Clinical and psychosocial predictors of treatment expectations in Brazilian patients with temporomandibular disorders: A retrospective cohort study.

BACKGROUND

To evaluate the influence of demographic, clinical, and psychosocial variables on patient expectations regarding the outcomes of orofacial pain and temporomandibular disorder (TMD) treatment.

MATERIALS AND

METHODS

This retrospective cohort included 609 Brazilian patients diagnosed with TMD according to the DC/TMD. Data were obtained on demographics, pain characteristics, bruxism, comorbidities, and psychosocial measures (Pain Catastrophizing Scale, Generalized Anxiety Disorder-7, Pittsburgh Sleep Quality Index). Patients' open-ended statements about treatment expectations were classified using a neurolinguistic programming-guided AI approach and validated manually. Descriptive analyses, chi-square/Fisher's exact tests, and multinomial logistic regression were applied. Latent class analysis (LCA) was used to identify subgroups (a < 0.05).

RESULTS

Most patients were female (78.7%) with a mean age of 38.0 years, and 84.1% reported pain. Male sex (OR = 1.8; 95% CI 1.2-2.6; p < 0.05), poor sleep quality (OR per unit increase = 1.1; 95% CI 1.0-1.2; p = 0.03), and sleep bruxism (OR = 1.5; 95% CI 1.1-2.1; p = 0.02) were significant predictors of expectations focused on the care experience. LCA identified five distinct patient subgroups, ranging from a low-distress/low-symptom class to a high-impairment/high-distress class, evidencing substantial heterogeneity in how patients formulate treatment expectations.

DISCUSSION: Clinical and psychosocial variables significantly shaped treatment expectations in patients with TMD. Identifying subgroups highlights the heterogeneity of expectation profiles and supports the need for individualized communication and management strategies in chronic orofacial pain.