Clinical Findings Related to Temporomandibular Disorders in Schoolchildren Aged 4–16 Years: A Multicenter Cross-Sectional Study

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Abstract
Background: Temporomandibular disorders (TMD) comprise a heterogeneous group of musculoskeletal conditions that may manifest during childhood and adolescence. However, standardized information regarding TMD-related clinical findings in pediatric populations remains limited because of methodological heterogeneity and the inconsistent application of validated diagnostic protocols. Objective: The aim of this study was to characterize clinical findings related to temporomandibular disorders in schoolchildren and to explore their potential contribution to individualized assessment strategies within the framework of personalized pediatric oral healthcare. Methods: A multicenter cross-sectional study was conducted in 1052 schoolchildren recruited from participating educational institutions. All participants underwent a standardized clinical examination that included assessment of masticatory muscle tenderness, temporomandibular joint tenderness, joint sounds, pain intensity, and perceived stress using an adapted pediatric DC/TMD protocol. Categorical variables were summarized as frequencies, percentages, and 95% confidence intervals (95% CIs). Associations between categorical variables were evaluated using Pearson’s chi-square test, and multivariable logistic regression was performed to identify factors independently associated with pain. Results: Pain during clinical examination was identified in 111 participants (10.6%; 95% CI: 8.8–12.6%), whereas temporomandibular joint sounds and myofascial pain were detected in 1.4% and 0.3% of participants, respectively. Most pain was classified as mild, and the masseter muscle was the most frequently affected anatomical site. Increasing age and female sex were independently associated with pain. Compared with children aged 4–6 years, participants aged 10–12 years (adjusted OR = 9.61; 95% CI: 2.22–41.51) and 13–16 years (adjusted OR = 35.49; 95% CI: 8.59–146.61) showed significantly greater odds of pain. Female participants also demonstrated higher odds of pain than males (adjusted OR = 7.49; 95% CI: 3.68–15.21; all p < 0.05). Conclusions: Clinically detectable TMD-related findings were generally uncommon among schoolchildren aged 4–16 years and were predominantly mild and muscular. Increasing age and female sex were independently associated with pain, emphasizing the importance of demographic factors in the early clinical expression of TMD. Standardized pediatric clinical examination protocols may facilitate early identification of TMD-related findings and support preventive strategies during childhood and adolescence. These findings support the implementation of individualized clinical assessment strategies for early identification of children at risk of temporomandibular disorders, contributing to personalized preventive and therapeutic approaches in pediatric oral healthcare.

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