Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017:2017:5957076.
doi: 10.1155/2017/5957076. Epub 2017 Aug 28.

Central Sensitization-Based Classification for Temporomandibular Disorders: A Pathogenetic Hypothesis

Annalisa Monaco  1 , Ruggero Cattaneo  1 , Maria Chiara Marci  1 , Davide Pietropaoli  1 , Eleonora Ortu  1
Affiliations
Review

Central Sensitization-Based Classification for Temporomandibular Disorders: A Pathogenetic Hypothesis

Annalisa Monaco et al. Pain Res Manag. 2017.

Abstract

Dysregulation of Autonomic Nervous System (ANS) and central pain pathways in temporomandibular disorders (TMD) is a growing evidence. Authors include some forms of TMD among central sensitization syndromes (CSS), a group of pathologies characterized by central morphofunctional alterations. Central Sensitization Inventory (CSI) is useful for clinical diagnosis. Clinical examination and CSI cannot identify the central site(s) affected in these diseases. Ultralow frequency transcutaneous electrical nerve stimulation (ULFTENS) is extensively used in TMD and in dental clinical practice, because of its effects on descending pain modulation pathways. The Diagnostic Criteria for TMD (DC/TMD) are the most accurate tool for diagnosis and classification of TMD. However, it includes CSI to investigate central aspects of TMD. Preliminary data on sensory ULFTENS show it is a reliable tool for the study of central and autonomic pathways in TMD. An alternative classification based on the presence of Central Sensitization and on individual response to sensory ULFTENS is proposed. TMD may be classified into 4 groups: (a) TMD with Central Sensitization ULFTENS Responders; (b) TMD with Central Sensitization ULFTENS Nonresponders; (c) TMD without Central Sensitization ULFTENS Responders; (d) TMD without Central Sensitization ULFTENS Nonresponders. This pathogenic classification of TMD may help to differentiate therapy and aetiology.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Current and alternative mechanism of action of ULFTENS. vlPAG-RVM: ventrolateral Periaqueductal Gray, LC: Locus Coeruleus, ANS: Autonomic Nervous System, sEMG/Kin: surface Electromyography and computed kinesiography of mandibular movements, HRV: Heart Rate Variability, PPT: Pressure Pain Threshold, CPM: Conditioned Pain Modulation, VAS: Visual Analogic Scale, and CSI: Central Sensitization Inventory.
Figure 2
Figure 2
Flow chart for differential diagnosis and therapy based on and response to ULFTENS. CSI: Central Sensitization Inventory, TMD CSS: TMD with Central Sensitization, TMD noCSS: TMD without Central Sensitization, PAG-RVM: Periaqueductal Gray-Rostroventral Medulla.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Isberg A. Clinical management of temporomandibular disorders and orofacial pain (1995). Richard A. Pertes and Sheldon G. Gross (Eds). Publisher: Quintessence Publishing Co. Inc., Chicago. Price: 58.00. ISBN: 0-86715-298-2. The European Journal of Orthodontics. 1996;18(6):669–670. doi: 10.1093/ejo/18.6.669. - DOI
    1. Dubner R., Ohrbach R., Dworkin S. F. The Evolution of TMD Diagnosis: : Past, Present, Future. Journal of Dental Research. 2016;95(10):1093–1101. doi: 10.1177/0022034516653922. - DOI - PMC - PubMed
    1. Okeson J. P. The Classification of Orofacial Pains. Oral and Maxillofacial Surgery Clinics of North America. 2008;20(2):133–144. doi: 10.1016/j.coms.2007.12.009. - DOI - PubMed
    1. Pimenta e Silva Machado L., de Macedo Nery M. B., de Góis Nery C., Leles C. R. Profiling the clinical presentation of diagnostic characteristics of a sample of symptomatic TMD patients. BMC Oral Health. 2012;12:p. 26. doi: 10.1186/1472-6831-12-26. - DOI - PMC - PubMed
    1. Hara K., Shinozaki T., Okada-Ogawa A., et al. Headache attributed to temporomandibular disorders and masticatory myofascial pain. Journal of Oral Science. 2016;58(2):195–204. doi: 10.2334/josnusd.15-0491. - DOI - PubMed

MeSH terms