Higher cumulative psychological-sleep burden was associated with greater odds of pain-related TMD among hospital healthcare staff, particularly in quartile-based analyses, supporting a cautious biopsychosocial interpretation.
Key Findings
Results
Pain-related temporomandibular disorder (TMD) was reported by approximately one-third of hospital healthcare staff.
67 out of 193 participants (34.7%) reported pain-related TMD symptoms.
The study was conducted at a tertiary public hospital in Beijing, China.
TMD-related symptoms were assessed using self-reported symptom items from the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Symptom Questionnaire for symptom screening, not definitive clinical diagnosis.
The sample consisted of 193 healthcare employees across various occupational roles.
Results
Each 1-SD increase in the composite psychological-sleep burden index showed a positive but borderline association with pain-related TMD.
Adjusted OR = 1.36, 95% CI: 1.00–1.86, p = 0.052.
The association did not reach conventional statistical significance (p < 0.05) in the continuous SD-based analysis.
Models were adjusted for age group, sex, and occupational role.
The composite index was constructed by summing standardized depression, anxiety, stress (from DASS-21), and global PSQI scores.
Results
In quartile-based analysis, each higher burden quartile was associated with significantly increased odds of pain-related TMD.
Adjusted OR = 1.37 per quartile increase, 95% CI: 1.03–1.81, p = 0.030.
This analysis demonstrated a graded pattern of association between cumulative psychological-sleep burden and pain-related TMD.
The trend was statistically significant at the p < 0.05 threshold, unlike the continuous SD-based model.
Quartile-based trend and sensitivity analyses were performed to corroborate primary findings.
Results
The quartile-based association between psychological-sleep burden and pain-related TMD remained significant after excluding headache-only cases.
After excluding participants with headache as their only TMD-related symptom, the adjusted OR remained 1.37, 95% CI: 1.02–1.85, p = 0.037.
This sensitivity analysis suggests the association was not driven solely by headache-only presentations.
The consistency of results across analyses supports the robustness of the quartile-based finding.
Results
Symptom-specific analyses showed heterogeneous patterns of association between psychological-sleep burden and individual TMD symptoms.
Not all individual TMD-related symptoms showed uniform associations with the composite burden index.
The heterogeneity suggests that the relationship between psychological-sleep burden and TMD symptoms may vary depending on symptom type.
This finding supports caution in generalizing associations across all TMD symptom categories.
Methods
The study used a cross-sectional design with a composite psychological-sleep burden index constructed from four standardized measures.
Psychological distress was measured using the Depression Anxiety Stress Scales-21 (DASS-21), capturing depression, anxiety, and stress subscales.
Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).
The composite index was exploratory, formed by summing standardized scores from all four components.
Cross-sectional design precludes causal inference; the study explicitly labels its biopsychosocial interpretation as 'cautious.'
Conclusions
The authors suggest that psychological distress and sleep quality may be relevant considerations in occupational oral health assessment for healthcare workers.
Findings support a biopsychosocial framework for understanding TMD in occupational settings.
The study population was hospital healthcare staff, a group potentially subject to elevated occupational stress.
Authors recommend that psychological distress and sleep quality be considered in occupational oral health evaluation.
The authors explicitly note the need for caution in interpreting these findings given the study's exploratory and cross-sectional nature.
What This Means
This research suggests that hospital healthcare workers who experience greater psychological distress (including depression, anxiety, and stress) and poorer sleep quality are more likely to report pain symptoms related to temporomandibular disorders (TMD) — problems affecting the jaw, jaw muscles, and surrounding tissues. In a study of 193 healthcare employees at a major Beijing hospital, about 35% reported pain-related TMD symptoms. When researchers combined psychological distress and sleep quality into a single 'burden score,' those with higher scores were more likely to report TMD pain, and this pattern appeared to increase in a step-wise fashion across burden quartiles.
The findings held up even when participants who only reported headache as their TMD symptom were excluded from analysis, suggesting the association was not simply driven by headache complaints. However, not every individual TMD symptom showed the same pattern, indicating that the relationship between mental and sleep health and jaw pain is complex and varies by symptom type. The main association was also borderline in one analysis (p = 0.052), meaning the results should be interpreted with caution.
This research suggests that mental health and sleep problems may be relevant factors to consider when evaluating oral and jaw health in healthcare workers. Because this was a cross-sectional study — meaning it captured a single snapshot in time — it cannot determine whether psychological distress and poor sleep cause TMD symptoms or vice versa. Nevertheless, the findings support a broader, biopsychosocial approach to occupational health in clinical settings, where jaw pain may not be purely a physical problem but may also be linked to the mental and sleep health burdens that healthcare staff commonly face.
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Bian X, Yan G. (2026). Associations Between Temporomandibular Disorder-Related Symptoms, Psychological Distress, and Sleep Quality Among Hospital Healthcare Staff.. Clinical and experimental dental research. https://doi.org/10.1002/cre2.70428