Int J Stomatol ›› 2024, Vol. 51 ›› Issue (3): 296-302.doi: 10.7518/gjkq.2024039

• Original Articles • Previous Articles     Next Articles

Differences in anxiety and depression in patients with different subtypes of temporomandibular disorders

Jing Zhang1,2(),Yisi Zhong3,Yunhao Zheng2,Li Zhang1,2,Xin Xiong2()   

  1. 1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    3.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West-District Out-patient Section, West China Hospital of Stomatology, Sichuan University, Chengdu 610000, China
  • Received:2023-09-02 Revised:2023-12-22 Online:2024-05-01 Published:2024-05-06
  • Contact: Xin Xiong;
  • Supported by:
    National Natural Science Foundation of China(82301129);Clinical Research Project of West China Hospital of Stomatology, Sichuan University(LCYJ-2023-YY-2);Correspondence: Xiong Xin, Email:


Objective This study aimed to investigate the differences in anxiety and depression and their associated factors in various subcategories of patients with temporomandibular disorders (TMD) and to provide a basis for multidisciplinary treatment of TMD patients. Methods Sociodemographic information such as age, gender, education level, and per capita monthly household income of TMD patients were collected. Anxiety and depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Based on the DC/TMD diagnostic criteria, TMD was classified into three subtypes, namely, painful TMD (PT), intra-articular TMD (IT), and combined TMD (CT), which has PT and IT. R 4.2.2 was used for data processing and statistical analysis. Results Among the 362 TMD patients included in this study, 131 (36.2%) had anxiety and 153 (42.3%) had depression. A significant positive correlation existed between GAD-7 and PHQ-9 scores in patients with TMD (r=0.733, P<0.001; ρ=0.710, P<0.001). GAD-7 and PHQ-9 scores in patients with CT were significantly higher than those in patients with IT (P<0.001, P=0.002). GAD-7 scores were significantly negatively associated with male gender, per capita monthly household income of 3 000-6 000 RMB and higher than 6 000 RMB, and education level of college or bachelor’s degree. Meanwhile, GAD-7 scores were significantly positively associated with the CT subtype (P<0.05). PHQ-9 scores were significantly negatively associated with age, male gender, and per capita monthly household income higher than 6 000 RMB, whereas they were significantly positively associated with the CT subtype (P<0.05). Conclusion Approximately 40% of TMD patients had anxiety and depression. Anxiety and depression in patients with painful TMD should be given attention in clinical practice, and psychological interventions and multidisciplinary treatments may have better therapeutic outcomes for patients with painful TMD. Anxiety and depression in young patients, female patients, and patients with low income and education level were also noteworthy.

Key words: temporomandibular disorders, pain, anxiety, depression

CLC Number: 

  • R782.6


Tab 1

Patient baseline informations"

<3 000元40(13.8)11(15.1)51(14.1)
3 000~6000元142(49.1)21(28.8)163(45.0)
>6 000元107(37.0)41(56.2)148(40.9)

Fig 1

Density map of patient distribution by gender and age"

Tab 2

Gender distribution of anxiety and depression emotions  n(%)"

没有174 (60.2)57 (78.1)231 (63.8)
轻微79 (27.3)12 (16.4)91 (25.1)
中度27 (9.3)3 (4.1)30 (8.3)
严重9 (3.1)1 (1.4)10 (2.8)
没有161 (55.7)48 (65.8)209 (57.7)
轻微87 (30.1)21 (28.8)108 (29.8)
中度28 (9.7)3 (4.1)31 (8.6)
中重度10 (3.5)1 (1.4)11 (3.0)
严重3 (1.0)0 (0.0)3 (0.8)

Fig 2

Scatter plot of GAD-7 and PHQ-9 scores in patients with different subtypes of TMD"

Tab 3

Linear regression model for GAD-7 score and PHQ-9 score"











家庭人均月收入(以<3 000元为参考)
3 000~6 000元





>6 000元

























1 Durham J, Newton-John TRO, Zakrzewska JM. Tem-poromandibular disorders[J]. BMJ, 2015, 350: h1154.
2 Manfredini D, Lombardo L, Siciliani G. Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era[J]. J Oral Rehabil, 2017, 44(11): 908-923.
3 Bond EC, Mackey S, English R, et al. Temporomandibular disorders: priorities for research and care[M]. Washington, DC: The National Academies Press, 2020.
4 Dutra Dias H, Botelho AL, Bortoloti R, et al. Neuroscience contributes to the understanding of the neurobiology of temporomandibular disorders associa-ted with stress and anxiety[J]. Cranio, 2021: 1-6.
5 Chen H, Pendleton C, Caplan DJ, et al. Chairside risk assessment for first-onset temporomandibular di-sorders: result from the orofacial pain: prospective evaluation and risk assessment data set[J]. J Am Dent Assoc, 2021, 152(7): 505-513.e2.
6 Penlington C, Bowes C, Taylor G, et al. Psychological therapies for temporomandibular disorders (TMDs) [J]. Cochrane Database Syst Rev, 2022, 8(8): CD013515.
7 Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network and orofacial pain special interest group[J]. J Oral Facial Pain Headache, 2014, 28(1): 6-27.
8 Keller S, Bocell FD, Mangrum R, et al. Patient-reported outcome measures for individuals with temporomandibular joint disorders: a systematic review and evaluation[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2023, 135(1): 65-78.
9 Cao Y, Yap AU, Lei J, et al. Oral health-related qua-lity of life of patients with acute and chronic temporomandibular disorder diagnostic subtypes[J]. J Am Dent Assoc, 2022, 153(1): 50-58.
10 Zhu R, Zhang L, Zheng YH, et al. Association between stigma and pain in patients with temporomandibular disorders[J]. Int J Clin Pract, 2022, 2022: 2803540.
11 Cao Y, Yap AU, Lei J, et al. Subtypes of acute and chronic temporomandibular disorders: their relation to psychological and sleep impairments[J]. Oral Dis, 2021, 27(6): 1498-1506.
12 张玉向, 梁峰, 汤政, 等. 脑内5-羟色胺受体6对疼痛与焦虑、抑郁调节的研究进展[J]. 神经解剖学杂志, 2016, 32(5): 660-664.
Zhang YX, Liang F, Tang Z, et al. Research pro-gress on the regulation of 5-hydroxytryptamine receptor 6 in the brain on pain, anxiety, and depression[J]. Chin J Neuroanat, 2016, 32(5): 660-664.
13 Hooten WM. Chronic pain and mental health disorders[J]. Mayo Clin Proc, 2016, 91(7): 955-970.
14 Ye C, Xiong X, Zhang YY, et al. Psychological profiles and their relevance with temporomandibular disorder symptoms in preorthodontic patients[J]. Pain Res Manag, 2022, 2022: 1039393.
15 Su N, Lobbezoo F, van Wijk A, et al. Associations of pain intensity and pain-related disability with psychological and socio-demographic factors in patients with temporomandibular disorders: a cross-sectional study at a specialised dental clinic[J]. J Oral Rehabilitation, 2017, 44(3): 187-196.
16 Zhang QB, Yuan SS, Deng KT, et al. Correlation of patients’ demographics and clinical symptoms with temporomandibular disorders[J]. Cranio, 2023, 41(5): 432-439.
17 Bueno CH, Pereira DD, Pattussi MP, et al. Gender differences in temporomandibular disorders in adult populational studies: a systematic review and meta-analysis[J]. J Oral Rehabil, 2018, 45(9): 720-729.
18 National Center for Health Statistics. National heal-th interview survey-2018 data release[EB/OL]. (2021-06-14)[2023-04-06]. .
19 唐军, 郁春华, 程蕙娟, 等. DC/TMD推荐心理量表在颞下颌关节紊乱病诊疗中的应用[J]. 上海口腔医学, 2023, 32(1): 109-112.
Tang J, Yu CH, Cheng HJ, et al. Application of psychological scales recommended by DC/TMD in patients with temporomandibular joint disorders[J]. Shanghai J Stomatol, 2023, 32(1): 109-112.
20 傅小兰, 张侃, 陈雪峰, 等. 中国国民心理健康发展报告(2021~2022)[M]. 北京: 社会科学文献出版社, 2023.
Fu XL, Zhang K, Chen XF, et al. Report on national mental health development (2021-2022)[M]. Beijing: Social Science Academic Press, 2023.
21 Hallers-Haalboom ET, Maas J, Kunst LE, et al. The role of sex and gender in anxiety disorders: being scared “like a girl”[J]. Handb Clin Neurol, 2020, 175: 359-368.
22 Théaudin M, Romero K, Feinstein A. In multiple sclerosis anxiety, not depression, is related to gender[J]. Mult Scler, 2016, 22(2): 239-244.
23 Ridley M, Rao G, Schilbach F, et al. Poverty, depression, and anxiety: causal evidence and mechanisms[J]. Science, 2020, 370(6522): eaay0214.
[1] Han Chong,He Dongning,Yu Feiyan,Wu Dongchao. Research progress on the mechanism and treatment of pain after oral implants [J]. Int J Stomatol, 2024, 51(1): 99-106.
[2] Liao Honglin,Fang Zhonghan,Zhang Yanyan,Liu Fei,Shen Jiefei.. Diagnosis and treatment of post-traumatic trigeminal neuropathic pain after dental implantation [J]. Int J Stomatol, 2023, 50(6): 729-738.
[3] He Jing,Hu Mingjia,Xiao Ning,Li Jia,Sun Wanxin,Ling Lü,Liu Fan. Investigation on the degree of psychological distress and its influencing factors in patients with oral lichen planus [J]. Int J Stomatol, 2023, 50(3): 308-313.
[4] Pei Ling,Zeng Ni,Yang Chao,Wang Yan,He Miao,Luo Qiang,Shi Bing. Analgesic effects of local anesthesia after cleft lip and palate repair [J]. Int J Stomatol, 2022, 49(6): 657-662.
[5] Ren Hai-xia,Liu Yingfeng,Liang Huimin,Li Jiayong,Wen Chunqin,Wang Chunmei. Intervention effect of virtual reality technology on dental fear in the treatment of deep caries in children [J]. Int J Stomatol, 2022, 49(5): 529-536.
[6] Yang Hong,Jin Yu,Lai Wenli. Randomized cross-control trial of placebo in the regulation of orthodontic tooth movement pain [J]. Int J Stomatol, 2020, 47(4): 424-430.
[7] Meijie Wang,Xin Tan,Yuwei Zhao,Haiyang Yu. Influences of immediat implant or traditional implant on postoperative pain [J]. Int J Stomatol, 2019, 46(3): 292-296.
[8] Weilin Pan,Yubin Cao,Chang Liu,Jiyuan Liu,Chunjie Li,Jian Pan,Chengge Hua. Flap design associated pain after the extraction of mandibular third molars: a systematic review and Meta-analysis [J]. Inter J Stomatol, 2019, 46(2): 142-148.
[9] Yuhao Liu,Na Bai,Menglong Cheng,Bing Shi,Zhihui Li,Caixia Gong. Effect of video modeling on the perioperative psychological status of parents of children with cleft lip and palate [J]. Inter J Stomatol, 2019, 46(1): 26-29.
[10] Chen Qingya, Huang Qian, Wang Li. Assessment of dental anxiety in patients undergoing surgical procedures for tooth implants [J]. Inter J Stomatol, 2018, 45(1): 14-19.
[11] Chen Jing, Huang Xiaofeng.. Development of laser applications in orthodontics [J]. Inter J Stomatol, 2017, 44(6): 712-716.
[12] Li Gege, Pan Jiahui, Tang Qiuling, Liu Xinchan, Hou Yubo, Yu Weixian. Immune evasion strategies of Porphyromonas gingivalis via gingipains [J]. Inter J Stomatol, 2017, 44(5): 519-522.
[13] Hou Yubo1, Liu Xinchan2, Yu Haiyan1, Cui Leihua3, Yu Weixian4. Effect of gingipains on osteoclasts and osteoblasts [J]. Inter J Stomatol, 2016, 43(5): 609-613.
[14] Han Zhiqiang, Bai Yang, Xiao Shuiqing, Sun Fei, He Ping. Influence of Porphyromonas gingivalis and its gingipain K in healthy gingiva of teenagers [J]. Inter J Stomatol, 2016, 43(3): 283-287.
[15] Zhang Ling, Jiang Wei, Li Haolai. Music therapy as a nursing intervention to reduce pain during treatment of patients with deep caries [J]. Inter J Stomatol, 2016, 43(2): 137-139.
Full text



[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[7] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[8] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[9] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[10] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .