Risk of Temporomandibular Disorders and Orofacial Pain Among Palestinian Adults in the Gaza Strip During the War.

BACKGROUND

Temporomandibular disorders (TMD) and orofacial pain (OFP) are influenced by behavioural and psychosocial stressors. The Gaza Strip's prolonged conflict provides a critical context for estimating burden and correlates.

OBJECTIVES

To estimate the prevalence of self-reported TMD/OFP symptoms and identify independent risk factors among adults in Gaza during wartime.

METHODS

Cross-sectional survey of 1000 adults (500 women, 500 men) equally allocated across five governorates. A structured questionnaire captured self-reported facial/TMJ/ear pain, jaw function, parafunctional behaviours (e.g., bruxism, oral habits) and psychological symptoms (tension, mood, sleep) was used. Analyses used descriptive statistics, chi-square tests and multivariable logistic regression adjusted for sex.

RESULTS

TMD-related pain was reported by 33.1% (n = 331). Neck pain occurred in 41.0% and morning facial stiffness in 28.2%. In bivariate analyses, men more often reported jaw dysfunction (limited opening, chewing difficulty, joint sounds), while women more often reported psychological symptoms; sex was not an independent predictor. Independent predictors were morning facial stiffness (AOR 2.57-5.27 across frequency categories), limited mouth opening (AOR 3.03; 95% CI 1.75-5.28), joint noises (AOR 3.13; 95% CI 2.08-4.72), sleep bruxism (AOR 2.33; 95% CI 1.51-3.60) and daily somatic pain elsewhere (AOR 2.99; 95% CI 1.53-5.84). Gum chewing showed an inverse association (AOR 0.62-0.31). Tension, sadness, global sleep disturbance, daytime bruxism, smoking, alcohol use, orthodontic history and governorate were not independent predictors. The multivariable model showed good performance (AUC = 0.882; Nagelkerke's R2 = 0.519).

CONCLUSIONS

During active war, self-reported TMD and OFP symptoms are prevalent among adults in Gaza and are strongly associated with parafunctional habits and psychological distress, both potentially intensified by war-related stress. These findings underscore the need for integrated dental and mental health interventions in conflict-affected populations.