Handbook of Pain Syndromes: Biopsychosocial Perspectives

By Andrew R. Block; Edwin F. Kremer et al. | Go to book overview
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Chapter 11
Psychological Factors Influencing Treatment of Temporomandibular Disorders

D. L. Massoth
Department of Oral Medicine
University of Washington

Temporomandibular disorders (TMD) are a heterogeneous set of clinical conditions characterized by pain in the masticatory and related muscles of the head and neck, the temporomandibular joint and associated hard and soft tissues; limitations in jaw function such as the inability to open one's mouth wide; and/or clicking, popping, or grating sounds in the temporomandibular joint ( American Dental Association, 1983). Headache, neck, and shoulder pain, as well as changes in how the teeth articulate, or fit together, also may be associated with TMD. Among individuals seeking treatment for TMD, pain is the most common symptom ( Dworkin, Huggins, et al., 1990).

Although a heterogeneous group of disorders, TMD can be categorized into three main conditions. The most common form of TMD is myofascial pain, which may be accompanied by limitations in jaw opening. The second and third categories of TMD include internal derangements of the temporomandibular joint (TMJ) and degenerative joint diseases. Persons with TMD can have one or more of these conditions at the same time. The clinical course of TMD varies from a brief single occurrence that can resolve in weeks to months, to a chronic episodic or chronic persistent pain problem with duration from 6 months to 20 or more years. TMD-related pain, limitations in jaw function, and pain-related disability vary from mild to severe and do not consistently relate to duration of the TMD problem.

Historically, there have been a variety of factors implicated in the etiology and maintenance of TMD symptoms. These have included physical


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