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Pain symptoms in TMD can be thought of as originating from the joint (arthralgia), or from the muscles (myofascial), or both. There is a poor correlation between TMD pain severity and evidence of tissue pathology. [6] Generally, degenerative joint changes are associated with greater pain.
Tongue thrusting is a type of orofacial myofunctional disorder, which is defined as habitual resting or thrusting the tongue forward and/or sideways against or between the teeth while swallowing, chewing, resting, or speaking. Abnormal swallowing patterns push the upper teeth forward and away from the upper alveolar processes and cause open bites.
Temporomandibular joint pain is generally due to one of four reasons. Myofascial pain dysfunction syndrome, primarily involving the muscles of mastication. This is the most common cause. Internal derangements, an abnormal relationship of the disc to any of the other components of the joint. Disc displacement is an example of internal derangement.
More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest. Static occlusion refers to contact between teeth when the jaw is closed and stationary, while dynamic occlusion refers to occlusal contacts made when the jaw is moving.
The relationship of bruxism with temporomandibular joint dysfunction (TMD, or temporomandibular pain dysfunction syndrome) is debated. Many suggest that sleep bruxism can be a causative or contributory factor to pain symptoms in TMD. [3] [5] [10] [16] Indeed, the symptoms of TMD overlap with those of bruxism. [17]
Odontogenic pain should especially be ruled out, since this accounts for over 95% of cases of orofacial pain. [8] There is considerable symptom overlap between atypical facial pain and temporomandibular joint dysfunction. [12] The diagnosis of facial pain generally is often multidisciplinary. [5]
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The pain is usually constant, described as aching or burning, and often affects both sides of the face (this is almost never the case in patients with trigeminal neuralgia). The pain frequently involves areas of the head, face, and neck that are outside the sensory territories that are supplied by the trigeminal nerve.