Orofacial pain caused by trigeminal neuralgia and/or temporomandibular joint disorder

Background and Purpose: The purpose was to evaluate an accurate method of differentiating between temporomandibular joint (TMJ) disorder and trigeminal neuralgia (TN) in the sample of patients from a subspecialist dental practice. Patients and Methods: Patients (n=239, mean age 39.3 years, 83.3% female) were examined for clinical symptoms and signs of orofacial pain of non-dental origin. The study included 12 female patients (group G-1; mean age 60.3 years) with determined co-morbidity of TMJ disorder and TN, and 17 patients (group G-2; mean age 53.8 years, 64.7% female) with only TN confirmed and the TMJ disorder ruled out. The TMJ diagnosis by means of magnetic resonance imaging (MRI) was confirmed. Pain intensity was rated on a visual-analogue scale (VAS with range 0–10) and maximal mouth opening capacity (mm) measured by gauge. Results: TMJ pain on the VAS scale for G-1 patients amounted to 6.91. TN related pain symptoms on the VAS scale for G-1 patients amounted to 9.0±1.6 and for G-2 patients 8.1±2.7. There was a statistically significant difference in the intensity of TMJ and TN related pain (p=0.0074) within the G-1 patients group. Pain in the TMJ area (p=0.0012), noise in the TMJs (p=0.0345) as well as ear pain (p<0.001) were more frequent in G-1 patients with TMJ disorder. Maximal mouth opening was statistically significant (p=0.0037) between G-1 (38.9±9.2 mm) and G-2 patients (48.9±5.2 mm). Conclusion: A thorough clinical evaluation of symptoms as well as MRI as the gold standard for TMJ diagnostics also includes a neurological examination in cases of uncommon orofacial pain conditions.