Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms

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• 作者：Yuri Martins Costa ; DDS ; PhD^a ; ^b ; ^{Yurimartinscosta@yahoo.com.br} ; Paulo Cé ; sar Rodrigues Conti ; DDS ; PhD^b ; ^c ; Flavio Augusto Cardoso de Faria ; DDS ; PhD^a ; Leonardo Rigoldi Bonjardim ; DDS ; PhD^a ; ^b
• 刊名：Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
• 出版年：2017
• 出版时间：March 2017
• 年：2017
• 卷：123
• 期：3
• 页码：288-297
• 全文大小：592 K
• 卷排序：123

文摘

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.