Assessment of Common Oral Behaviors in Patients with Temporomandibular Joint Disorders and Their Relationship to Psychosocial Factors

<b>Background:</b> Temporomandibular disorders (TMDs) exhibit a complex relationship with depression, anxiety disorders, and oral behaviors. This cross-sectional study aimed to assess the differences in oral behaviors among subgroups of TMD-related pain and patients with varying levels of anxiety and depression. <b>Methods:</b> A total of 120 patients diagnosed with TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), completed the Oral Behavior Checklist (OBC), Visual Analog Scale (VAS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder (GAD-7), Graded Chronic Pain Scale (GCPS), Patient Health Questionnaire-15 (PHQ-15), and Jaw Functional Limitation Scale-8 (JFLS-8). Associations were examined using Chi-square, Fisher's exact, and Spearman's correlation; logistic regression and multivariable linear regression were performed (<i>p</i> < 0.05). <b>Results:</b> In univariate analyses, several item-level OBs were more prevalent with higher anxiety, including nocturnal bruxism, sleep positions exerting jaw pressure, daytime grinding, and gum chewing (<i>p</i> = 0.007, 0.041, 0.011, and 0.014, respectively). A modest difference among pain subgroups was observed for sleep position (<i>p</i> = 0.044). In multivariable models, anxiety was independently associated only with nocturnal bruxism (OR = 2.95; 95% CI: 1.30-6.67; <i>p</i> = 0.010), whereas depression showed no independent associations. Pain intensity remained the sole predictor of total OBC scores (Coef = 1.829; 95% CI: 0.51-3.15; <i>p</i> = 0.007). No independent effects were detected for TMD subgroups. <b>Conclusions:</b> Psychosocial factors appeared related to OBs in univariate analyses, but these associations were explained by confounding influences. After adjustment, pain intensity and anxiety emerged as key determinants. These findings highlight the need for comprehensive TMD management integrating pain control with behavioral strategies.