ASSESSMENT OF CRANIOFACIAL PAIN AND DYSFUNCTION - A MULTIDISCIPLINARY APPROACH

The etiopathogenetic mechanisms leading to TM dysfunction and/or craniofacial pain are still disputed. In the dental literature such conditions are often referred to in different ways, ''TMJ pain dysfunction syndrome'' and ''myofascial pain dysfunction syndrome'' being the terms more frequently employed.1.2 Although there is a fairly general agreement about the multifactorial etiology of these pathologies,3-6 disagreement still persists as to how different factors (structural, neuromuscular, psychogenic, and others) are relevant.2.7-9 This lack of consensus depends on several reasons: (1) different etiologic factors may be present in the same patient; (2) the same etiologic factors may lead, in different patients, to different consequences; (3) problems arising from craniomandibular structures may be complicated by the superimposition of other disorders (such as hormonal and vasomotor alterations, nerve conduction, or central nervous system (CNS) disorders); (4) the latter disorders may prevail and consequently some patients considered as having a craniomandibular dysfunction by dental clinicians would receive a different diagnosis by other specialists. Therefore, any sound investigation and clinical management of these conditions presuppose that all possible etiologic factors are assessed and, to some extent, quantified, and that they are kept separate from the consequential factors. This work is intended to discuss these problems on the basis of the ideas and methodologies applied at the Center for Cranio-Facial Pathophysiology and of the data obtained from our research.