Bruxism and temporomandibular disorders:biopsychosocial framework for diagnosis and management

Objective: Bruxism and temporomandibular Disorders (TMD) frequently co-occur and represent a major source of chronic OFP. Traditional biomechanical approaches have shown limited ability to account for symptom het- erogeneity, pain persistence, and variable treatment outcomes. This systematic review aimed to synthesize current evidence on the biological, psychological, and social determinants of bruxism-related TMD within a biopsychosocial framework. Methods: A systematic search of major electronic databases was performed to identify clinical and observational studies examining the relationship between bruxism and TMD. Studies investigating biological mechanisms, psychological factors, sleep-related variables, and social or behavioral influences were included. Data were extracted and synthesized according to established guidelines for systematic reviews. Results: Evidence indicates that bruxism-related TMDs arise from complex interactions between peripheral and central mechanisms. Psychological factors, including ANX, perceived stress, depressive symptoms, emotional dysregulation, and pain catastrophizing, were consistently associated with increased muscle activity, enhanced pain perception, and greater risk of chronicity. Sleep disturbances and stress-related neuroendocrine activation emerged as relevant contributors, while structural and occlusal factors alone showed limited and inconsistent associations with symptom severity. Conclusions: Bruxism-related TMDs are best conceptualized within a biopsychosocial model integrating biological vulnerability, psychological processes, and social context. Exclusive reliance on mechanical paradigms may result in incomplete diagnosis and suboptimal management. Incorporating psychosocial assessment and inter- disciplinary, patient-centered interventions may improve clinical outcomes and long-term prognosis.