What is the role of temporomandibular joint (TMJ) disorders in the etiology of facial pain and headache?

Updated: Jan 29, 2020
  • Author: Tejas Raval, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Pain of dental origin can be referred to many areas of the head and face. Facial pain of dental origin is often caused by caries that progress to infection of the pulp or apical abscess or periodontal disease. [27]

Temporomandibular joint (TMJ) disorders are known to cause facial pain and headache. Females with TMJ disorders outnumber males, and the onset is in those aged 30-50 years. The TMJ is a diarthrodial joint between the mandibular condyle and the glenoid fossa of the temporal bone. A fibrocartilaginous disc that is attached to the joint capsule allows the condyle to perform both rotational and translational movements.

The 3 main categories of TMJ syndrome are chronic myofascial pain, internal derangement, and degenerative joint disease (DJD). [27]

  • Chronic myofascial pain is most common and is similar in nature to fibromyalgia. The pain is unilateral, dull in character, and localized to the preauricular region. Pain is exacerbated by chewing, yawning, or the stimulation of certain trigger points that are usually located with palpable bands of muscle. Treatment consists of soft diet, analgesics, corticosteroids, local anesthetic blocks, muscle stretching, and treatment of psychological factors. [27]

  • Internal derangement usually consists of an anterior displacement of the disc. A dull preauricular pain with joint tenderness and an audible or palpable joint “click” is present upon examination. [27] Treatment consists of a soft diet, orthotic appliances, and physical therapy. [28] Surgical management can be used in refractory cases, but this is becoming less common.

  • DJD is essentially osteoarthritis of the joint and should be treated with a soft diet and NSAIDs.


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