Abstract
OBJECTIVE: To assess the prevalence of unilateral chewing among Italian university students and investigate its association with sex, anxiety, and somatic symptom severity. MATERIAL AND METHODS: In this cross-sectional study, 1536 students completed a self-administered questionnaire. Prevalence of unilateral chewing behavior, anxiety, and somatic symptoms was described using frequencies and percentages. Anxiety and somatic symptoms were measured using the self-reported Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-15 (PHQ-15). Pearson Chi-square and Cramér's V examined the association between sex and unilateral chewing behavior. Differences in GAD-7 and PHQ-15 scores across unilateral chewing categories were analyzed using ANOVA-based methods with post hoc tests. Ordinal logistic regression was performed to assess the association between unilateral chewing behavior, anxiety, and somatic symptom severity while controlling for age and sex. RESULTS: Overall, 19% of participants reported unilateral chewing "most" or "all of the time." Moderate-to-severe anxiety and somatic symptoms were each reported by 45% of participants, assessed separately. A significant weak to moderate association between sex and unilateral chewing was reported (p < 0.001). Unilateral chewing behavior was significantly associated with total anxiety scores (p < 0.001), with "all of the time" chewers having four points higher scores than "none of the time" or "a little of the time," and three points higher scores than "some of the time" chewers. A significant association (p < 0.001) was also observed between unilateral chewing and PHQ-15 scores, with "all of the time" chewers having three points higher scores than "none of the time" and two points higher scores than "a little of the time." Ordinal regression analysis confirmed these associations, although the effect sizes were modest. CONCLUSION: Frequent unilateral chewing behavior is associated with higher levels of anxiety and somatic symptoms. Assessing unilateral chewing may help guide interventions promoting bilateral mastication and mindful eating.