Revealing the Latent Structure of the Oral Behaviours Checklist: Integrating Bayesian Factor Analysis and Network Analysis.

BACKGROUND

The Oral Behaviours Checklist (OBC) is widely used, but its latent structure remains unclear. This study was designed to clarify its latent structure and to identify common factors and isolated items relevant to TMD assessment.

METHODS

A cross-sectional study of 1014 patients with TMD (79.1% female; median age, 25.0 years) was conducted. The waking-state OBC's structure was examined using Bayesian exploratory factor analysis (EFA) and validated by confirmatory factor analysis (CFA). Network analysis was used to identify central and isolated items and to examine bridging connections with depression, anxiety, jaw function, and oral health-related quality of life.

RESULTS

Bayesian EFA revealed a robust five-factor structure for the waking-state OBC: (1) Awake Bruxism, (2) Jaw Posturing, (3) Oral Manipulation, (4) Jaw Bracing, and (5) Functional Behaviours. This structure was supported by sensitivity analyses and demonstrated good fit in CFA (CFI = 0.943, TLI = 0.919, RMSEA = 0.050, SRMR = 0.044). Network analysis identified three isolated items. Only the Awake Bruxism factor was significantly associated with pain-related TMD and pain intensity. Cross-scale network analysis showed the Oral Manipulation factor was a central bridge to depression, while Awake Bruxism items bridged to anxiety, jaw dysfunction, and reduced oral health-related quality of life.

CONCLUSION

The waking-state OBC exhibits a five-factor structure, with three isolated items that should be evaluated separately. For clinical efficiency, focusing on the core 'Awake Bruxism' items is justified, whereas factor-specific scoring is recommended in research to capture the heterogeneity of oral behaviours.