Perceived Stress Scale (PSS-10) for perceived stress. Statistical analyses included nonparametric tests and regression analyses. A total of 350 students were invited to participate, of whom 273 provided complete, analyzable data (response rate: 78.0%). Moderate-to-severe FAI-defined TMD symptoms were observed in 12.5% of the sample. Higher FAI scores were moderately correlated with higher PHQ-9, PSS-10, and GAD-7 scores ( p < 0.001). In multivariable analyses, GAD-7 showed a consistent association with FAI-defined TMD symptoms across sensitivity analyses, whereas the association with PHQ-9 was less robust across alternative modelling approaches. PSS-10 and sex were not independently associated with FAI scores. In this cross-sectional sample of clinical-year medical and dental students, anxiety symptoms showed the most consistent association with FAI-defined TMD symptoms, whereas the association with depressive symptoms was less robust across sensitivity analyses. These findings support the relevance of considering psychological symptoms when screening for self-reported TMD-related complaints. Given the cross-sectional design and screening-based TMD assessment, the findings should not be interpreted causally.

The authors' abstract, as published at the source. BMC Oral Health, 2026 · DOI ↗