Sex differences in pain and psychosocial burden in adolescent temporomandibular disorders

To examine sex differences in pain, symptom burden, and psychological distress among adolescents with and without temporomandibular disorders (TMD), and to evaluate these differences in youth reporting or not comorbid headache. In this cross-sectional case-control study (N = 115; 57.4% females; age 14.6 ± 2.4 years), adolescents were classified as having TMD or non-TMD based on the validated 3 screening questions for TMD. Participants completed validated measures of pain intensity , symptom burden, and anxiety/depression and stress symptomatology. Sex differences were assessed using t-tests, chi-square tests, correlations, and two-way ANOVA. Compared to males, females reported higher pain intensity (30.7 ± 24.3 vs. 21. ± 21.9; p = .032), symptom burden (7.9 ± 3.8 vs. 1.2 ± 1.5; p = .006), anxiety/depression (16.3 ± 12.4 vs. 10.8 ± 9.8; p = .012) and stress (13.4 ± 5.4 vs. 11.3 ± 4.7; p = .030). Within the TMD group (n = 65), females showed higher pain (45.8 ± 16.5 vs. 33.7 ± 19.6; p = .010), headache intensity (4.4 ± 2.7 vs. 3.0 ± 2.2, p = .036), and symptom burden (7.9 ± 3.8 vs. 1.2 ± 1.5, p = .017), whereas males with TMD demonstrated stronger correlations between pain and psychological symptoms (anxiety: r(47) = 0.399, p = .006; depression: r(47) = 0.312, p = .033). Anxiety/depression scores were higher in participants with TMD and in females, with similar TMD-related increases across sexes. Among youth reporting headache (n = 50), females exhibited greater symptom burden (p = .035), anxiety (p = .017), and stress (p = .040). Adolescent females show greater pain and psychosocial burden overall and among those with TMD or headache, while in males with TMD, pain intensity was more strongly correlated with anxiety and depression symptoms.