Adolescents with temporomandibular disorder (TMD) symptoms may be more likely to experience psychological distress and frequent headaches, according to a study published recently in the Journal of the American Dental Association.
Therefore, adding psychosocial screenings and headache assessments to routine care for these young patients may help identify those at a higher risk for pain-related disability earlier, the authors wrote.
“Adolescents with self-reported TMD symptoms exhibited greater pain, symptom burden, and psychological distress than their pain-free peers, highlighting the multifactorial nature of TMD,” wrote the authors, led by Calli Ann Marando of the University of North Carolina at Chapel Hill Adams School of Dentistry (JADA, December 22, 2025).
The cross-sectional case-control study screened 100 adolescents ages 10 to 19 for TMDs using a validated three-question TMD screening tool. The participants were then assigned to either TMD or non-TMD control groups. All completed validated questionnaires, they wrote.
Pain intensity and its effect on daily activities were measured using the Graded Chronic Pain Scale. The Symptom Questionnaire for Adolescents assessed TMD-related symptoms such as jaw pain, headaches, TMJ noises, and functional limitations. Psychosocial functioning was evaluated using the Revised Child Anxiety and Depression Scale and the Perceived Stress Scale for Children.
Most adolescents with TMD reported intermittent pain (78%), commonly triggered by chewing (74%), mouth opening (70%), and parafunctional activities (52%).
Compared with controls, the TMD group showed significantly worse outcomes across pain, function, and psychological measures, including higher pain intensity (44.6 vs. 7.9), pain interference (26.8 vs. 2.1), symptom burden (7.9 vs. 1.2), anxiety (10.8 vs. 6.5), and depression (7.8 vs. 4.3) (all p ≤ 0.002), they wrote.
Overall, 39% of participants reported headaches in the past 30 days, and those with headaches had significantly greater pain intensity, interference, symptom burden, anxiety, depression, and stress than those without headaches (p ≤ .037).
Headaches were more common in the TMD group than controls (56% vs. 22%; p < 0.001). Among those with headaches, participants with TMD reported higher headache intensity (4 vs. 1.3; p < 0.001). Within the TMD group specifically, adolescents with headaches had significantly higher TMD pain (51.1 vs. 37.3), pain interference (34.8 vs. 17.4), symptom burden (9.6 vs. 5.7), anxiety (12.8 vs. 8.3), depression (9.7 vs. 5.4), and stress (15.4 vs. 5.7).
The study, however, had limitations. Its reliance on self-reported measures may have introduced recall bias and variability due to differences in how participants accurately reported their symptoms, the authors added.
“Incorporating psychosocial screening and headache assessment into routine care for adolescents with TMDs may improve early identification of those at greater risk of developing pain-related disability and facilitate timely, targeted intervention,” Marando and colleagues concluded.
