Bruxism, Sleep Quality, Anxiety Disorders, and Tension-Type Headache in Temporomandibular Joint Disorders: A Systematic Review.

Temporomandibular joint disorders (TMD) involve pain and dysfunction of the temporomandibular joint and associated muscles. Emerging evidence suggests associations with bruxism, poor sleep quality, anxiety disorders, and tension-type headache (TTH). To systematically review the associations between bruxism, sleep quality, anxiety disorders, and TTH in patients with TMD. Systematic searches were conducted in PubMed, Scopus, Web of Science, and Cochrane Library up to May 2025. Studies included adults with TMD and reported associations with bruxism, sleep quality, anxiety, or TTH. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data were narratively synthesized. Twenty-six studies were included. Bruxism prevalence ranged from 45% to 87% in TMD patients, with significant associations with myofascial pain (P < 0.05). Poor sleep quality was reported in 40-75% of TMD patients and correlated with pain severity. Anxiety disorders were present in 30-60% of TMD patients, often exacerbating pain perception. TTH coexisted in 25-65% of TMD patients, sharing central sensitization as a mechanism. Study heterogeneity prevented meta-analysis. Bruxism, poor sleep quality, anxiety disorders, and TTH frequently coexist with TMD. Multidisciplinary assessment is crucial. Future longitudinal studies are warranted.