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Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Mar;123(3):288-297. doi: 10.1016/j.oooo.2016.12.005. Epub 2016 Dec 24.

Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms.

Author information

1
Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil; Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil. Electronic address: Yurimartinscosta@yahoo.com.br.
2
Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil; Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
3
Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
4
Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil; Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.

Abstract

The association between temporomandibular disorders (TMDs) and headaches, cervical spine dysfunction, and 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 the comorbid relationship between TMD and cervical spine dysfunction, 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 has supporting evidence in the literature, and the proposed main mechanism underlying this relationship is the impairment of the descending pain inhibitory system. In this particular scenario, a cause-effect relationship is more likely to occur in one direction, that is, fibromyalgia as a risk factor for TMD. Therefore, clinical awareness of the association between TMD and painful comorbidities and the support of multidisciplinary approaches are required to recognize these related conditions.

PMID:
28153123
DOI:
10.1016/j.oooo.2016.12.005
[Indexed for MEDLINE]

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