Temporomandibular disorders and headache

Headache is a common symptom, but when severe, it may be extremely disabling. It is assumed that patients who present to dentists with headache often are diagnosed with a temporomandibular disorder (TMD), although many may have migraine. TMD as a collective term may include several clinical entities, including myogenous and arthrogenous components. Because headache and TMD are so common they may be integrated or separate entities. Nevertheless, the temporomandibular joint (TMJ) and associated orofacial structures should be considered as triggering or perpetuating factors for migraine. This article discusses the relationship between the TMJ, muscles, or other orofacial structures and headache.     

Temporomandibular disorders: associated features

Temporomandibular disorder (TMD) encompasses a number of clinical problems involving the masticatory muscles or the temporomandibular joints. These disorders are a major cause of nondental pain in the orofacial region, and are considered to be a subclassification of musculoskeletal disorders. Orofacial pain and TMD can be associated with pathologic conditions or disorders related to somatic and neurologic structures. When patients present to the dental office with a chief complaint of pain or headaches, it is vital for the practitioner to understand the cause of the complaint and to perform a thorough examination that will lead to the correct diagnosis and appropriate treatment. A complete understanding of the associated medical conditions with symptomology common to TMD and orofacial pain is necessary for a proper diagnosis.     

Temporomandibular disorders in headache patients

Objective: To identify the frequency of signs and symptoms of temporomandibular disorder (TMD) and its seve-rity in individuals with headache. Study Design: 60 adults divided into three groups of 20 individuals: chronic daily headache (CDH), episodic headache (EH) and a control group without headache (WH). Headache diagnosis was performed according to the criteria of International Headache Society and the signs and symptoms of TMD were achieved by using a clinical exam and an anamnestic questionnaire. The severity of TMD was defined by the temporomandibular index (TMI). Results: The TMD signs and symptoms were always more frequent in individuals with headache, especially report of pain in TMJ area (CDH, n=16; EH, n=12; WH, n=6), pain to palpation on masseter (CDH, n=19; EH, n=16; WH, n=11) which are significantly more frequent in episodic and chronic daily headache. The mean values of temporomandibular and articular index (CDH patients) and muscular index (CDH and EH patients) were statistically higher than in patients of the control group, notably the articular (CDH=0.38; EH=0.25;WH=0.19) and muscular (CDH=0.46; EH=0.51; WH=0.26) indices. Conclusions: These findings allow us to speculate that masticatory and TMJ pain are more common in headache subjects. Besides, it seems that the TMD is more severe in headache patients. Key words:Temporomandibular dysfunction, headache disorders.     

Temporomandibular disorders and orthognathic surgery

The relations between temporomandibular dysfunctions (TMDs) and maxillomandibular malformations requiring orthognathic surgery for correction have been the object of different studies in medical literature. The authors have performed a bibliographic revision on this issue to show the state of the art. This study, an analysis of the literature of the last 20 years, is chronologically presented. It analyzes the prevalence of TMD in patients with different types of maxillomandibular deformities undergoing orthognathic surgery and the TMD changes that occurred after an orthognathic surgical treatment. Medical studies reported in literature show a high variation of results related both to the prevalence of TMD in patients with maxillomandibular deformities and to the changes ensuing from an orthognathic surgical treatment. It has been difficult to compare the different studies because of the different methods used to individuate TMD signs and symptoms in the groups of patients analyzed, as well as the different types of orthognathic surgery performed and the specific TMD treatments used when required. It is concluded that despite the different results provided by the various studies, a certain prevalence of TMD is always present in patients with maxillomandibular deformity. This can be assumed to be within a correlation between dysgnathia and TMDs, and it asserts the necessity to treat patients who have maxillomandibular deformities and TMD by performing a specific treatment of TMD.     

Temporomandibular disorders: standard treatment options

Proper diagnosis is essential in all phases of health care, and dentistry certainly is no exception. Without a proper diagnosis, effective treatment may never be rendered and the patient's suffering and costs will continue to escalate. Dentists who treat patients who have temporomandibular disorders (TMDs) and orofacial pain also must strive to stay abreast of the latest treatment options. This article summarizes the current recommended treatment options for TMDs. Because it would be virtually impossible to cover every type of treatment available, only standard recognized types of treatment will be presented.     

Temporomandibular disorders: referred cranio-cervico-facial clinic

The bond between temporomandibular disorders and referred craniofacial symptomatology is more and more evident. In it subsists the prevailing necessity of understanding the temporomandibular disorders and the cranio-cervico-facial referred symptomatology from a neurophysiologic and muscle-skeletal perspective contained in the stomatognatic system. Diagnosis in head and neck areas is difficult because of its complex anatomy. Some painful craniofacial syndromes exhibit the same symptoms although they don.t seem objectively possible and that is what confuses the specialist and the patient. Pain in the head and the neck is one of the most complex to diagnose because of its varied origins that can be neurological, vascular, muscular, ligamental and bony. This article seeks to show some reasonable anatomical and pathophysiological connections of this muscle-skeletal disorder expressed with symptoms like tinnitus, otic fullness, otalgia and migraine among others. Disciplines in health such as neurology, the otolaryngology and dentistry share common anatomical and pathophysiological roads constructed in an increased muscular activity that generates muscle-skeletal disorders and is difficult to locate referred craniofacial symptomatology. This revision aspires to sensitize the medical specialist and the odontologist in the understanding of the important interdisciplinary handling in the detection of this disorder. This offers better tools in the conservative therapy phase of this craniofacial referred symptomatology.     

Temporomandibular disorders and mandibular vertical asymmetry

Objective To analyze the association between mandibular vertical asymmetry and the presence of TMD in adult patients.

Methods This case-control study recruited patients from the orthodontic clinic at FEBUAP. Patients were classified on the basis of diagnostic criteria for temporomandibular disorders (DC/TMD). Panoramic radiographs were measured to determine mandibular vertical asymmetry indices according to criteria described by Kjellberg and Habets. Both methods (DC/TMD and index criteria) were standardized a priori.

Results A total of 56 patients were analyzed, of whom 25 (44.6%) met the inclusion criteria and were divided into two groups (TMD group, n = 15; non-TMD group, n = 10). The highest asymmetry index was observed in the condylar neck, followed by the total condylar asymmetry index, but without significant differences between groups (p > .05).

Conclusion There is no association (p > .05) between temporomandibular disorders and mandibular vertical asymmetry.     

Temporomandibular disorders. A case-control study

Objective: To compare the risk factors and clinical manifestations of patients with temporomandibular disorders (TMDs) diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (axis I) versus an age and gender matched control group. Study Design: A total of 162 patients explored according to the RDC/TMD (mean age 40.6±18.8 years, range 7-90; 11.1% males and 88.9% females) were compared with 119 controls, measuring differences in TMD risk factors (sleep disturbances, stress, psychoactive medication, parafunctions, loss of posterior support, ligament hyperlaxity) and clinical variables (joint sounds, painful muscle and joint palpation, maximum aperture). Results: Myofascial pain (MFP) (single or multiple diagnoses) was the most frequent diagnosis (42%). The most common diagnostic combination was MFP plus arthralgia (16.0%). Statistically significant differences were observed in clenching (OR 2.3; 95%CI: 1.4-3.8) and in maximum active aperture (MAA) on comparing the two groups both globally (TMD vs. controls) (patients 36.7±8.6 mm, controls 43.1±5.8 mm; F=45.41, p = 0.000) and on comparing according to diagnostic categories. MFP explained most of the observed differences in the risk factors: stress perception (OR=1.98;I.C.:1.01-3.89), psychoactive medication (OR=2.21; I.C.:1.12-4.37), parafunctions (OR=2.14;I.C.:1.12-4.11), and ligament laxity (OR=2.6;I.C.:1.01-6.68). Joint sounds were more frequent in patients with MFP (39.7% vs. 24.0%; χ2=4.66; p=0.03), and painful joint palpation was more common in patients with disc displacement with reduction (DDWR)(15.9% vs. 5.0%; χ2= 5.2; p = 0.02) and osteoarthrosis (20.8% vs. 5.0%; χ2= 7.0; p = 0.008). Conclusions: There is a high prevalence of signs and symptoms of TMDs in the general population. Significant differences are observed in clenching and MAA between patients and controls considered both globally and for each diagnostic category individually. The analyzed risk factors (except loss of posterior support) show a statistically significant OR for the diagnosis of MFP.     

Temporomandibular disorders. 2. Non-surgical treatment

There are many treatment modalities for temporomandibular disorders (TMD), most of which are effective in controlling symptoms, at least in the short term. The non-surgical treatment of temporomandibular disorders continues to be the most effective way of managing over 80 per cent of patients who present with symptoms of temporomandibular pain and dysfunction. In this, the second article in the series, a general overview of the current non-surgical treatment strategies for TMD will be presented.     

Temporomandibular joint disorders: a diagnostic challenge

During the past decade much interest has been focused on disorders of the TMJ. The etiology appears to be multifactorial, with signs and symptoms difficult to evaluate and radiologic investigations insufficient. This review attempted to analyze current diagnostic tools. The recent introduction of various techniques promises optimism for this diagnostic and therapeutic challenge.