Headaches in people with TMJ dysfunction

Abstract

Introduction: TMJ dysfunction is a collective term that meets a wide variety of clinical problems including masticatory muscle problems, TMJ and associated topographic anatomical structures problems. Dysfunctions are only a subset of a larger group of craniofacial pain and dysfunctions, which includes somatic, psychological and neuropathic pain. The complexity and difficulty of the sensitive and motor innervation of TMJ elements and muscles as well as connections and interrelations of various cranial nerves, highlights the importance of the CNS in achieving lower jaw function and at the same time causes difficulties in the differential diagnosis of pain symptoms in the craniofacial area. Purpose and Objectives: (1) To describe the relation between craniofacial pain and TMJ disorders. (2) The use of new diagnostic methods and technologies in patients with TMJ dysfunction, allowing early detection of pathological changes in stomatognathic system. Materials and methods: 2 questionnaires: 1-headache questionnaire;2-TMJ Health Questionnaire (BioRESEARCHAssociates,Inc.). 20 patients aged between 18-50 with TMJ dysfunction accusing headache and orofacial pain were examinated. Paraclinic diagnostic methods used: JVA- Joint Vibration Analyzis; EMG- Electromyography; Quadra TENS- Transcutaneus Electrical Neural Stimulator; T-Scan - Occlusal analyzis system designed to measure and record relative bite forces over time. Results: According to data with clinical and laboratory investigations mentioned, most patients who presented with headache were diagnosed with TMJ dysfunction (disc displacement with/without reduction, degenerative processes, etc.). TMJ dysfunction prevalent in patients aged 35-50 years, affected the feminine sex. Explanation: estrogen through PNS affects blood flow in the TMJ. This in turn reduces the patient's ability to repair damage caused in the joint capsule. Lack of estrogen affects permeability of magnesium in the cell wall, while magnesium is a mineral involved in the production of synovial fluid. The decrease of it means low lubrication of the joint and that low levels of estrogen decreases the pain threshold of the patient and makes them more sensitive to discomfort. The useflilness of these investigations helped early diagnosis of TMJ diseases with further development of treatment plan properly and efficiently. In 15 patients following treatment performed was observed improvement of dolor symptoms in orofacial region and decrease headache. The other 5 patients, through interdisciplinary collaboration (dentist, neurologist, psychiatrist, rheumatologist) were subjected to further investigation to determine the etiopathogenetic polymorphism of headache. Conclusions: In patients who presented in the dental office with headache and oro-facial pain, most are of joint pain, a smaller percentage representing another cause pain. TMJ disorders are encountered more often in women being criminalized hormonal and psycho-emotional factors. Also, low quality dental restorations and incorrect orthodontic procedures can complicate and even initiate TMJ dysfunctions. The investigations carried out have helped diagnose the TMJ disease itself with a plan for effective treatment and relief of dolore symptoms.