Temporomandibular disorders: Old ideas and new concepts

Abstract

Background Temporomandibular disorders (TMD) is an umbrella term for pain and dysfunction involving the masticatory muscles and the temporomandibular joints (TMJs). TMD is the most common orofacial pain condition. Its prominent features include regional pain in the face and preauricular area, limitations in jaw movement, and noise from the TMJs during jaw movements. TMD affects up to 15% of adults and 7% of adolescents. Chronic pain is the overwhelming reason that patients with TMD seek treatment. TMD can associate with impaired general health, depression, and other psychological disabilities, and may affect the quality of life of the patient. Assessment Evaluations indicate that the recently published Diagnostic Criteria for TMD (DC/TMD) are reliable and valid. These criteria cover the most common types of TMD, which include pain-related disorders (e.g., myalgia, headache attributable to TMD, and arthralgia) as well as disorders associated with the TMJ (primarily disc displacements and degenerative disease). As peripheral mechanisms most likely play a role in the onset of TMD, a detailed muscle examination is recommended. The persistence of pain involves more central factors, such as sensitization of the supraspinal neurons and second-order neurons at the level of the spinal dorsal horn/trigeminal nucleus, imbalanced antinociceptive activity, and strong genetic predisposition, which also is included in DC/TMD. Conclusion The etiology is complex and still not clearly understood, but several biological and psychosocial risk factors for TMD have been identified. Several studies indicate that patients with TMD improve with a combination of noninvasive therapies, including behavior therapy, pharmacotherapy, physical therapy, and occlusal appliances. More stringently designed studies, however, are needed to assess treatment efficacy and how to tailor treatment to the individual patient.

Decision‐making in dentistry related to temporomandibular disorders: a 5‐yr follow‐up study

“…Occlusal appliances were the most frequent treatment performed, in line with our previous report , but other treatments, such as information and jaw exercises, remained scarce despite the reported benefits of these approaches for this patient group . Instead, information and jaw exercises were primarily represented in the group ‘treatment not charged for’.…”

Tension‐Type Headache – The Normal and Most Prevalent Headache

“…21 Oromandibular treatment with occlusal splints is often recommended but has not yet been tested in trials of reasonable quality and cannot be recommended in general. 22,23 There are also conflicting results regarding the efficacy of acupuncture for the treatment of TTH. 19 Psychological treatment strategies have achieved reasonable scientific support for effectiveness.…”

Abstracts and Citations

“…I would also like to highlight a small study which found C1 root simulation referred pain to the periorbital region in patients with a history of migraine. 1 I am not sure what to make of the authors' statement of an "economic burden" due to this clinical symptom. I can see where "unnecessary" diagnostic tests may be performed when a patient has neck related migraine.…”

“…RGK should have more to say on that, but I reference below his first report on cervicalgia in migraine. 1 Some of the data were later summarized: "A subset of 30 patients from a study of 144 patients diagnosed with IHS-defined migraine treated 278 headaches, 231 of which were accompanied by neck pain, with sumatriptan or a pharmacologically similar triptan. The percentage of mild, moderate, or severe headaches with a pain-free response 2 h after dosing was 68% for head pain and 73% for neck pain."…”