Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms

Publication date: Available online 24 December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Yuri Martins Costa, Paulo César Rodrigues Conti, Flavio Augusto Cardoso de Faria, Leonardo Rigoldi Bonjardim
The association between temporomandibular disorders (TMD) and a) headaches, b) cervical spine dysfunction (CSD) and c) fibromyalgia is not artefactual. The aim of this review is to describe the comorbid relationship between TMD and these three major painful conditions, and to discuss the clinical implications and the underlying pain mechanisms involved in these relationships. Common neuronal pathways and central sensitization processes are acknowledged as the main factors for the association between TMD and primary headaches, although the establishment of cause-effect mechanisms requires further clarification and characterization. The biomechanical aspects are not the main factors involved in comorbid relationship between TMD and CSD, which can be better explained by the neuronal convergence of the trigeminal and cervical spine sensory pathways, as well as by central sensitization processes. The association between TMD and fibromyalgia also finds support in the literature and the proposed main mechanism underlying this relationship is the impairment of the descending pain inhibitory system. In this particular scenario, cause-effect relationship is more likely to occur in one direction, i.e., fibromyalgia as a risk factor for TMD. Therefore, the association between TMD and painful comorbidities requires clinical awareness in order to recognize these related conditions and support of multidisciplinary approaches.



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