Does Pain Localization in Patients With Temporomandibular Disorders Discriminate Between Myogenous and Arthrogenous Sources?
J Oral Maxillofac Surg. 2026 Feb 25:S0278-2391(26)00184-9. doi: 10.1016/j.joms.2026.02.020. Online ahead of print.
ABSTRACT
BACKGROUND: Temporomandibular disorders (TMDs) are common, yet distinguishing myogenous from arthrogenous pain remains challenging.
PURPOSE: The purpose of the study was to measure the association between 3 patient-reported pain characteristics (anatomical localization, laterality, and modality used to indicate the painful area), individually and in combination, and the diagnosis of myogenous or arthrogenous TMD.
STUDY DESIGN, SETTING, AND SAMPLE: A retrospective cross-sectional study was implemented. Patients presenting to Studio Dentistico Prati (Goito, Mantova, Italy) between January 2020 and January 2024 with a TMD diagnosis were identified through medical record. Inclusion criteria are subjects of ≥18 years of both sexes with painful TMD. Exclusion criteria are myogenous-arthrogenous TMD; orthodontic therapy within 3 years; gnathological, physiotherapeutic, or pharmacological therapy; neurological disorders; and head and neck cancer.
PREDICTOR VARIABLE: Subjects self-reported pain profile based on location (preauricular, intra-auricular, masseteric, temporal, and craniofacial mass), modality of indication (finger vs hand), and unilaterality versus bilaterality of pain.
OUTCOME VARIABLE: The outcome variable was the TMD diagnosis of myogenous or arthrogenous pain sources based on the Diagnostic Criteria for TMD.
COVARIATES: Demographic variables were available only in aggregated form and not linkable to individual records; additional clinical covariates were inconsistently documented and therefore not included in multivariable adjustment.
ANALYSES: Cross-classification of categorical pain characteristics, prevalence odds ratio (POR), χ2 test, Fisher's exact test for small samples, and logistic regression models were performed with R software 4.5.0, considering a significant P value of < .05.
RESULTS: The sample was composed of 600 subjects (mean age 40.6 ± 17.4), 121 men (20.2%) and 479 women (79.8%). A total of 356 subjects (59.3%) presented with arthrogenous TMD and 244 myogenous (40.7%). Myogenous TMD is statistically significant associated with masseteric or temporal pain (P < .001), while preauricular and intra-auricular pain have statistical association with arthrogenous TMD (P < .001). In all areas, arthrogenous patients report unilateral pain (P < .001), while bilateral pain is therefore indicative of myogenous TMD (P < .001). The association between localization and indication modality is also statistically significant; finger-pointing was more likely among arthrogenous patients (P < .001).
CONCLUSIONS AND RELEVANCE: Self-reported unilateral pain with finger indication is more likely associated with arthrogenous pain, both on cranial or masticatory areas.
PMID:41831833 | DOI:10.1016/j.joms.2026.02.020