Gender Is Biggest Genetic Contribution for Developing TMD, Orofacial Pain

Take-Home Pearl: The most important factors that determine whether a person will have a long-term problem with TMJ disorders caused by arthritis or musculoskeletal function are psychosocial (depression, pain coping mechanisms, etc) and are affected by gender.

Article Reviewed: Shaefer JR, Holland N, et al. Pain and Temporomandibular Disorsders: A Pharmaco-Gender Dilemma. Dent Clin N Am 2013;57 (April): 233-262.

Background: Understanding the etiology of  temporomandibular joint (TMJ) pain is pertinent for appropriate treatment.

Objective: To " ...provide an evidence-based review of temporomandibular disorders (TMD) and pain in relation to: (1) genderbased effects on musculoskeletal disorders; (2) pain-processing disorders leading to TMD and its comorbidities; (3) neuropathic pain affecting the trigeminal distribution: is this process gender specific?; (4) genetic influences on orofacial pain; and (5) pharmacokinetics/pharmacodynamics of medications for orofacial paint".

Methods: Review of the literature.

Results: The most common TMD patient is female around the age of 60 years with osteoarrthritis in the temporomandibular joint. Gender differences in pain, musculoskeletal function, pain processing, and opiod efficacy are discussed, as well as genderbased traetments. Pain Differences: According to the peer-reviewed literature, temporomandibular pain is 2 to 3 times more common in women than in men, with icnreasing prevalence during the pre-pubertal period. This may be due to the role of sex hormones, like estrogen, in the TMD inflammatory cascade. Musculoskeletal Function: Due to differences in types of collagen in the retrodiscal tissue (causing joint laxity) and intra-articular pessures, women tend to experience more displaced discs in the TMJs. Therefore, females tend to have more disabilities from chronic TMJ symptoms caused by arthritis versus men. Although most patients respond to palliative therapy (80%), the most important factors that determine whether a person will have a long-term problem with TMJ disorders caused by arthritis or musculoskeletal function are psychosocial (depression, pain-coping mechanismis, etc) and are affected by gender. Pain Processing: Research has shown that: (1) osteoarthritisin the TMJ possesses characteristics of central sensitization syndrome (CSS), a chronic up-regulation of pain receptors; (2) chronically symptomatic TMJ patients show signs and symptoms consistent with neuropathic pain and have a higher incidence of wind-up pain (a transient up-regulation of pain receptors); (3) females have increased nerve growth factor and its receptors than do males; (4) gender-based coping strategies based upon biologic, psychological, and social variables exist; and (5) women show increased pharmacodynamics of opioids (opioids are more potent) and pharmacokinetics of the drugs used to treat TMD pain, whose metabolism is throught the cytochrome p450 enzyme system. Gender-Based Treatments: Althought a genetic influence on TMD pain has not been identified, current research is focusing on identification of alleles to prevent gender-based TMJ arthralgia or functional disorders.

Conclusions: Gender is the biggest risk factor in terms of genetic contribution for developing TMD and orofacial pain. Future research should focus on the reasons for and increased pain-incidence in  females, as well as how sex differences prevent pain from progressing.

Reviewer's Comments: This was an interesting and hard-to-read article. However, the authors accomplished their goals of discussing how gender inflluences TMD pain.

Reviewer: Kelly Halligan, DDS, PC


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