TMD-relaterad huvudvärk och orofacial smärta
Tomas List, Professor, övertandläkare, Avd. för orofacial smärta och käkfunktion, Odontologiska fakulteten, Malmö högskola, Malmö; Scandinavian Center for Orofacial Neurosciences (SCON); Avd. för specialiserad smärtrehabilitering, Rehabiliteringsmedicinska kliniken, Skånes universitetssjukhus, Lund
Temporomandibular disorders (TMDs) is an umbrella term for pain and dysfunction involving the masticatory muscles and the temporomandibular joints (TMJs) and is the most common orofacial pain condition. Prominent features are regional pain in the face and preauricular area, limitations in jaw movements, and noise from the TMJs during jaw movements. TMD affects up to 15% of adults, with a peak incidence at 20 to 40 years of age. Chronic pain is the overwhelming reason for patients with TMD treatment. TMD can be associated with impaired general health, depression and other psychological disabilities and affect quality of life and well-being of the patent.
The recently published Diagnostic Criteria for TMD (DC/TMD) have been found to be reliable and valid. These criteria include the most common types of TMDs including pain-related disorders, such as myofascial pain, headache attributed to TMD, arthralgia, as well as disorders associated with the TMJ, primarily disc displacements and degenerative disease.
Co-morbid pain conditions such as headache, back and neck pain are common among TMD patients. Of these headache is most commonly reported, and a significant overlap between headache and TMD-pain has been reported. Both conditions involve trigeminal neural processes, are characterized by pain in the head and/or face and pericranial tenderness. The primary utility of the DC/TMD diagnosis headache attributed to TMD), is that it points to TMD treatment as a therapeutic approach for headache.
Most patients with TMD improve with a combination of noninvasive therapies, including behavior therapy, pharmacotherapy, physical therapy, and occlusal appliances.