engleski

Temporomandibular joint disorder in comorbidity with trigeminal neuralgia or persistent idiopathic facial pain

Aim. The aim of this study was to evaluate accurate differentiating between the temporomandibular joint (TMJ) disorder with idiopathic trigeminal neuralgia (TN) and persistent idiopathic facial pain (PIFP) in the sample of patients from a subspecialist dental practice. Methods. All 36 patients (35 female) were previously neurologically examined due to unconfirmed suspicions of a neurological origin of orofacial pain. TMJ-disorder was diagnosed by using the Diagnostic Criteria for Temporomandibular Disorders and the diagnosis was confirmed by using magnetic resonance imaging. The study included 18 patients (group G-1, mean age 59.6 years, 17 female) with TMJ disorder and TN, and 18 patients (group G-2, mean age 52.9 years, all female) with TMJ disorder and PIFP. Clinical characteristics, pain intensity related to TMJs and neurological disorder (TN or PIFP) rated on a visual-analogue scale (VAS with range 0-10). Results. There was no significant difference between TMJ pain on the VAS scale for G-1 patients with 6.1 and for G-2 patients with 6.2 (p>0.05). However, there was a statistically significant difference in the intensity of TN and PIFP related pain (p<0.001) for G-1 patients (pain on VAS was 9.8) and for G-2 patients (pain on VAS was 4.0). In group G-1 with TN, flashing pain was dominant in 77.8% of the patients and 22.2% suffered from stabbing pain. Patients with PIFP (G-2) mostly suffered from a tingling sensation (61.1%), numbing pain (16.6%), pulsating sensation in the face (11.1%) as well as from burning sensation and swelling 5.6% each. The triggering stimuli are dominant in 61.1% of patients with TN, whereas in patients with PIFP they occur rarely (11.1%). In G-1 group, 55.5% of the patients have undergone various dental procedures, and only 11.1% of patients from the G-2 group. All the patients with TN had localized paroxysmal attacks, whereas in patients with PIFP, 72.2% of them had long-term diffuse pain and the other 27.8% had long-term localized pain. The ophthalmic branch was the least involved (16.6% of patients). Conclusions. In the diagnostic process of TMJ- pain, neuropathic pain disorders (TN and PIFP) make the diagnostics of musculoskeletal pain in the orofacial region difficult. Correct diagnosis is the key to managing facial pain of non-dental origin, which includes participation of several experts from the fields of dental medicine, neurology and radiology.

trigeminal neuralgia ; orofacial pain ; temporomandibular joint

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