Role of temporomandibular disorders (TMD) in facial pain: Occlusion, muscle and TMJ pain

Temporomandibular disorders (TMD) which comprise myogenic and arthralgic co mponents have been reported to predispose subjects to headache and facial p ain. The aim of this study was to evaluate the role of these components in patients with facial pain and to investigate the influence of treatment of TMD on pain of these patients. The subject group consisted of 25 patients s uffering from facial pain. The clinical stomatognathic examination was perf ormed before conservative treatment of TMD, and one-two weeks, three months and one year after treatment. The severity of TMD was assessed using the a namnestic (Al) and clinical dysfunction (DI) indices of Helkimo. The intens ity of pain was evaluated on a numerical rating scale (NRS). According to c linical findings the patients were classified to following diagnostic subgr oups: TMD myo (mainly myogenic), TMD arthro (mainly arthrogenous) and TMD c omb (both myogenic and arthrogenous components involved), Fifteen patients were classified in the TMD myo group, nine in the TMD comb group and one in the TMD arthro group, The DI index decreased significantly one-two weeks a fter treatment and remained at this level at three month and one year follo w-up examinations. At the first examination the TMD myo group had the highe st level of NRS index, which decreased significantly during the time of fol low-up, while no significant changes were found in other groups. Bruxism re ported by the patient had a positive correlation with the amount of painful muscles on the right side at first examination. The results show that faci al pain combined with TMD may be mostly of myogenic origin, and myogenic pa in seems to have most favorable response to conservative treatment of TMD.