Skip to main content

Advertisement

SpringerLink
Log in

Clinical and experimental aspects of temporomandibular disorders

  • Published:
Current Review of Pain Aims and scope Submit manuscript

Abstract

Temporomandibular disorders (TMDs) are currently viewed as a family of related pain conditions in the craniofacial muscles, temporomandibular joint, and associated structures. The etiology and pathophysiology of pain is still far from being known, but several important neurobiological aspects have emerged in the last decade. This article reviews the present knowledge on three clinically relevant topics in TMD: referred pain mechanisms, somatosensory changes, and sensory-motor integration in the craniofacial region. It is proposed that the synthesis of this information from systematic studies in experimental animals and healthy human volunteers together with controlled clinical trials in well-defined patient populations is an essential prerequisite in order to advance the diagnostic procedure and management of TMD pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Woda A, Pionchon P: A unified concept of idiopathic orofacial pain: clinical features. J Orofac Pain 1999, 13:172–184.

    CAS  PubMed  Google Scholar 

  2. Dworkin SF, LeResche L: Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992, 6:301–355.

    CAS  PubMed  Google Scholar 

  3. Woolf CJ, Bennett GJ, Doherty M, et al.: Towards a mechanismbased classification of pain? Pain 1998, 77:227–229. Position paper with recommendation for mechanistic classification of pain.

    Article  CAS  PubMed  Google Scholar 

  4. Mense S: Nociception from skeletal muscle in relation to clinical muscle pain. Pain 1993, 54:241–289.

    Article  CAS  PubMed  Google Scholar 

  5. Stohler CS, Lund JP: Effects of noxious stimulation of the jaw muscles on the sensory experience of volunteer human subjects. In Biological & Psychological Aspects of Orofacial Pain. Craniofacial Growth Series 29. Center for Human Growth and Development. Edited by Stohler CS, Carlson DS. Ann Arbor: The University of Michigan; 1994:55–73.

    Google Scholar 

  6. Gandevia SC, Phegan CML: Perceptual distortions of the human body image produced by local anaesthesia, pain and cutaneous stimulation. J Physiol (Lond) 1999, 514:609–616.

    Article  CAS  Google Scholar 

  7. Türp JC, Kowalski CJ, O’Leary NO, Stohler CS: Pain maps from facial pain patients indicate a broad pain geography. J Dent Res 1998, 77:1465–1472.

    Article  PubMed  Google Scholar 

  8. Dao TT, Reynolds WJ, Tenenbaum HC: Comorbidity between myofascial pain of the masticatory muscles and fibromyalgia. J Orofac Pain 1997, 11:232–241.

    CAS  PubMed  Google Scholar 

  9. Travell JG, Simons DG: Myofascial Pain and Dysfunction. The Trigger Point Manual. Baltimore: Williams & Wilkins; 1983.

    Google Scholar 

  10. Kreiner M, Okeson JP: Toothache of cardiac origin. J Orofac Pain 1999, 13:201–207.

    CAS  PubMed  Google Scholar 

  11. Ramakantan R, Ketkar M, Maddali K, Deshmukh H: Referred pain to the ipsilateral forehead and orbit: an unusual phenomenon during bronchial artery embolization. Cardiovasc Intervent Radiol 1999, 22:275–277.

    Article  CAS  PubMed  Google Scholar 

  12. Schultz G, Melzack R: A case of referred pain evoked by remote light touch after partial nerve injury. Pain 1999, 81:199–202.

    Article  CAS  PubMed  Google Scholar 

  13. Svensson P, Jensen K: Human studies of experimental pain from muscle. In The Headaches. Edited by Olesen J et al. Philadelphia: Lippincott-Raven Press; 1999:565–571.

    Google Scholar 

  14. Svensson P, Graven-Nielsen T, Arendt-Nielsen L: Mechanical hyperesthesia of human facial skin induced by tonic painful stimulation of jaw-muscles. Pain 1998, 74:93–100.

    Article  CAS  PubMed  Google Scholar 

  15. Svensson P, Arendt-Nielsen L, Nielsen H, Larsen JK: Effect of chronic and experimental jaw muscle pain on pressure-pain thresholds and stimulus-response curves. J Orofac Pain 1995, 9:347–356.

    CAS  PubMed  Google Scholar 

  16. Hutchins HC, Reynolds OE: Experimental investigation of the referred pain of aerodontalgia. J Dent Res 1947, 26:3–8.

    Article  CAS  PubMed  Google Scholar 

  17. Arendt-Nielsen L, Graven-Nielsen T, Drewes AM: Referred pain and hyperalgesia related to muscle and visceral pain. IASP Newsletter 1998, January/February:3–5.

  18. Laursen RJ, Graven-Nielsen T, Jensen TS, Arendt-Nielsen L: The effect of compression and regional anaesthetic block on referred pain intensity in humans. Pain 1999, 80:257–263.

    Article  CAS  PubMed  Google Scholar 

  19. Simone DA, Marchettini P, Ochoa JL: Primary afferent nerve fibers that contribute to muscle pain sensation in humans. Pain Forum 1997, 6:207–212.

    Article  Google Scholar 

  20. Hu JW, Sessle BJ, Raboisson P, et al.: Stimulation of craniofacial muscle afferents induces prolonged facilitatory effects in trigeminal nociceptive brain-stem neurons. Pain 1992, 48:53–60.

    Article  CAS  PubMed  Google Scholar 

  21. Hoheisel U, Mense S, Simons DG, Yu X-M: Appearance of new receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain? Neurosci Lett 1993, 153:9–12.

    Article  CAS  PubMed  Google Scholar 

  22. McMahon SB: Mechanisms of cutaneous, deep and visceral pain. In Textbook of Pain. Edited by Wall PD, Melzack R. Edinburgh: Churchill Livingstone; 1994:129–151.

    Google Scholar 

  23. Sessle BJ, Hu JW, Amano N, Zhong G: Convergence of cutaneous, tooth pulp, visceral, neck and muscle afferents onto nociceptive and non-nociceptive neurones in trigeminal subnucleus caudalis (medullary dorsal horn) and its implication for referred pain. Pain 1986, 27:219–235.

    Article  CAS  PubMed  Google Scholar 

  24. Foreman RD, Schmidt RF, Willis WD: Convergence of muscle and cutaneous input onto primate spinothalamic tract neurons. Brain Res 1977, 124:555–560.

    Article  CAS  PubMed  Google Scholar 

  25. Dubner R: Hyperalgesia in response to injury to cutaneous and deep tissues: In Orofacial Pain and Temporomandibular Disorders. Advances in Pain Research and Therapy, vol 21. Edited by Fricton JR, Dubner R. New York: Raven Press; 1995:61–71.

    Google Scholar 

  26. Kellgren JH: Observations on referred pain arising from muscle. Clin Sci 1938, 3:175–190.

    Google Scholar 

  27. Mense S, Hoheisel U, Kaske A, Reinert A: Muscle pain: basic mechanisms and clinical correlates. In Proceedings of the 8th World Congress on Pain. Progress in Pain Research and Management, vol 8. Edited by Jensen TS et al. Seattle: IASP Press; 1997:479–496.

    Google Scholar 

  28. Arendt-Nielsen L: Induction and assessment of experimental pain from human skin, muscle, and viscera. In Proceedings of the 8th World Congress on Pain. Progress in Pain Research and Management, vol 8. Edited by TS Jensen et al. Seattle: IASP Press; 1997:393–425.

    Google Scholar 

  29. Gracely RH, Reid KI: Orofacial pain measurement. In Orofacial Pain and Temporomandibular Disorders. Advances in Pain Research and Therapy, vol 21. Edited by Fricton JR, Dubner R. New York: Raven Press; 1995:117–143.

    Google Scholar 

  30. Reid KI, Gracely RH, Dubner RA: The influence of time, facial side, and location on pain-pressure thresholds in chronic myogenous temporomandibular disorder. J Orofac Pain 1994, 8:258–265.

    CAS  PubMed  Google Scholar 

  31. Carlson CR, Reid KI, Curran SL, et al.: Psychological and physiological parameters of masticatory muscle pain. Pain 1998, 76:297–307.

    Article  CAS  PubMed  Google Scholar 

  32. Maixner W, Fillingim R, Sigurdsson A, et al.: Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain: evidence for altered temporal summation of pain. Pain 1998, 76:71–81. Careful psychophysical study in well-designed groups of patients with TMD followed by a detailed discussion of mechanisms.

    Article  CAS  PubMed  Google Scholar 

  33. Langemark M, Jensen K, Jensen TS, Olesen J: Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache. Pain 1989, 38:203–210.

    Article  CAS  PubMed  Google Scholar 

  34. Jensen R, Bendtsen L, Olesen J: Muscular factors are of importance in tension-type headache. Headache 1998, 38:10–17.

    Article  CAS  PubMed  Google Scholar 

  35. Berberich P, Hoheisel U, Mense S: Effects of carrageenaninduced myositis on the discharge properties of group III and IV muscle receptors in the cat. J Neurophysiol 1988, 59:1395–1409.

    CAS  PubMed  Google Scholar 

  36. Reinert A, Kaske A, Mense S: Inflammation-induced increase in the density of neuropeptide-immunoreactive nerve endings in rat skeletal muscle. Exp Brain Res 1998, 121:174–180.

    Article  CAS  PubMed  Google Scholar 

  37. Sessle BJ: The neural basis of temporomandibular joint and masticatory muscle pain. J Orofac Pain 1999, 13:238–245. Recent review of the most important mechanisms in craniofacial pain.

    CAS  PubMed  Google Scholar 

  38. Ren K, Dubner R: Central nervous system plasticity and persistent pain. J Orofac Pain 1999, 13:155–163.

    CAS  PubMed  Google Scholar 

  39. Malow RM, Grimm L, Olson RE: Differences in pain perception between myofascial pain dysfunction patients and normal subjects: a signal detection analysis. J Psychosom Res 1980, 24:303–309.

    Article  CAS  PubMed  Google Scholar 

  40. Maixner W, Fillingim R, Booker D, Sigurdsson A: Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain 1995, 63:341–351.

    Article  CAS  PubMed  Google Scholar 

  41. Lautenbacher S, Rollman GB, McCain GA: Multi-method assessment of experimental and clinical pain in patients with fibromyalgia. Pain 1994, 59:45–53.

    Article  CAS  PubMed  Google Scholar 

  42. Jensen K, Tuxen C, Pedersen-Bjergaard U, Jansen I: Pain, tenderness wheal and flare induced by substance-P, bradykinin, and 5-hydroxytryptamine in humans. Cephalalgia 1991, 11:175–182.

    Article  CAS  PubMed  Google Scholar 

  43. Babenko V, Graven-Nielsen T, Svensson P, et al.: Experimental human muscle pain and muscular hyperalgesia induced by combinations of sertonin and bradykinin. Pain 1999, 82:1–8.

    Article  CAS  PubMed  Google Scholar 

  44. Witting N, Svensson P, Gottrup H, et al.: Intramuscular and intradermal injection of capsaicin: a comparison of local and referred pain. Pain 2000, in press.

  45. Vecchiet L, Dragani L, Bigontina P, et al.: Experimental referred pain and hyperalgesia from muscles in humans. In New Trends in Referred Pain and Hyperalgesia. Pain Research and Clinical Management, vol 7. Edited by Vecchiet L et al. Amsterdam: Elsevier; 1993:239–249.

    Google Scholar 

  46. Jensen K, Norup M: Experimental pain in human temporal muscle induced by hypertonic saline, potassium and acidity. Cephalalgia 1992, 12:101–106.

    Article  CAS  PubMed  Google Scholar 

  47. Madeleine P, Lundager B, Voigt M, Arendt-Nielsen L: Sensory manifestations in experimental and work-related chronic neck-shoulder pain. Eur J Pain 1998, 2:251–260.

    Article  CAS  PubMed  Google Scholar 

  48. Arendt-Nielsen L, Graven-Nielsen T, Svensson P, Jensen TS: Temporal summation in muscles and referred pain areas: an experimental human study. Muscle Nerve 1997, 20:1311–1313.

    Article  CAS  PubMed  Google Scholar 

  49. Graven-Nielsen T, Arendt-Nielsen L, Svensson P, Jensen TS: Stimulus-response functions in areas with experimentally induced referred muscle pain—a psychophysical study. Brain Res 1997, 744:121–128.

    Article  CAS  PubMed  Google Scholar 

  50. Graven-Nielsen T, Babenko V, Svensson P, Arendt-Nielsen L: Experimentally-induced muscle pain induces hypoalgesia in heterotopic deep tissues, but not in homotopic deep tissues. Brain Res 1998, 787:203–210.

    Article  CAS  PubMed  Google Scholar 

  51. Le Bars D, Dickenson AH, Besson J-M: Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat. Pain 1979, 6:283–304.

    Article  Google Scholar 

  52. Gjerstad J, Tjølsen A, Svendsen F, Hole K: Inhibition of evoked C-fibre responses in the dorsal horn after contralateral intramuscular injection of capsaicin involves activation of descending pathways. Pain 1999, 80:413–418.

    Article  CAS  PubMed  Google Scholar 

  53. Wei F, Dubner R, Ren K: Nucleus reticularis gigantocellularis and nucleus raphe magnus in the brain stem exert opposite effects on behavioral hyperalgesia and spinal Fos protein expression after peripheral inflammation. Pain 1999, 80:127–141.

    Article  CAS  PubMed  Google Scholar 

  54. Mongini F, Tempia-Valenta G, Conserva E: Habitual mastication in dysfunction: a computer-based analysis. J Prosthet Dent 1989, 61:484–494.

    Article  CAS  PubMed  Google Scholar 

  55. Tsolka P, Fenlon MR McCullock AJ, Preiskel HW: A controlled clinical, electromyographic, and kinesiographic assessment of craniomandibular disorders in women. J Orofac Pain 1994, 8:80–89.

    CAS  PubMed  Google Scholar 

  56. Møller E, Sheikholeslam A, Lous I: Response of elevator activity during mastication to treatment of functional disorders. Scand J Dent Res 1984, 92:64–83.

    PubMed  Google Scholar 

  57. Nielsen IL, Marcel T, Chun D, Miller AJ: Patterns of mandibular movements in subjects with craniomandibular disorders. J Prosthet Dent 1990, 63:202–217.

    Article  CAS  PubMed  Google Scholar 

  58. Kumai T: Difference in chewing patterns between involved and opposite sides in patients with unilateral temporomandibular joint and myofascial pain-dysfunction. Arch Oral Biol 1993, 38:467–478.

    Article  CAS  PubMed  Google Scholar 

  59. Stohler CS, Ashton-Miller JA, Carlson DS: The effects of pain from the mandibular joint and muscles on masticatory motor behaviour in man. Arch Oral Biol 1988, 33:175–182.

    Article  CAS  PubMed  Google Scholar 

  60. Lund JP, Donga R, Widmer CG, Stohler CS: The painadaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 1991, 69:683–694.

    Article  CAS  PubMed  Google Scholar 

  61. Travell J, Rinzler S, Herman M: Pain and disability of the shoulder and arm. Treatment by intramuscular infiltration with procaine hydrochloride. J Am Med Assoc 1942, 120:417–422.

    Article  Google Scholar 

  62. Johansson H, Sojka P: Pathophysiological mechanisms involved in genesis and spread of muscular tension in occupational muscle pain. Med Hypotheses 1991, 135:196–203.

    Article  Google Scholar 

  63. Lund JP: Mastication and its control by the brain stem. Crit Rev Oral Biol Med 1991, 2:33–64.

    CAS  PubMed  Google Scholar 

  64. Svensson P, Arendt-Nielsen L, Houe L: Sensory-motor interactions of human experimental unilateral jaw muscle pain: a quantitative analysis. Pain 1996, 64:241–249.

    Article  CAS  PubMed  Google Scholar 

  65. Arendt-Nielsen L Graven-Nielsen T, Svarrer H, Svensson P: The influence of low back pain on muscle activity and coordination during gait: a clinical and experimental study. Pain 1996, 64:231–240.

    Article  CAS  PubMed  Google Scholar 

  66. Graven-Nielsen T, Svensson P, Arendt-Nielsen L: Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function. Electroencephalogr Clin Neurophysiol 1997, 105:156–164.

    Article  CAS  PubMed  Google Scholar 

  67. Madeleine P, Lundager B, Voigt M, Arendt-Nielsen L: Shoulder muscle coordination during chronic and acute experimental neck-shoulder pain. An occupational pain study. Eur J Appl Physiol 1999, 79:127–140.

    Article  CAS  Google Scholar 

  68. Schwartz G, Lund JP: Modification of rhythmical jaw movements by noxious pressure applied to the periosteum of the zygoma in decerebrate rabbits. Pain 1995, 63:153–161.

    Article  CAS  PubMed  Google Scholar 

  69. Westberg K-G, Clavelou P, Schwartz G, Lund JP: Effects of chemical stimulation of masseter muscle nociceptors on trigeminal motoneuron and interneuron activities during fictive mastication in the rabbit. Pain 1997, 73:295–308.

    Article  CAS  PubMed  Google Scholar 

  70. Dao TTT, Lund JP, Lavigne GJ: Pain responses to experimental chewing in myofascial pain patients. J Dent Res 1994, 73:1163–1167.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orofacial Pain Laboratory, Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7D-3, E DK-9220, Aalborg, Denmark

    Peter Svensson DDS, PhD & Lars Arendt-Nielson PhD, DSc

Authors
  1. Peter Svensson DDS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lars Arendt-Nielson PhD, DSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Svensson, P., Arendt-Nielson, L. Clinical and experimental aspects of temporomandibular disorders. Current Review of Pain 4, 158–165 (2000). https://doi.org/10.1007/s11916-000-0051-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-000-0051-1

Keywords

Search

Navigation