Temporomandibular Joint Disorders (TMD) represent a group of complex musculoskeletal and neuromuscular conditions affecting the temporomandibular joints, masticatory muscles, and associated craniofacial structures. These disorders are characterized by pain, joint dysfunction, and functional limitations of the jaw, and are frequently accompanied by comorbid conditions such as primary headache disorders, cervical spine dysfunction, and other chronic pain syndromes.

Contemporary understanding of TMD emphasizes a biopsychosocial framework, recognizing the interaction of peripheral tissue pathology, altered neuromuscular function, central pain processing, and psychosocial contributors. Accurate diagnosis requires systematic clinical evaluation and differential diagnosis to distinguish TMD from odontogenic, neurologic, and otologic pathologies.

Evidence-based management prioritizes conservative, reversible interventions and interdisciplinary care, reflecting the multifactorial and often chronic nature of these disorders.

Trigeminal Neuropathic Pain is defined as facial pain resulting from a lesion or disease affecting the trigeminal nerve or its branches, characterized by positive and/or negative sensory signs within the trigeminal distribution. Clinical manifestations include continuous or paroxysmal pain, dysesthesia, paresthesia, hypoesthesia, mechanical or thermal allodynia, and hyperalgesia.

Etiologies encompass traumatic trigeminal nerve injury, post- surgical or post-dental procedural nerve damage, compressive or inflammatory neuropathies, neoplastic involvement, and idiopathic neuropathic mechanisms. Pathophysiology involves aberrant peripheral nerve signaling, ectopic impulse generation, and maladaptive central nervous system plasticity, including central sensitization within the trigeminal system.

Diagnostic evaluation requires a detailed history, focused neurosensory examination, and exclusion of alternative diagnoses such as trigeminal neuralgia, persistent idiopathic facial pain, and odontogenic sources. Management is mechanism-based and typically interdisciplinary, emphasizing pharmacologic agents targeting neuropathic pain pathways alongside adjunctive behavioral and rehabilitative approaches.

Primary Headache Disorders, as classified by the International Classification of Headache Disorders, 3rd edition (ICHD-3), include migraine, tension-type headache, and trigeminal autonomic cephalalgias (TACs). These conditions are highly relevant to orofacial pain, given their shared neuroanatomical and neurophysiological mechanisms within the trigeminovascular system. Sensitization of trigeminal afferents can result in pain perceived in the face, jaw, teeth, and temporomandibular region, often mimicking odontogenic or temporomandibular disorders.

Pathophysiology involves dysregulated trigeminal nociceptive processing, central sensitization, and altered brainstem and hypothalamic function, with mechanisms such as CGRP-mediated neurogenic inflammation contributing to facial allodynia and referred orofacial pain.

Current evidence supports management with an integrated, multidisciplinary approach that combines pharmacologic and non-pharmacologic therapies. Optimal care typically involves collaboration among a neurologist or headache medicine specialist, an orofacial pain specialist, a physical therapist, and a behavioral medicine specialist, reflecting the complex and overlapping nature of headache and orofacial pain disorders.

Sleep-Related Breathing Disorders (SRBDs), including obstructive sleep apnea, are frequently associated with orofacial pain, temporomandibular disorders, and other craniofacial symptoms. Orofacial pain specialists have established competence in screening for and managing sleep disorders associated with orofacial pain, as well as in sleep-related breathing disorders, and function as integral members of multidisciplinary care teams.

The pathophysiology of sleep-disordered breathing is multifactorial, involving both mechanical upper airway obstruction and impaired neuromuscular control of the jaw, tongue, and associated craniofacial structures. Orofacial pain specialists contribute to management by addressing neuromuscular and musculoskeletal components, including jaw position, masticatory muscle function, and coexisting temporomandibular disorders, which may influence airway patency and symptom burden.

Current evidence supports a collaborative, interdisciplinary approach involving orofacial pain specialists, sleep physicians, pulmonologists, and otolaryngologists. This integrated model allows for comprehensive management of both airway pathology and associated orofacial pain, with studies demonstrating improvements in sleep quality, pain symptoms, and functional outcomes.

Myofascial pain is a prevalent musculoskeletal disorder characterized by the presence of myofascial trigger points within taut bands of skeletal muscle, resulting in localized and referred pain as well as functional impairment. In the orofacial region, it most commonly presents as masticatory myalgia, with jaw pain, muscle tenderness, fatigue, and pain exacerbated by mandibular function, often in association with cervical myofascial involvement that influences head, neck, and jaw biomechanics.

Management is typically multimodal and may include patient education, behavioral and postural modification, pharmacologic therapies, physical and manual therapies, and, when indicated, oral appliance therapy or trigger point interventions.

Orofacial pain specialists are uniquely trained to integrate stomatognathic, musculoskeletal, and neurologic principles and serve a central role within an interdisciplinary care model, collaborating with physical therapists, physicians, psychologists, and other dental and medical specialists to provide coordinated, evidence-based treatment for complex masticatory and cervical myofascial pain conditions.