Temporomandibular Disorder and Orofacial Pain

The Temporomandibular joint (TMJ) is the most complex joint of the human body. Attaches the jaw to the skull, being responsible for supporting the movements of the jaw. It is part of a dynamic and complex system that is the stomatognathic system and that includes, in addition to TMJ, teeth, muscles and support structures.

Temporomandibular disorders (TMD) refer to problems affecting TMJ and/or mastication muscles, head and neck. At the base it reflects an imbalance in the functioning of the patient's stomatognathic system, of multifactorial origin and which is reflected through various signs and symptoms, such as:
Pain in the face
Pain in the ear region
Tension headaches / migraines
Limitation of jaw opening or closing movements
Joint sounds (at the opening or closing you can hear a "click")
Generalized gingival recessions
Generalized tooth sensitivity
Dental fractures or broken restorations

Bruxism is a behavior identified in healthy individuals, which is characterized by an increased muscle activity of the masticatory muscles It has a multifactorial origin and translates into mechanical and biological consequences on muscles, joints and teeth (dental fractures, restorations, dentures, tooth mobility, increased sensitivity, muscle and/or joint symptomatology). It can generate muscle and/or joint overload and be a perpetuating/triggering factor of TMD. Patients with TMD do not necessarily have bruxism and vice versa.

The dentist plays a very important role in the early identification of Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS). The relationship between bruxism behavior and this type of pathology is supported by scientific literature and clinical data. In this sense, the dentist can be an agent of identification and early screening of this condition, since the manifestations of bruxism may exist and should be framed in a general health condition of the patient. In addition to the diagnosis, dentists can contribute to the therapeutic approach, with the confection of mandibular advancement devices (MAD) that are indicated for OSAHS, depending on the diagnosis and type of condition presented. Interdisciplinary work is crucial in these conditions, with interaction and sharing among the medical professionals who accompany the patient.

The diagnosis and personalized therapeutic approach of these conditions, requiring a careful analysis and an interdisciplinary approach involving different professionals and medical areas (dentist, physiotherapist, maxillo-facial surgeon, psychologist, ENT, neurologist, among others).

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