Awake oral behaviors associated with temporomandibular-related pain symptoms in a non-patient student population—a dual assessment approach

Background: It is unclear which oral behaviors are harmless and which might become harmful when performed excessively. This study aimed to determine which awake oral behaviors are associated with Temporomandibular Disorder (TMD)-related pain symptoms in a non-patient population. Methods: Subjects’ awake oral behaviors were assessed through: (i) Oral Behavior Checklist (OBC), a single-point self-report questionnaire that quantifies the frequency of awake functional and non-functional oral behaviors; and (ii) Ecological Momentary Assessment (EMA), a designated smartphone application which enabled real-time repeated data collection of oral behaviors throughout the day, for multiple days. 118 participants (62.7% female) completed both the OBC and EMA assessment modes. Subjects were allocated into two groups: (i) subjects with TMD-related pain symptoms (TMDPS, N = 34, 85.29% female); and (ii) subjects without TMD-related pain symptoms (noTMDPS, N = 84, 53.57% female). Results: TMDPS subjects performed more awake oral behaviors compared to noTMDPS subjects. EMA behaviors that showed a significant predictive ability of masticatory muscle pain in binomial logistic regressions were entered into a multiple logistic regression model. Results show that teeth grinding increased the odds of subjects belonging to the TMDPS group by 22%. The final logistic regression demonstrated acceptable fit (Nagelkerke’s R² = 0.232). In a multiple regression model evaluating the predictive ability of OBC behaviors, the final model showed a Nagelkerke’s R² of 0.468. In addition to sex, three OBC behaviors came out as significant predictors in the final model: teeth grinding increased the odds of subjects belonging to the TMDPS group by 85%; holding or jutting the jaw increased the odds by 82%, and clenching increased the odds by 67%. Conclusions: Reports of teeth clenching, holding or jutting jaw forward or to the side, and teeth grinding may be associated with the report of TMD-related pain symptoms in a non-patient student population.