One of the ways that we can help diagnose different types of pain–and therefore decide which treatments are best–is by categorizing the pain. When we can divide pain into different categories, we can narrow down potential causes and get closer to finding the best treatment option.
Now a new recommendation from the International Association for the Study of Pain (IASP) recommended a new division of orofacial pain for the International Classification of Diseases (ICD-11) that can help us categorize our patients’ pain to better identify temporomandibular joint disorders (TMJ or TMD) and recommend treatment.
The IASP committee proposed 6 different categories for orofacial pain, including:
- Chronic primary headache
- Chronic primary orofacial pain
- Chronic secondary headache or orofacial pain
- Chronic headache or orofacial pain attributed to infection
- Chronic dental pain
- Chronic secondary TMD pain
Chronic primary headache is defined as 15 or more headache days a month, with headaches that last more than two hours a day for more than three months.
Chronic primary orofacial pain includes many different types of pain, though most people that fall into this category will have some form of TMJ. Different types of TMJ were defined by related diagnostic criteria published a few years ago. This is also the category that impacts the most people. It may affect as much as 25% of Americans.
Chronic secondary headache or orofacial pain is pain that comes from some other type of dysfunction or disorder not necessarily in the head and face.
Chronic headache or orofacial pain attributed to infection is exactly what it says. Some infection causes listed include meningitis, encephalitis, empyema, and brain abscess.
Chronic dental pain is pain related to dental problems in the teeth or gums, such as tooth infection or gum disease.
Chronic secondary TMD pain is pain in the joints or muscles linked to other causes like injury, autoimmune disorders, crystal deposition, or nervous system disease.
TMJ is a very difficult condition to diagnose, in part because it’s not just one condition, but many, with overlapping symptoms, and people can simultaneously have multiple different forms. Just how complicated is the condition? It took 20 years for the diagnostic criteria to be finalized. The initial criteria were published in 1992, then refined and tested through 2012. Since then, the diagnostic criteria have been largely accepted.
The diagnostic criteria are built on two main pillars. First, there’s a division of TMJ into three main categories:
- Joint-related pain (mostly associated with muscle pain)
- Joint disorders (mostly related to disc disorders)
- Degenerative joint disease (such as arthritis)
But the other main part of the diagnostic criteria (technically called the DC/TMD) is the delineation of both medical history and clinical exam features that should be considered characteristic in diagnosing the different disorders. You will likely show both certain things in your medical history and certain traits during your clinical exam that can help isolate the diagnosis of TMJ.
Despite the existence of ever-better diagnostic and categorization tools, many people with TMJ suffer for years before they find an effective treatment. Just getting doctors to take your pain seriously can be a challenge. And then you might experience numerous misdiagnoses and treatments that don’t help. You might be referred to multiple specialists who can’t help.
Many of our patients went through this ordeal, and, while we hope it will diminish, it continues to be a problem. If you suspect you have TMJ, but can’t get effective treatment in Spokane, let us help. Please call (509) 532-1111 today for an appointment with a TMJ dentist at Collins Dentistry & Aesthetics.