Temporomandibularni poremećaji – problemi u dijagnostici

Temporomandibular disorders (TMD) is a group of conditions affecting the temporomandibular joint, masticatory muscles and the adjacent structures, and most clinicians and researchers believe that it is multifactorial etiology. There are multiple risk factors associated with TMD. The etiology of TMD has not been yet completely understood. Likewise with other chronic musculoskeletal pain disorders, TMD seems to be best explained from a biopsychosocial perspective, in which it is viewed as a psychophysiological disorder involving changes in endogenous regulatory pain pathways, resulting in maladaptive emotional, physiological and neuroendocrine responses to physical and psychological stressors. In adolescents with TMD, psychosocial factors such as increased levels of stress, somatic complaints, and emotional problems seem to play a more prominent role than dental factors. Multiple pains in the body and fatigue are significantly more common with TMD group than with the controls. Several studies have categorized TMD into subgroups. So far, studies which examined psychological differences between subgroups generally pointed to the fact that patients with myogenic diagnoses had more pain and distress than those with joint-related diagnoses. It seems that muscular pain may overshadow joint pain. However, subjects in the myogenous group more often reported parafunction, depression, and worrying. Recent studies suggest that subjects with muscular diagnoses have more severe pain and psychological distress than those with joint diagnoses. Further studies are needed to clarify the temporal sequence of risk factors, as well as the mechanisms accounting for the association between TMD pain and gender.Temporomandibularnim poremećajem (TMP) uglavnom su zahvaćeni temporomandibularni zglobovi (TMZ) i žvačni mišići s okolnim strukturama. Smatra se da su uzročnici mnogobrojni te neki izravno utječu na pojavu i razvoj TMP-a, dok se drugi pojavljuju kao čimbenici koji mogu doprinijeti nastanku bolesti. Kao i ostali kronični mišićno-koštani bolni poremećaji, i TMP bi se mogao opisati kao psihofizički poremećaj s promjenama u endogenim regulacijskim putovima boli i posljedično otežanom prilagodbom na emocionalne, fiziološke i neuroendokrine odgovore na fizičke i psihičke stresore. Čini se da kod adolescenata s TMP-om važniju ulogu imaju psihosocijalni čimbenici, kao što su povećana razina stresa, somatske tegobe i emocionalni problem, nego sami dentalni čimbenici. U pacijenata s TMP-om znatno je prisutnija pojava multiplih boli u tijelu i općenito umora nego u kontrolnih ispitanika. Postoje različite klasifikacije TMP-a; neki ih dijele u podgrupe. Pacijenti s mišićnim dijagnozama imaju izraženije pritužbe na bol i distres nego oni koji imaju poremećaje vezane uz zglob. Čini se da mišićna bol može zasjeniti zglobnu, a pacijenti iz miogene skupine više se žale na parafunkcije, depresiju i zabrinutost. Smatra se da pacijenti s mišićnim dijagnozama imaju više bolnih simptoma od onih sa zglobnim dijagnozama. Bit će potrebna daljnja istraživanja kako bi se razjasnila uloga i utjecaj čimbenika rizika i mehanizama koji su odgovorni za povezanost TMP-a i boli te utjecaj spola