top of page
What is Orofacial Pain?
Orofacial pain is a painful condition involving structures of the head, face, and neck, making it an extremely critical issue as it encompasses various areas of health knowledge. This sometimes makes differential diagnosis difficult for healthcare professionals, as well as the terminology used for certain disorders. For example, there is considerable confusion regarding the use of the terms Orofacial Pain and TMD (usually by professionals who do not work in the field).
Many professionals use the terms Orofacial Pain and Temporomandibular Dysfunction (TMD) interchangeably. As mentioned earlier, Orofacial Pain encompasses all structures of the head, face, and neck, while TMD is a set of disorders affecting the muscles of masticatory function, the temporomandibular joint, and associated structures. A toothache, maxillary sinusitis, and a migraine are some examples of Orofacial Pain, as is TMD, which is actually a type of Orofacial Pain and not its synonym.
What causes Temporomandibular Joint Dysfunction (TMD)?
Temporomandibular disorders (TMD) have a multifactorial etiology, meaning that several factors are involved. Ash, MM (1995) states that TMD is generally caused by the unfavorable interaction between the following factors: neuromuscular, articular, and psychological. The psychological aspect was reported by Yap, AUJ et al, 2002, in their study, whose patients diagnosed with myofascial pain and other articular conditions (joint pain and osteoarthritis) presented significant levels of depression and somatization.
It is generally agreed that there are factors related to TMDs (Temporomandibular Disorders) that can predispose a patient to develop the dysfunction (predisposing factors), or even initiate it (initiating factors), as well as hinder the patient's control (perpetuating factors). These include: stress, anxiety, depression, trauma, increased muscle activity (due to a parafunction, for example: bruxism (sleep and wakefulness - teeth clenching), postural changes (head posture, body posture), sleep disturbances, nutritional deficiencies, and genetic factors. Occlusal alterations are mentioned in some studies, but there is still no scientific evidence of a cause-and-effect relationship between them.
What are the signs and symptoms of TMD (Temporomandibular Joint Disorder)?
The symptoms most frequently reported by patients are pain in the face, masticatory muscles, temporomandibular joint (TMJ), and headaches. Some patients report ear pain and tinnitus. The most commonly observed signs are muscle and TMJ tenderness upon palpation, limitation and/or alterations in mandibular movements, and joint noises.
A thorough examination must be performed by a dentist in order to establish a correct diagnosis and consequently develop a treatment plan.
How do I know if I have TMD (Temporomandibular Joint Disorder)?
You should seek a qualified professional for diagnosis. However, there are some self-administered questionnaires that help screen patients at risk of having TMD. Click on the image below (Fig. 1.) and answer the questions. If you answer yes to 3 or more questions, you may have TMD and should seek a professional for a specific examination.
Fig. 1. American Academy of Orofacial Pain (AAOP) questionnaire for diagnosing TMD.
What are the therapies for TMD (Temporomandibular Joint Disorder)?
There are several treatment options for patients with TMD. As mentioned earlier, due to its multifactorial nature, treatment should be multidisciplinary, involving various specialties. Among dental procedures, we can mention occlusal splints (Fig. 2).
Fig. 2. Occlusal splint (made of acrylic resin) installed on the patient.
Other forms of therapy include counseling regarding the patient's habits (Fig. 3), low-level laser therapy, pharmacology, physiotherapy (thermotherapy, muscle exercises, postural re-education, muscle stretching, electrostimulation), biofeedback , acupuncture, speech therapy, psychological and/or psychiatric treatment (performed by a psychologist, usually in patients who present with anxiety and/or depression), among others.
Fig. 3. Counseling leaflet provided to patients. Click on the image to download the leaflet.
In TMDs, we can divide therapeutic approaches into three types: initial (or emergency) therapy, supportive (or adjuvant) therapy, and definitive (or control) therapy. Initial therapy should focus on relieving symptoms and providing the patient with information about their problem (what the dysfunction is, possible contributing factors to the problem, therapeutic approaches that can be used, and their potential results).
Supportive therapies are generally used to improve patient function (mandibular opening, masticatory function, etc.) and are often indicated in conjunction with initial therapies.
Definitive therapy aims to eliminate the factors that contributed to the development of TMD. Therefore, a correct diagnosis is essential for the use of these therapies. We must precisely identify the causative agent of the dysfunction (if it exists) in order to indicate the best therapeutic option.
Regarding therapeutic approaches, we should initially use conservative, reversible, and evidence-based therapeutic modalities, as these present a lower risk of causing further harm to the patient.
bottom of page