Differential diagnosis

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Spontaneous pain or pain on jaw movement is a characteristic and necessary feature for the diagnosis of myofascial TMD pain. Patient-based drawings of their typical pain patterns demonstrate a concentration around the masseter muscle and spreading towards the anterior part of the temporalis muscle.44 When patients with episodic or chronic tension-type headache (TTH) draw the location of their typical pain, the lower part of the face, including the masseter muscle, is usually spared, whereas there is a significant occurrence of pain in the neck and pericranial regions.45 These findings imply that different muscles and structures are involved in myofascial TMD pain and TTH. TMD and TTH disorders do overlap and appear to share many of the same pathophysiological mechanisms; however, it would be premature to consider them as identical entities since the importance of, for example, the affected muscles and associated function in addition to genetic background factors need to be further examined.44

Rheumatoid arthritis and other systemic manifestations of arthritis (psoriatic or infectious arthritis) may also affect the TMJ. Differential diagnosis will be based on history, blood tests, and magnetic resonance imaging (MRI) of the TMJ.

A number of more generalized pain conditions such as fibromyalgia, whiplash-associated disorders, low-back pain, and general joint laxity have been found to be comorbid with TMD pain conditions.46,47 These conditions should be taken into consideration in the management strategy and calls for the involvement of healthcare providers other than dentists.

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