BACKGROUND: Temporomandibular disorders (TMD), psychological distress, and sleep disturbances are common and frequently co-occur in children and adolescents. However, the patterns and nature of their interrelationships-including potential underlying mechanisms-remain systematically underexplored in this age group. OBJECTIVE: To synthesize the evidence on the associations among TMD, psychological distress, and sleep disturbances in children and adolescents, and to explore potential interacting mechanisms described in the literature. METHODS: We systematically searched PubMed, CNKI, Wanfang, Medline, CINAHL, Cochrane, Web of Science, and Scopus for observational studies between January 2010 and December 15, 2025, that investigated associations among TMD, sleep quality, and mental health in children and adolescents. We included studies reporting on at least two of the three conditions and assessed methodological quality using established critical appraisal tools. RESULTS: We included 17 studies (16 cross-sectional, 1 case-control), which reported intricate associations among TMD, psychological distress, and sleep disturbances. Anxiety and depression were the most prevalent psychological comorbidities, while poor sleep quality and sleep bruxism were the most frequently reported sleep disturbances. These associations were particularly pronounced in painful TMD subtypes, and their strength was influenced by sex (stronger effects in females), age, and developmental context. CONCLUSION: This systematic review summarizes consistent associations among TMD, psychological distress, and sleep disturbances in children and adolescents. The available evidence supports the hypothesis that psychological factors may be involved in the observed association between TMD and sleep disturbances, but this requires confirmation through longitudinal mediation analyses. Given the predominantly cross‑sectional design of the available studies, causal conclusions cannot be drawn. From a clinical perspective, an integrated, multidisciplinary approach addressing all three domains may be beneficial, and future longitudinal research is needed. TRIAL REGISTRATION: The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD420251218752. CLINICAL TRIAL NUMBER: Not applicable.
Zheng et al. (Thu,) studied this question.