Latent profiles of oral health–related quality of life in temporomandibular disorders: implications for nurse-led stratified care

BACKGROUND: Temporomandibular disorders (TMD) are common chronic orofacial pain conditions that substantially impair oral health-related quality of life (OHRQoL). The multidimensional burden of TMD, involving pain, functional limitation, psychological distress, and maladaptive behaviors, is highly heterogeneous. However, nursing practice lacks empirically derived frameworks that support early risk stratification and profile-informed, nurse-led care. METHODS: This cross-sectional study was conducted in a tertiary TMD specialty clinic between February 2024 and August 2025. A total of 515 adults diagnosed with TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were enrolled. OHRQoL was assessed using the OHIP-TMD-22. Latent profile analysis (LPA) was performed based on seven OHIP-TMD-22 domain scores to identify distinct OHRQoL profiles. Pain intensity (NRS), jaw functional limitation (JFLS-8), psychological distress (DASS-21), and oral-related behaviors were compared across profiles. Multinomial logistic regression was used to examine factors associated with profile membership from a nursing assessment perspective. RESULTS: Four latent OHRQoL profiles with a clear gradient structure were identified: minimal impact (46.80%), mild-moderate impact (31.26%), psychological-functional high impact (16.89%), and severe generalized impairment (5.05%). Progressive increases in pain, functional limitation, psychological distress, and behavioral risk clustering were observed across profiles. Pain intensity, jaw functional limitation, and stress emerged as the most consistent factors associated with profile membership, while depressive symptoms were additionally associated with the most severe profile. These patterns suggest that pain, function, and stress may serve as practical candidate indicators for nurse-led early screening of patients with higher multidimensional burden. CONCLUSIONS: This study suggests that TMD is a nursing-sensitive chronic pain condition characterized by substantial heterogeneity in OHRQoL. The identified latent profiles may offer a preliminary framework for nurse-led risk stratification and stratified care planning. Integrating OHRQoL, pain, functional, and psychological assessments into routine nursing practice may help improve early identification of vulnerable subgroups and inform more tailored nursing care; however, the practical utility of this approach warrants further validation in longitudinal and multicenter studies. CLINICAL TRIAL NUMBER: Not applicable.