Stratification of orthognathic surgery patients for painful TMD and associated factors

Objective. To identify clusters of patients with DFD based on variables related to TMD, psychological aspects, somatization, oral habits, and sleep. Method. Ninety-two patients with DFD were evaluated before orthognathic surgery according to demographic data, facial profile, presence of painful TMD (DC/TMD), psychological aspects, oral habits, comorbidities, substance use, and sleep quality. Results. Eighty-six individuals comprised the final sample. The K-means cluster analysis identified two distinct but internally similar groups. One called "Vulnerable" with a higher prevalence of muscular TMD and associated factors with 43 (50%) participants, and another with 43 (50%) participants, called "Adaptive" with a lower prevalence of these variables (P<.01). The determining variables were signs and symptoms of anxiety and somatization, awake bruxism and self- reported sleep quality. The presence of arthralgia, comorbidities, or smoking did not influence the formation of the groups. The clusters were tested with gender, age, facial profile, maxillary excess, and deficiency. Only females were associated with the vulnerable group (P=.015). These results highlight the importance of multidimensional assessment of patients with DFD. The stratification of these individuals can help with personalized treatment, targeting specific strategies for each group, such as behavioral interventions and referrals to a multidisciplinary team.