{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T10:44:33Z","timestamp":1776854673464,"version":"3.51.2"},"reference-count":54,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: The aim of this study was to compare the relationship between psychological factors and the thickness of masticatory muscles in patients with temporomandibular disorders (TMD) and healthy controls. Methods: This cross-sectional study included 106 female participants aged 18\u201335 years, recruited from students of the Medical University of Lublin. The study group consisted of individuals diagnosed with myalgia based on the Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD), while the control group included participants without TMD. Psychological factors were assessed using the PHQ-9, GAD-7, and PHQ-15 questionnaires. The thickness of the temporalis and masseter muscles was measured using an M-Turbo (Sonosite) ultrasound device under relaxed and contracted conditions. Results: Participants with TMD-related myalgia scored significantly higher on the PHQ-9 (mean \u00b1 SD: 8.82 \u00b1 5.02 vs. 5.00 \u00b1 3.41; p &lt; 0.001), GAD-7 (8.53 \u00b1 4.48 vs. 4.65 \u00b1 3.58; p &lt; 0.001), and PHQ-15 (9.47 \u00b1 4.07 vs. 6.02 \u00b1 3.89; p &lt; 0.001) compared to controls. No statistically significant differences were observed in temporalis or masseter muscle thickness at rest or during contraction between groups (p &gt; 0.05). Significant differences in correlations were found between depression scores and temporalis muscle thickness in the study group compared to the control group (r = 0.32 vs. \u22120.13, p = 0.011) as well as between anxiety scores and temporalis muscle thickness (r = 0.25 vs. \u22120.30, p = 0.002) No significant associations were found for the masseter muscle. Conclusions: Individuals with myalgia did not show increased muscle thickness compared to healthy individuals. Psychological distress, particularly depression and anxiety, was differentially related to temporalis muscle morphology in individuals with myalgia compared to healthy controls.<\/jats:p>","DOI":"10.3390\/jcm15093183","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T09:01:24Z","timestamp":1776848484000},"page":"3183","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Psychological Factors and Masticatory Muscle Thickness Assessed by Ultrasonography in Female Dental Students with TMD-Related Myalgia: A Cross-Sectional Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2287-4342","authenticated-orcid":false,"given":"Marcin","family":"W\u00f3jcicki","sequence":"first","affiliation":[{"name":"Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"Litko-Rola","sequence":"additional","affiliation":[{"name":"Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacek","family":"Szkutnik","sequence":"additional","affiliation":[{"name":"Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0800-6103","authenticated-orcid":false,"given":"Micha\u0142","family":"Ginszt","sequence":"additional","affiliation":[{"name":"Department of Stomatognathic System Rehabilitation, Medical University of Lublin, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0265-9960","authenticated-orcid":false,"given":"Piotr","family":"Gawda","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingrid","family":"R\u00f3\u017cy\u0142o-Kalinowska","sequence":"additional","affiliation":[{"name":"Department of Dental and Maxillofacial Radiodiagnostics with Digital Dentistry Lab., Medical University of Lublin, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"ref_1","unstructured":"Okeson, J.P. (2020). Management of Temporomandibular Disorders and Occlusion, Elsevier. [8th ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chan, N.H.Y., Ip, C.K., Li, D.T.S., and Leung, Y.Y. (2022). Diagnosis and Treatment of Myogenous Temporomandibular Disorders: A Clinical Update. Diagnostics, 12.","DOI":"10.3390\/diagnostics12122914"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Zieli\u0144ski, G. (2025). Quo Vadis Temporomandibular Disorders? By 2050, the Global Prevalence of TMD May Approach 44%. J. Clin. Med., 14.","DOI":"10.3390\/jcm14134414"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2857","DOI":"10.1519\/JSC.0b013e3181e840f3","article-title":"The Mechanisms of Muscle Hypertrophy and Their Application to Resistance Training","volume":"24","author":"Schoenfeld","year":"2010","journal-title":"J. Strength Cond. Res."},{"key":"ref_5","first-page":"309","article-title":"Global Co-Occurrence of Bruxism and Temporomandibular Disorders: A Meta-Regression Analysis","volume":"62","author":"Ginszt","year":"2025","journal-title":"Dent. Med. Probl."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"472346","DOI":"10.1155\/2014\/472346","article-title":"Prevalence and Correlation between TMD Based on RDC\/TMD Diagnoses, Oral Parafunctions and Psychoemotional Stress in Polish University Students","volume":"2014","author":"Wieckiewicz","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"T75","DOI":"10.1016\/j.jpain.2013.06.009","article-title":"Psychological Factors Associated with Development of TMD: The OPPERA Prospective Cohort Study","volume":"14","author":"Fillingim","year":"2013","journal-title":"J. Pain"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"T75","DOI":"10.1016\/j.jpain.2011.09.002","article-title":"Potential Autonomic Risk Factors for Chronic TMD: Descriptive Data and Empirically Identified Domains from the OPPERA Case-Control Study","volume":"12","author":"Maixner","year":"2011","journal-title":"J. Pain"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Zieli\u0144ski, G., Ginszt, M., Zawadka, M., Rutkowska, K., Podstawka, Z., Szkutnik, J., Majcher, P., and Gawda, P. (2021). The Relationship between Stress and Masticatory Muscle Activity in Female Students. J. Clin. Med., 10.","DOI":"10.3390\/jcm10163459"},{"key":"ref_10","first-page":"e35685","article-title":"The Association Between Neck Pain and Psychological Distress Experienced by King Abdulaziz University Students: A Cross-Sectional Study","volume":"15","author":"Alghamdi","year":"2023","journal-title":"Cureus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1515\/cipms-2015-0044","article-title":"Psychological Aspects of Temporomandibular Disorders\u2014Literature Review","volume":"28","author":"Berger","year":"2015","journal-title":"Curr. Issues Pharm. Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1177\/070674370404901002","article-title":"Somatization Disorder: A Practical Review","volume":"49","author":"Mai","year":"2004","journal-title":"Can. J. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e01360","DOI":"10.1002\/brb3.1360","article-title":"Is There a Relationship between Psychological Factors and TMD?","volume":"9","author":"Stelcer","year":"2019","journal-title":"Brain Behav."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zieli\u0144ski, G., Paj\u0105k, A., and W\u00f3jcicki, M. (2024). Global Prevalence of Sleep Bruxism and Awake Bruxism in Pediatric and Adult Populations: A Systematic Review and Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13144259"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1001\/archinte.163.20.2433","article-title":"Depression and Pain Comorbidity: A Literature Review","volume":"163","author":"Bair","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"305","DOI":"10.3109\/07853890008995932","article-title":"Evidence-Based Data on Pain Relief with Antidepressants","volume":"32","author":"Fishbain","year":"2000","journal-title":"Ann. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1517\/14740338.2014.947262","article-title":"Psychotropic Drugs and Bruxism","volume":"13","author":"Falisi","year":"2014","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"20170052","DOI":"10.1259\/dmfr.20170052","article-title":"Masseter Muscle Measurement Performed by Ultrasound: A Systematic Review","volume":"46","author":"Morosolli","year":"2017","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3855","DOI":"10.1007\/s00784-023-05004-3","article-title":"Long-Term Evaluation of Masseter Muscle Activity, Dimensions, and Elasticity After Orthognathic Surgery in Skeletal Class III Patients","volume":"27","author":"Muftuoglu","year":"2023","journal-title":"Clin. Oral Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"103429","DOI":"10.1016\/j.msksp.2025.103429","article-title":"Masseter Muscle Thickness, Jaw Functional Limitation, Oral Behaviors, and Psychosocial Factors in Chronic Non-Specific Neck Pain: A Cross-Sectional Study","volume":"80","author":"Paker","year":"2025","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1002\/jcu.24021","article-title":"The Relationship Between Anxiety and Masseter Muscle in Temporomandibular Disorders: An Ultrasonographic Assessment","volume":"53","author":"Baybars","year":"2025","journal-title":"J. Clin. Ultrasound"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zieli\u0144ski, G., and Paj\u0105k-Zieli\u0144ska, B. (2024). Association between Estrogen Levels and Temporomandibular Disorders: An Updated Systematic Review. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25189867"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s00784-020-03710-w","article-title":"Prevalence of Temporomandibular Joint Disorders: A Systematic Review and Meta-Analysis","volume":"25","author":"Valesan","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5","DOI":"10.17219\/dmp\/181149","article-title":"Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD): Polish Assessment Instruments","volume":"61","author":"Osiewicz","year":"2024","journal-title":"Dent. Med. Probl."},{"key":"ref_25","first-page":"e948365","article-title":"Defining Effect Size Standards in Temporomandibular Joint and Masticatory Muscle Research","volume":"31","author":"Gawda","year":"2025","journal-title":"Med. Sci. Monit."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Zieli\u0144ski, G., W\u00f3jcicki, M., Rapa, M., Matysik-Wo\u017aniak, A., Baszczowski, M., Ginszt, M., Litko-Rola, M., Szkutnik, J., R\u00f3\u017cy\u0142o-Kalinowska, I., and Rejdak, R. (2022). Masticatory Muscle Thickness and Activity Correlates to Eyeball Length, Intraocular Pressure, Retinal and Choroidal Thickness in Healthy Women versus Women with Myopia. J. Pers. Med., 12.","DOI":"10.3390\/jpm12040626"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1093\/ejo\/cji052","article-title":"Comparative Data on Facial Morphology and Muscle Thickness Using Ultrasonography","volume":"27","author":"Arun","year":"2005","journal-title":"Eur. J. Orthod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"14357","DOI":"10.1038\/s41598-020-71378-z","article-title":"Ultrasound Measurements of Superficial and Deep Masticatory Muscles in Various Postures: Reliability and Influencers","volume":"10","author":"Chang","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"182","DOI":"10.5395\/rde.2013.38.3.182","article-title":"Statistical Notes for Clinical Researchers: Evaluation of Measurement Error 2: Dahlberg\u2019s Error, Bland-Altman Method, and Kappa Coefficient","volume":"38","author":"Kim","year":"2013","journal-title":"Restor. Dent. Endod."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Cohen, J. (2013). Statistical Power Analysis for the Behavioral Sciences, Routledge.","DOI":"10.4324\/9780203771587"},{"key":"ref_31","first-page":"19","article-title":"The Need to Report Effect Size Estimates Revisited. An Overview of Some Recommended Measures of Effect Size","volume":"1","author":"Tomczak","year":"2014","journal-title":"TRENDS Sport Sci."},{"key":"ref_32","first-page":"1415","article-title":"Depression, Somatization and Anxiety in Female Patients with Temporomandibular Disorders (TMD)","volume":"34","author":"Lajnert","year":"2010","journal-title":"Coll. Antropol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Santos, E.A.D., Peinado, B.R.R., Fraz\u00e3o, D.R., N\u00e9, Y.G.D.S., Fagundes, N.C.F., Magno, M.B., Maia, L.C., Lima, R.R., and Souza-Rodrigues, R.D.D. (2022). Association between Temporomandibular Disorders and Anxiety: A Systematic Review. Front. Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.990430"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1067\/mpr.2002.129375","article-title":"Depression and Somatization in Patients with Temporomandibular Disorders","volume":"88","author":"Yap","year":"2002","journal-title":"J. Prosthet. Dent."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"246","DOI":"10.26574\/maedica.2021.16.2.246","article-title":"Somatization and Sleep Quality on Patients with Comorbid Anxiety\/Depression","volume":"16","author":"Ionescu","year":"2021","journal-title":"Maedica"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.aanat.2009.10.002","article-title":"Changes in Bite Force, Masticatory Muscle Thickness, and Facial Morphology between Primary and Mixed Dentition in Preschool Children with Normal Occlusion","volume":"192","author":"Castelo","year":"2010","journal-title":"Ann. Anat. Anat. Anz."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/ejo\/cjl089","article-title":"Masticatory Muscle Thickness, Bite Force, and Occlusal Contacts in Young Children with Unilateral Posterior Crossbite","volume":"29","author":"Castelo","year":"2007","journal-title":"Eur. J. Orthod."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1002\/mus.10375","article-title":"Measurement of Muscle Contraction with Ultrasound Imaging","volume":"27","author":"Hodges","year":"2003","journal-title":"Muscle Nerve"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1080\/08869634.2015.1106811","article-title":"Impact of Sleep Bruxism on Masseter and Temporalis Muscles and Bite Force","volume":"34","author":"Palinkas","year":"2016","journal-title":"CRANIO\u00ae"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"111","DOI":"10.2147\/CIA.S118338","article-title":"Electromyographic Activity of Masticatory Muscles in Elderly Women\u2014A Pilot Study","volume":"12","author":"Gaszynska","year":"2017","journal-title":"Clin. Interv. Aging"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"290","DOI":"10.7126\/cumudj.428957","article-title":"Ultrasonographic Evaluation of Mandibular Elevator Muscles to Assess Effects of Attrition-Type Tooth Wear on Masticatory Function","volume":"21","year":"2018","journal-title":"Cumhur. Dent. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.oooo.2013.06.011","article-title":"Ultrasound Evaluation of Masseter Muscle Changes in Stabilization Splint Treatment of Myofascial Type Painful Temporomandibular Diseases","volume":"116","author":"Aldemir","year":"2013","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1111\/j.1365-2842.1995.tb01059.x","article-title":"Ultrasound Imaging of the Masseter Muscle in Myotonic Dystrophy Patients","volume":"22","author":"Kiliaridis","year":"1995","journal-title":"J. Oral Rehabil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"87","DOI":"10.14712\/23362936.2020.7","article-title":"Osteoarthrosis: Analyze of the Molar Bite Force, Thickness and Masticatory Efficiency","volume":"121","author":"Righetti","year":"2020","journal-title":"Prague Med. Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"20130016","DOI":"10.1259\/dmfr.20130016","article-title":"Assessment of Cross-Sectional Thickness and Activity of Masseter, Anterior Temporalis and Orbicularis Oris Muscles in Oral Submucous Fibrosis Patients and Healthy Controls: An Ultrasonography and Electromyography Study","volume":"43","author":"Kant","year":"2014","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_46","unstructured":"Carlsson, A., and Mattsson, J. (2020). Masseter and Temporalis Muscle Thickness as Assessed by Ultrasound. [Master\u2019s Thesis, Malm\u00f6 University]."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.15537\/1658-3175.2251","article-title":"The Effect of Unilateral Partial Edentulism to Muscle Thickness","volume":"24","author":"Guler","year":"2003","journal-title":"Saudi Med. J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.tripleo.2004.06.068","article-title":"Ultrasonographic Features of the Masseter Muscle in Female Patients with Temporomandibular Disorder Associated with Myofascial Pain","volume":"98","author":"Ariji","year":"2004","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"102919","DOI":"10.1016\/j.msksp.2024.102919","article-title":"Investigation of Masticatory Muscle Thickness and Mechanosensitivity of Cervical and Masticatory Muscles in Myofascial Temporomandibular Disorder Patients with Bruxism: A Cross-Sectional Study","volume":"70","author":"Kilinc","year":"2024","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"3939","DOI":"10.1007\/s00784-020-03260-1","article-title":"Depression and Anxiety Levels in Patients with Temporomandibular Disorders: Comparison with the General Population","volume":"24","author":"Simoen","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1080\/00016357.2022.2042380","article-title":"Association of Oral Behaviours\u2019 Frequency with Psychological Profile, Somatosensory Amplification, Presence of Pain and Self-Reported Pain Intensity","volume":"80","author":"Alajbeg","year":"2022","journal-title":"Acta Odontol. Scand."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1039393","DOI":"10.1155\/2022\/1039393","article-title":"Psychological Profiles and Their Relevance with Temporomandibular Disorder Symptoms in Preorthodontic Patients","volume":"2022","author":"Ye","year":"2022","journal-title":"Pain Res. Manag."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"59","DOI":"10.11607\/ofph.3060","article-title":"Fear of Movement and Catastrophizing in Participants with Temporomandibular Disorders","volume":"36","author":"Jawad","year":"2022","journal-title":"J. Oral Facial Pain Headache"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1080\/08869634.2021.1982496","article-title":"Somatic and Temporomandibular Disorder Symptoms\u2014Idioms of Psychological Distress in Southeast Asian Youths","volume":"42","author":"Yap","year":"2021","journal-title":"CRANIO\u00ae"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3183\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T09:51:26Z","timestamp":1776851486000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":54,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093183"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093183","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]}}}