Parafunctional habits and temporomandibular joint symptoms in children and adolescents: a retrospective study

Background: Parafunctional habits, such as bruxism, mouth breathing, and nail or lip biting, are common in children and may disturb the neuromuscular balance of the stomatognathic system, contributing to malocclusion and temporomandibular joint (TMJ) dysfunction. This study aimed to describe the prevalence and clinical correlates of TMJ symptoms in children and adolescents, with particular focus on their associations with parafunctional habits, malocclusion, and mandibular asymmetry. Methods: This retrospective cross-sectional study analyzed 190 orthodontic examination records from patients aged 6–18 years (mean = 12.34 ± 2.76 years), collected between January 2022 and March 2024. Data on parafunctional habits, TMJ symptoms, and clinical variables were extracted from standardized forms. Chi-square tests assessed associations between categorical variables, and Spearman’s rho examined correlations with age. Binary logistic regression was used to explore variables associated with the presence of TMJ symptoms. Statistical significance was set at p < 0.05. Results: Mouth breathing was the most common parafunctional habit (34.7%), followed by nail biting (17.4%) and bruxism (14.2%). TMJ symptoms were present in 39.5% of participants, and mandibular asymmetry in 11%. Bruxism was associated with higher odds of TMJ symptoms (β = 1.03, p = 0.020, Odds Ratio (OR) = 2.79), whereas mouth breathing showed an inverse association (β = −0.75, p = 0.028, OR = 0.47). Thumb-sucking decreased with age (ρ = −0.147, p = 0.043), while lip-biting increased (ρ = 0.170, p = 0.019). Patients with mandibular asymmetry were more likely to have TMJ symptoms (χ2 = 28.16, p < 0.001). Conclusions: Parafunctional habits and TMJ symptoms were prevalent in this orthodontic population. Bruxism showed a significant association with TMJ symptoms, whereas mouth breathing was negatively associated. Incorporating systematic screening for parafunctional habits and functional deviations into orthodontic evaluations may contribute to earlier recognition of patients who could benefit from closer functional monitoring.

Parafunctional habits; Temporomandibular joint; Bruxism; Mouth breathing; Children; Adolescents; Orthodontic evaluation

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