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J Chiropr Educ. 2019 Feb 5. doi: 10.7899/JCE-18-3. [Epub ahead of print]

A cross-sectional study of the association between anxiety and temporomandibular disorder in Australian chiropractic students.



This study examined the association between anxiety and temporomandibular disorder (TMD) in Australian chiropractic students, particularly its effect on quality of life.


Chiropractic students ( n = 185) completed online surveys, including the Oral Health Impact Profile for TMDs (OHIP-TMD) and the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. The OHIP-TMD psychometric properties were assessed using principal component analysis. Linear regression models were used to examine demographic predictors for anxiety and TMD. A general linear model assessed the association between anxiety and the psychosocial and function scales identified through analysis of the OHIP-TMD questionnaire.


The mean value for the OHIP-TMD and PROMIS was 1.3 (SD = 0.7) and 9.5 (SD = 4.1), respectively. Women reported significantly lower quality of life (QoL) related to TMD symptoms ( p = 0.006) and that QoL related to TMD symptoms increased significantly as students progressed through the course ( p = .025). Lower levels of anxiety were significantly associated with male gender ( p = .000), employment ( p = .008), higher program levels ( p = .003), and having children ( p = .005). General linear model analysis revealed that increased anxiety was significantly associated with higher levels of oral physical function impairment ( p = .003) and elevated psychosocial distress ( p = .0001).


Anxiety was significantly associated with psychosocial distress and oral physical function impairment in university chiropractic students. In addition to impacting on oral health-related QoL, anxiety also affects students' engagement with learning and academic performance. It would therefore be beneficial to implement strategies that mitigate students' anxiety levels.


Anxiety; Chiropractic; Education; Oral Health; Pain; Temporomandibular Joint Disorders


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