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| TEMPOROMANDIBULAR DISORDERS: A SET OF FEMALE BIASED CONDITIONS ASSOCIATED WITH ALTERED PAIN SENSITIVITY William Maixner, D.D.S., Ph.D., Department of Endodontics, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina and Roger Fillingim, Ph.D., Department of Psychology, School of Social and Behavioral Science, University of Alabama, Birmingham, Alabama Temporomandibular disorders (TMD) represent a group of painful conditions involving the muscles of mastication and the temporomandibular joint [1]. Relatively little is known about the risk factors for TMD, particularly the underlying neural mechanisms that contribute to the onset and maintenance of these complex disorders. Epidemiological studies have revealed a considerable range of TMD prevalence in the general population, ranging from the low teens to upwards of 50%. The prevalence of TMD amongst young female adults has been estimated to be approximately 26% [7] with a female to male ratio of approximately 7:1 [2]. A number of risk factors have been proposed that may contribute to the development and maintenance of painful TMD [6]. Recent studies from our laboratory have suggested that alterations in the underlying neural mechanisms that contribute to pain sensitivity may be important in both maintaining and initiating the development of TMD. In general, female TMD patients are more sensitive to thermal and ischemic stimuli [3], show enhanced temporal summation of thermal pain [4], and appear to be less able to engage endogenous pain regulatory systems [5]. A general presentation of the various biological factors that possibly regulate pain sensitivity in a gender-dependent manner will be provided and discussed in the context of how they may contribute to the development of TMD and other related disorders. References 1 Dworkin, S.F., Fricton, J.R., Hollendcr, L., Huggins, K.H., LeResche, L., Lund, J., Mohl, N., Ohrbach, R., Palla, S.F., Sommers E.E., Stohler. C., Truclove, E.L., Von Korff, M. and Widmer, C.G., Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique, Journal of Craniomandibular Disorders Facial Pain and Oral Pain, 6 (1992) 302-355. 2 Dworkin, S.F., Huggins, K. H., Le Resche. L.. Von Korff, M., Howard, J., Truelove, E. and Sommers, F. Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls, JADA, 120 (1990) 273-281. 3 Maixner, W., Fillingim R.. Booker, D. and Sigurdsson, A., Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain, Pain, 63 (1995) 341-351.4 Maixner, W., Fillingim, R.B.. Sigurdsson, A., Kincaid. S. and Silva, S., Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain: evidence for altered temporal summation of pain, In press, Pain, (1998) 5 Maixner, W., Sigurdsson.A, Fillingim, R., Lundeen, T. and Booker, D., Regulation of acute and chronic orofacial pain. In: J.R. Fricton and R.B. Dubner (Eds.), Orofacial Pain and Temporomandibular Disorders, Raven Press, Ltd., New York,1995, pp. 85-102. 6 Okeson, J.P., Adler, R.C., Anderson, G.C., Baragona, P.M., Broker, E.B.. Falace. D.A., Graff-Radford, S.B, Kaplan, A.S., McDonald, C., McNeill, C., Milliner E.K., Rosenbaum, R.S. and Seligman, DA., Differential Diagnosis and Management Considerations of Temporomandibular Disorders. In: J.P. Okeson (Ed.), Orofacial Pain, Quintessence, Chicago, 1996, pp. 113-184. 7 Solberg, W.K., Woo, M. and Houston, J. Prevalence of mandibular disorders in young adults, JADA, 98 (1979) 25-33.
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