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

Temporomandibular disorders (TMD) which comprise myogenic and arthralgic components have been reported to predispose subjects to headache and facial pain. 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 suffering from facial pain. The clinical stomatognathic examination was performed before conservative treatment of TMD, and one-two weeks, three months and one year after treatment. The severity of TMD was assessed using the anamnestic (AI) and clinical dysfunction (DI) indices of Helkimo. The intensity of pain was evaluated on a numerical rating scale (NRS). According to clinical findings the patients were classified to following diagnostic subgroups: TMD myo (mainly myogenic), TMD arthro (mainly arthrogenous) and TMD comb (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 after treatment and remained at this level at three month and one year follow-up examinations. At the first examination the TMD myo group had the highest level of NRS index, which decreased significantly during the time of follow-up, while no significant changes were found in other groups. Bruxism reported by the patient had a positive correlation with the amount of painful muscles on the right side at first examination. The results show that facial pain combined with TMD may be mostly of myogenic origin, and myogenic pain seems to have most favorable response to conservative treatment of TMD.