Differential Diagnostics of Pain in the Course of Trigeminal Neuralgia and Temporomandibular Joint Dysfunction

Abstract

Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest.

Effect of Manual Therapy and Splint Therapy in People with Temporomandibular Disorders: A Preliminary Study

“…Different treatment options for TMD are currently available: (a) splint therapy (ST), which has been widely studied and its efficacy proved [3,8,9]; thus, being proposed as part of a reversible occlusal treatment that includes elimination or reduction of pain levels and frequency [3], reduction of excessive activity, restoration of symmetry of masticatory muscles tone [8], and an increase of mouth opening ability [3]; (b) pharmacologic approaches, by taking analgesics, anti-depressants, muscle relaxant, or non-steroidal anti-inflammatory drugs [10], or by intra-articular administration of medications, which has been proved to have a positive impact on the reduction of the intensity of pain [11]; (c) psychological support [3] and behavioral changes, such as reduction of stress levels, are also important factors in the management of patients suffering from TMD [12]; (d) physical therapy techniques involving, active and passive stretching, endurance exercises of involved muscles, postural exercises, and isolated manual therapy techniques (MT) that have proven to be effective in TMD treatment [13]; and (e) in severe cases, surgical procedures are sometimes applied [6].…”

Assessment of the Short-Term Effectiveness of Kinesiotaping and Trigger Points Release Used in Functional Disorders of the Masticatory Muscles

“…Chronic myofascial pain syndrome is a diagnostic and therapeutic problem for many specialists, such as dentists, laryngologists, neurologists, neurosurgeons, general surgeons, anesthetists, psychiatrists, and oncologists [1]. This indicates the interdisciplinary and complex nature of these diseases.…”

Class II Division 2 subdivision left malocclusion associated with anterior deep overbite in an adult patient with temporomandibular disorder

“…Because of that, it is important that, before any dental intervention, differential diagnosis is made, requiring medical assessment to rule out the possibility of presence of systemic pathologies with similar TMD symptoms, as gout, 7 osteosarcoma 8 and pseudotumor 9 in TMJs, Eagle’s syndrome, 10 fibromyalgia, 11 rheumatoid arthritis 12 and trigeminal neuralgia. 13 …”