{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:16:07Z","timestamp":1790709367183,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Oradea"},{"id":[{"id":"https:\/\/ror.org\/00wzhv093","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Temporomandibular disorders (TMDs) are heterogeneous conditions whose clinical expression cannot be fully explained by local or structural findings alone. DC\/TMD Axis II provides a psychobehavioral framework for assessing pain, disability, jaw functional limitation, psychological symptoms, and oral behaviors. This conceptual narrative review aimed to clarify how oral behaviors, anxiety, and depressive symptoms can be clinically interpreted together within the DC\/TMD Axis II framework. Materials and Methods: A structured search was conducted in PubMed\/MEDLINE and Scopus, with records exported in March 2026. Eligible English-language publications were limited to January 2001\u2013March 2026. Google Scholar was used as a supplementary verification source. After deduplication, 2756 records were screened, 87 full-text reports were assessed, and 36 publications were included in the final narrative synthesis. Evidence was synthesized thematically and appraised according to study design, population, diagnostic framework, Axis II instruments, self-report reliance, confounding, and inferential strength. Results: Current literature supports associations between oral behaviors, anxiety, depressive symptoms, pain intensity, and mandibular functional limitation in TMD, especially in painful and functionally impaired profiles. These associations are not uniform across all TMD subtypes and are influenced by factors such as sex, pain burden, comorbidities, and psychosocial context. The Oral Behaviors Checklist is useful for standardizing self-reported oral behaviors, but its interpretation is limited by recall, awareness, and reporting bias. Conclusions: The reviewed evidence supports an interactional interpretation of oral behaviors, psychological symptoms, pain, and jaw function within the DC\/TMD Axis II framework. However, because most available studies are cross-sectional and self-reported, this model should be understood as a clinically informed hypothesis supported by convergent associations, not as a confirmed causal pathway. Longitudinal and intervention-based studies are needed to clarify directionality, prognosis, and treatment-response relevance.<\/jats:p>","DOI":"10.3390\/medicina62050999","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:19:52Z","timestamp":1779877192000},"page":"999","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Oral Behaviors, Anxiety, and Depression in Temporomandibular Disorders: A Conceptual Narrative Review Within the DC\/TMD Axis II Framework"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7645-5904","authenticated-orcid":false,"given":"Alexandra Lavinia","family":"Vlad","sequence":"first","affiliation":[{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2643-761X","authenticated-orcid":false,"given":"Ioana","family":"Scrobota","sequence":"additional","affiliation":[{"name":"Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2953-3842","authenticated-orcid":false,"given":"Raluca Ortensia Cristina","family":"Iurcov","sequence":"additional","affiliation":[{"name":"Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4897-9321","authenticated-orcid":false,"given":"Ioan Andrei","family":"\u021aig","sequence":"additional","affiliation":[{"name":"Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2217-6755","authenticated-orcid":false,"given":"Anca Maria","family":"Fratila","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"},{"name":"Military Clinical Emergency Hospital of Sibiu, 550024 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1417-5963","authenticated-orcid":false,"given":"Gabriela","family":"Ciavoi","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.11607\/jop.1151","article-title":"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","volume":"28","author":"Schiffman","year":"2014","journal-title":"J. Oral Facial Pain Headache"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.adaj.2016.01.007","article-title":"Executive summary of the Diagnostic Criteria for Temporomandibular Disorders for clinical and research applications","volume":"147","author":"Schiffman","year":"2016","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1111\/ors.12473","article-title":"Temporomandibular disorders: A review of current concepts in aetiology, diagnosis and management","volume":"13","author":"Kapos","year":"2020","journal-title":"Oral Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s13005-025-00522-9","article-title":"The relationship between psychological factors and temporomandibular disorders: A systematic review and meta-analysis","volume":"21","author":"Saini","year":"2025","journal-title":"Head Face Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s10194-025-01985-6","article-title":"Temporomandibular disorders and mental health: Shared etiologies and treatment approaches","volume":"26","author":"Wan","year":"2025","journal-title":"J. Headache Pain"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1111\/joor.13260","article-title":"Comparison of Axis II psychosocial assessment methods of RDC\/TMD and DC\/TMD as part of DC\/TMD-FIN phase II validation studies in tertiary care Finnish TMD pain patients","volume":"48","author":"Hietaharju","year":"2021","journal-title":"J. Oral Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1177\/0022034516653922","article-title":"The evolution of TMD diagnosis: Past, present, future","volume":"95","author":"Ohrbach","year":"2016","journal-title":"J. Dent. Res."},{"key":"ref_8","first-page":"219","article-title":"The jaw functional limitation scale: Development, reliability, and validity of 8-item and 20-item versions","volume":"22","author":"Ohrbach","year":"2008","journal-title":"J. Orofac. Pain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s10194-016-0622-0","article-title":"The associations between psychosocial aspects and TMD-pain related aspects in children and adolescents","volume":"17","author":"Gjelset","year":"2016","journal-title":"J. Headache Pain"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"35620","DOI":"10.1038\/s41598-025-19524-3","article-title":"Impact of comorbid depression and anxiety on temporomandibular disorders related pain, sleep, function, behaviors, and quality of life","volume":"15","author":"Yap","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e929985","DOI":"10.12659\/MSM.929985","article-title":"Association of oral behaviors with anxiety, depression, and jaw function in patients with temporomandibular disorders in China: A cross-sectional study","volume":"27","author":"Xu","year":"2021","journal-title":"Med. Sci. Monit."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1080\/08869634.2024.2323424","article-title":"Depression and the risk of developing temporomandibular disorders in different diagnostic groups: A systematic review with meta-analysis","volume":"43","author":"Grossi","year":"2025","journal-title":"Cranio"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1111\/joor.14023","article-title":"General and health anxiety in temporomandibular disorders: Correlates with depression, pain intensity, sleep propensity, oral behaviours, jaw function, and oral health-related quality of life","volume":"52","author":"Yap","year":"2025","journal-title":"J. Oral Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/joor.12114","article-title":"Validity of the Oral Behaviours Checklist: Correlations between OBC scores and intensity of facial pain","volume":"41","author":"Lobbezoo","year":"2014","journal-title":"J. Oral Rehabil."},{"key":"ref_15","first-page":"306","article-title":"Oral behaviors checklist: Reliability of performance in targeted waking-state behaviors","volume":"20","author":"Markiewicz","year":"2006","journal-title":"J. Orofac. Pain"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Vlad, A.L., Marcu, O.A., Scrobota, I., \u021aig, I.A., Iurcov, R.O.C., and Ciavoi, G. (2025). Prevalence and Patterns of Oral Behaviors in Romanian Adults: An Exploratory Study. Medicina, 61.","DOI":"10.3390\/medicina61101857"},{"key":"ref_17","first-page":"87","article-title":"Associations between oral behaviors, temporomandibular disorder subtypes and psychological distress in adult women: A retrospective case-control study","volume":"38","author":"Zhong","year":"2024","journal-title":"J. Oral Facial Pain Headache"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1111\/joor.13221","article-title":"Association between waking-state oral behaviours, according to the oral behaviors checklist, and TMD subgroups","volume":"48","author":"Donnarumma","year":"2021","journal-title":"J. Oral Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yu, Y., Wang, L., Chen, C., Wang, M., Nie, S., and Fu, L. (2025). Correlations of oral behaviors, pain, and psychological distress among patients with temporomandibular disorders: Clinical investigation of axial II evaluation. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1604995"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Hoa, N.N., Hai, H.V., Binh, T.T., Dong, T.T., Quyen, T.T.M., and Do, T. (2025). Assessment of Common Oral Behaviors in Patients with Temporomandibular Joint Disorders and Their Relationship to Psychosocial Factors. Dent. J., 13.","DOI":"10.3390\/dj13100480"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"26869","DOI":"10.1038\/s41598-024-78216-6","article-title":"Relationships between personality factors and DC\/TMD Axis II scores of psychosocial impairment among patients with pain related temporomandibular disorders","volume":"14","author":"Assiri","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2577","DOI":"10.1111\/joor.13852","article-title":"The Association Between the Central Sensitisation Inventory and Temporomandibular Disorders Is Confounded by Migraine, Depression, Widespread Pain and Parafunction. A Cross-Sectional Telehealth Study","volume":"51","author":"Calixtre","year":"2024","journal-title":"J. Oral Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S216","DOI":"10.1016\/j.ajodo.2015.02.007","article-title":"Evolution of occlusion and temporomandibular disorder in orthodontics: Past, present, and future","volume":"147","author":"Okeson","year":"2015","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Pascu, L., Haiduc, R.S., Almasan, O., and Leucuta, D.C. (2025). Occlusion and Temporomandibular Disorders: A Scoping Review. Medicina, 61.","DOI":"10.3390\/medicina61050791"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1111\/joor.13215","article-title":"Centric relation critically revisited-What are the clinical implications?","volume":"48","author":"Zonnenberg","year":"2021","journal-title":"J. Oral Rehabil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1111\/joor.13331","article-title":"Distribution of anxiety and depression among different subtypes of temporomandibular disorder: A systematic review and meta-analysis","volume":"49","author":"Reis","year":"2022","journal-title":"J. Oral. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/joor.12413","article-title":"Is bruxism a disorder or a behavior? Rethinking the international consensus on defining and grading of bruxism","volume":"43","author":"Raphael","year":"2016","journal-title":"J. Oral Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1111\/joor.12302","article-title":"Association between waking-state oral parafunctional behaviors and biopsychosocial characteristics","volume":"42","author":"Khawaja","year":"2015","journal-title":"J. Oral Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"107","DOI":"10.11607\/ofph.1592","article-title":"Self-Report of Waking-State Oral Parafunctional Behaviors in the Natural Environment","volume":"30","author":"Kaplan","year":"2016","journal-title":"J. Oral Facial Pain Headache"},{"key":"ref_30","first-page":"66","article-title":"Awake oral behaviors associated with temporomandibular-related pain symptoms in a non-patient student population-a dual assessment approach","volume":"39","author":"Czygrinow","year":"2025","journal-title":"J. Oral Facial Pain Headache"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"273","DOI":"10.11607\/ofph.2629","article-title":"The association between self-reported awake oral behaviors and orofacial pain depends on the belief of patients that these behaviors are harmful to the jaw","volume":"34","author":"Visscher","year":"2020","journal-title":"J. Oral Facial Pain Headache"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/joor.13411","article-title":"Standardised Tool for the Assessment of Bruxism","volume":"51","author":"Manfredini","year":"2024","journal-title":"J. Oral Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.genhosppsych.2010.03.006","article-title":"The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: A systematic review","volume":"32","author":"Kroenke","year":"2010","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1111\/joor.12661","article-title":"Gender differences in temporomandibular disorders in adult populational studies: A systematic review and meta-analysis","volume":"45","author":"Bueno","year":"2018","journal-title":"J. Oral Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Khan, A., Liu, S., and Tao, F. (2024). Mechanisms underlying sex differences in temporomandibular disorders and their comorbidity with migraine. Brain Sci., 14.","DOI":"10.3390\/brainsci14070707"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Minervini, G., Franco, R., Marrapodi, M.M., Mehta, V., Fiorillo, L., Badnjevi\u0107, A., Cervino, G., and Cicciu, M. (2023). The association between COVID-19 related anxiety, stress, depression, temporomandibular disorders, and headaches from childhood to adulthood: A systematic review. Brain Sci., 13.","DOI":"10.3390\/brainsci13030481"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Emodi-Perlman, A., Eli, I., Smardz, J., Uziel, N., Wieckiewicz, G., Gilon, E., Grychowska, N., and Wieckiewicz, M. (2020). Temporomandibular disorders and bruxism outbreak as a possible factor of orofacial pain worsening during the COVID-19 pandemic\u2014Concomitant research in two countries. J. Clin. Med., 9.","DOI":"10.3390\/jcm9103250"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Moca, A.E., \u021aig, I.A., Ciavoi, G., Iurcov, R., \u0218ipo\u0219, L.R., and Todor, L. (2022). The impact of the COVID-19 pandemic on the dental emergency service from Oradea, Romania: A retrospective study. Healthcare, 10.","DOI":"10.3390\/healthcare10091786"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1111\/joor.12871","article-title":"Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain","volume":"47","author":"Sharma","year":"2020","journal-title":"J. Oral Rehabil."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/999\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:34:04Z","timestamp":1779878044000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/999"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["medicina62050999"],"URL":"https:\/\/doi.org\/10.3390\/medicina62050999","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]}}}