Current Review of Pain

, Volume 4, Issue 1, pp 71–81 | Cite as

The role of psychosocial factors in temporomandibular disorders

  • Gary B. Rollman
  • Joanne M. Gillespie


The temporomandibular disorders (TMDs) comprise a constellation of symptoms affecting the joints and muscles involved in jaw movement. Patients complain of orofacial pain, limited jaw opening, and clicking or popping sounds. Although pain is generally the defining characteristic of TMD, patients often report marked degrees of stress and interference in daily life. This article reviews recent studies on epidemiology, sex differences, pediatric TMD, classification systems, comparisons to other chronic pain disorders of uncertain etiology, psychological assessment, depression, central modulation and hypervigilance, sleep disturbances, stress, and the management of TMD by conservative physical interventions and cognitive behavioral therapy. Both the assessment and the management of TMD requires a multidisciplinary perspective with strong emphasis on psychosocial variables.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Dworkin SF: Temporomandibular disorders: a problem in dental health. In Psychosocial Factors in Pain: Critical Perspectives. Edited by Gatchel RJ, Turk DC. New York: Guilford Press; 1999:213–226. A broad review of the biopsychosocial perspective of TMD with emphasis on assessment and management of the disorder.Google Scholar
  2. 2.
    Plesh O, Gansky SA, Curtis DA, Pogrel MA: The relationship between chronic facial pain and a history of trauma and surgery. Oral Surg Oral Med. Oral Pathol Oral Radiol Endod 1999, 88:16–21.Google Scholar
  3. 3.
    Dworkin SF, Huggins KH, LeResche L, et al.: Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am Dent Assoc 1990, 120:273–281.PubMedGoogle Scholar
  4. 4.
    Jaspers JP, Heuvel F, Stegenga B, de Bont LG: Strategies for coping with pain and psychological distress associated with temporomandibular joint osteoarthrosis and internal derangement. Clin J Pain 1993, 9:94–103.PubMedGoogle Scholar
  5. 5.
    Eversole LR, Stone CE, Matheson D, Kaplan H: Psychometric profiles and facial pain. Oral Surg Oral Med Oral Pathol Radiol Endod 1985, 60:269–274.Google Scholar
  6. 6.
    Greco CM, Rudy TE, Herlich A:Temporomandibular disorders. In Functional Somatic Syndromes: Etiology, Diagnosis and Treatment. Edited by Manu P. Cambridge,UK: Cambridge University Press; 1998:127–158.Google Scholar
  7. 7.
    Dworkin SF, Huggins KH, LeResche L, et al.: Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am Dent Assoc 1990, 120:273–281.PubMedGoogle Scholar
  8. 8.
    LeResche L: Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 1997, 8:291–305. Reviews the epidemiologic data on TMD pain in specific subtypes, with the aim of identifying possible etiologic factors for these conditions.PubMedGoogle Scholar
  9. 9.
    Von Korff M, Dworkin SF, Le Resche L, Kruger A: An epidemiologic comparison of pain complaints. Pain 1988, 32:173–183.Google Scholar
  10. 10.
    Dworkin SF, Massoth DL: Temporomandibular disorders and chronic pain: disease or illness? J Prosthet Dent 1994, 72:29–38.PubMedGoogle Scholar
  11. 11.
    Goulet JP, Lavigne GJ, Lund JP: Jaw pain prevalence among French-speaking Canadians in Quebec and related symptoms of temporomandibular disorders. J Dent Res 1995, 74:1738–1744.PubMedGoogle Scholar
  12. 12.
    De Kanter RJ, Truin GJ, Burgersdijk RC, et al.: Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder. J Dent Res 1993, 72:1509–1518.PubMedGoogle Scholar
  13. 13.
    Dworkin SF, LeResche L, Von Korff MR: Diagnostic studies of temporomandibular disorders: challenges from an epidemiologic perspective. Anesth Prog 1990, 37:147–154.PubMedCentralPubMedGoogle Scholar
  14. 14.
    LeResche L, Saunders K, Von Korff MR, et al.: Use of exogenous hormones and risk of temporomandibular disorder pain. Pain 1997, 69:153–160.PubMedGoogle Scholar
  15. 15.
    Greene CS: Temporomandibular disorders in the geriatric population. J Prosthet Dent 1994, 72:507–509.PubMedGoogle Scholar
  16. 16.
    Osterberg T, Carlsson GE, Wedel A, Johansson U: A crosssectional and longitudinal study of craniomandibular dysfunction in an elderly population. J Craniomandib Disord 1992, 6:237–245.PubMedGoogle Scholar
  17. 17.
    Ow RK, Loh T, Neo J, Khoo J: Symptoms of craniomandibular disorder among elderly people. J Oral Rehabil 1995, 22:413–419.PubMedGoogle Scholar
  18. 18.
    Riley JL, III, Robinson ME, Wise EA, et al.: Sex differences in the perception of noxious experimental stimuli: a metaanalysis. Pain 1998, 74:181–187.PubMedGoogle Scholar
  19. 19.
    Fillingim RB, Edwards RR, Powell T: The relationship of sex and clinical pain to experimental pain responses. Pain 1999, 83:419–425.PubMedGoogle Scholar
  20. 20.
    Krogstad BS, Jokstad A, Dahl BL, Vassend O: The reporting of pain, somatic complaints, and anxiety in a group of patients with TMD before and 2 years after treatment: sex differences. J Orofac Pain 1996, 10:263–269.PubMedGoogle Scholar
  21. 21.
    LeResche L, Saunders K, Von Korff MR, et al.: Use of exogenous hormones and risk of temporomandibular disorder pain. Pain 1997, 69:153–160.PubMedGoogle Scholar
  22. 22.
    Dao TT, Knight K, Ton-That V: Modulation of myofascial pain by the reproductive hormones: a preliminary report. J Prosthet Dent 1998, 79:663–670.PubMedGoogle Scholar
  23. 23.
    Alamoudi N, Farsi N, Salako NO, Feteih R: Temporomandibular disorders among school children. J Clin Pediatr Dent 1998, 22:323–328.PubMedGoogle Scholar
  24. 24.
    Barone A, Sbordone L, Ramaglia L: Craniomandibular disorders and orthodontic treatment need in children. J Oral Rehabil 1997, 24:2–7.PubMedGoogle Scholar
  25. 25.
    List T, Wahlund K, Wenneberg B, Dworkin SF: TMD in children and adolescents: prevalence of pain, gender differences, and perceived treatment need. J Orofac Pain 1999, 13:9–20.PubMedGoogle Scholar
  26. 26.
    Hartrick CT, Dobritt DW, Eckstein L: Clinical impression that familial models are an important influence in the development and expression of chronic pain and pain behavior [letter]. Pain 1986, 25:279–280.PubMedGoogle Scholar
  27. 27.
    Morrow D, Tallents RH, Katzberg RW, et al.: Relationship of other joint problems and anterior disc position in symptomatic TMD patients and in asymptomatic volunteers. J Orofac Pain 1996, 10:15–20.PubMedGoogle Scholar
  28. 28.
    Raphael KG, Marbach JJ, Gallagher RM, Dohrenwend BP: Myofascial TMD does not run in families. Pain 1999, 80:15–22.PubMedGoogle Scholar
  29. 29.
    Dworkin SF, LeResche L: Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992, 6:301–355.PubMedGoogle Scholar
  30. 30.
    Garofalo JP, Gatchel RJ, Wesley AL, Ellis E, III: Predicting chronicity in acute temporomandibular joint disorders using the research diagnostic criteria. J Am Dent Assoc 1998, 129:438–447. A prospective study designed to evaluate the clinical use of the Research Diagnostic Criteria, which shows that psychosocial factors are of great importance in predicting the course of TMD.PubMedGoogle Scholar
  31. 31.
    Turk DC, Rudy TE: A dual-diagnostic approach assesses TMD patients. J Mass Dent Soc 1995, 44:16–19.PubMedGoogle Scholar
  32. 32.
    Wahlund K, List T, Dworkin SF: Temporomandibular disorders in children and adolescents: reliability of a questionnaire, clinical examination, and diagnosis. J Orofac Pain 1998, 12:42–51.PubMedGoogle Scholar
  33. 33.
    Turk DC: Psychosocial and behavioral assessment of patients with temporomandibular disorders: diagnostic and treatment implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997, 83:65–71.PubMedGoogle Scholar
  34. 34.
    Steed PA: Etiological factors and temporomandibular treatment outcomes: the effects of trauma and psychological dysfunction. Funct Orthod 1997, 14:17–20, 22.PubMedGoogle Scholar
  35. 35.
    Steed PA: TMD treatment outcomes: a statistical assessment of the effects of psychological variables. Cranio 1998, 16:138–142.PubMedGoogle Scholar
  36. 36.
    Dahlstrom L: Psychometrics in temporomandibular disorders. An overview. Acta Odontol Scand 1993, 51:339–352.PubMedGoogle Scholar
  37. 37.
    Kight M, Gatchel RJ, Wesley L: Temporomandibular disorders: evidence for significant overlap with psychopathology. Health Psychol 1999, 18:177–182.PubMedGoogle Scholar
  38. 38.
    Pankhurst CL: Controversies in the aetiology of temporomandibular disorders. Part 1. Temporomandibular disorders: all in the mind? Prim Dent Care 1997, 4:25–30.PubMedGoogle Scholar
  39. 39.
    Wexler GB, McKinney MW: Assessing treatment outcomes in two temporomandibular disorder diagnostic categories employing a validated psychometric test. Cranio 1995, 13:256–263.PubMedGoogle Scholar
  40. 40.
    Wexler GB, McKinney MW: Temporomandibular treatment outcomes within five diagnostic categories. Cranio 1999, 17:30–37.PubMedGoogle Scholar
  41. 41.
    Michelotti A, Martina R, Russo M, Romeo R: Personality characteristics of temporomandibular disorder patients using M.M.P.I. Cranio 1998, 16:119–125.PubMedGoogle Scholar
  42. 42.
    Barsky AJ, Borus JF: Functional somatic syndromes. Ann Intern Med 1999, 130:910–921. An argument that numerous pain disorders of uncertain etiology involve somatic symptoms that are incorrectly attributed to serious abnormality, reinforcing the patient’s belief that he or she has a serious disease.PubMedGoogle Scholar
  43. 43.
    Manu P: Functional Somatic Syndromes: In Etiology, Diagnosis and Treatment. Cambridge, UK: Cambridge University Press; 1998.Google Scholar
  44. 44.
    Wessely S, Nimnuan C, Sharpe M: Functional somatic syndromes: one or many? Lancet 1999, 354:936–939.PubMedGoogle Scholar
  45. 45.
    McNeill C: History and evolution of TMD concepts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997, 83:51–60.PubMedGoogle Scholar
  46. 46.
    Dao TT, Reynolds WJ, Tenenbaum HC: Comorbidity between myofascial pain of the masticatory muscles and fibromyalgia. J Orofac Pain 1997, 11:232–241.PubMedGoogle Scholar
  47. 47.
    Klineberg I, McGregor N, Butt H, et al.: Chronic orofacial muscle pain: a new approach to diagnosis and management. Alpha Omegan 1998, 91:25–28.PubMedGoogle Scholar
  48. 48.
    Cimino R, Michelotti A, Stradi R, Farinaro C: Comparison of clinical and psychologic features of fibromyalgia and masticatory myofascial pain. J Orofac Pain 1998, 12:35–41.PubMedGoogle Scholar
  49. 49.
    Hedenberg-Magnusson B, Ernberg M, Kopp S: Symptoms and signs of temporomandibular disorders in patients with fibromyalgia and local myalgia of the temporomandibular system. A comparative study. Acta Odontol Scand 1997, 55:344–349.PubMedGoogle Scholar
  50. 50.
    McKinney MW, Londeen TF, Turner SP, Levitt SR: Chronic TM disorder and non-TM disorder pain: a comparison of behavioral and psychological characteristics. Cranio 1990, 8:40–46.PubMedGoogle Scholar
  51. 51.
    Vassend O, Krogstad BS, Dahl BL: Negative affectivity, somatic complaints, and symptoms of temporomandibular disorders. J Psychosom Res 1995, 39:889–899.PubMedGoogle Scholar
  52. 52.
    Morris S, Benjamin S, Gray R, Bennett D: Physical, psychiatric and social characteristics of the temporomandibular disorder pain dysfunction syndrome: the relationship of mental disorders to presentation. Br Dent J 1997, 182:255–260.PubMedGoogle Scholar
  53. 53.
    Rollman GB: Pain responsiveness. In The Psychology of Touch. Edited by Heller MA, Schiff W. Hillsdale, NJ: Lawrence Erlbaum Associates; 1991:91–114.Google Scholar
  54. 54.
    Smythe HA: Problems with the MMPI [editorial]. J Rheumatol 1984, 11:417–418.PubMedGoogle Scholar
  55. 55.
    Schnurr RF, Brooke RI, Rollman GB: Psychosocial correlates of temporomandibular joint pain and dysfunction. Pain 1990, 42:153–165.PubMedGoogle Scholar
  56. 56.
    Schnurr RF, Rollman GB, Brooke RI: Are there psychologic predictors of treatment outcome in temporomandibular joint pain and dysfunction? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1991, 72:550–558.Google Scholar
  57. 57.
    Turk DC: Psychosocial and behavioral assessment of patients with temporomandibular disorders: diagnostic and treatment implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997, 83:65–71.PubMedGoogle Scholar
  58. 58.
    Dahlstrom L, Widmark G, Carlsson SG: Cognitive-behavioral profiles among different categories of orofacial pain patients: diagnostic and treatment implications. Eur J Oral Sci 1997, 105:377–383.PubMedGoogle Scholar
  59. 59.
    Korszun A, Hinderstein B, Wong M: Comorbidity of depression with chronic facial pain and temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996, 82:496–500.PubMedGoogle Scholar
  60. 60.
    List T, Dworkin SF: Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders. J Orofac Pain 1996, 10:240–253.PubMedGoogle Scholar
  61. 61.
    Gallagher RM, Marbach JJ, Raphael KG, et al.: Is major depression comorbid with temporomandibular pain and dysfunction syndrome? A pilot study. Clin J Pain 1991, 7:219–225.PubMedGoogle Scholar
  62. 62.
    Dohrenwend BP, Raphael KG, Marbach JJ, Gallagher RM: Why is depression comorbid with chronic myofascial face pain?. A family study test of alternative hypotheses. Pain 1999, 83:183–192. A detailed examination of depression in patients with TMD, controls, and first degree relatives, which provides evidence that the experience of chronic pain contributes to the elevated rates of depression in TMD.PubMedGoogle Scholar
  63. 63.
    Chung SC, Kim JH, Kim HS: Reliability and validity of the pressure pain thresholds (PPT) in the TMJ capsules by electronic algometer. Cranio 1993, 11:171–176.PubMedGoogle Scholar
  64. 64.
    Maixner W, Fillingim R, Booker D, Sigurdsson A: Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain 1995, 63:341–351.PubMedGoogle Scholar
  65. 65.
    Maixner W, Fillingim R, Kincaid S, et al.: Relationship between pain sensitivity and resting arterial blood pressure in patients with painful temporomandibular disorders. Psychosom Med 1997, 59:503–511.PubMedGoogle Scholar
  66. 66.
    McMillan AS, Blasberg B: Pain-pressure threshold in painful jaw muscles following trigger point injection. J Orofac Pain 1994, 8:384–390.PubMedGoogle Scholar
  67. 67.
    Reid KI, Gracely RH, Dubner RA: The influence of time, facial side, and location on pain-pressure thresholds in chronic myogenous temporomandibular disorder. J Orofac Pain 1994, 8:258–265.PubMedGoogle Scholar
  68. 68.
    Fillingim RB, Maixner W: The influence of resting blood pressure and gender on pain responses. Psychosom Med 1996, 58:326–332.PubMedGoogle Scholar
  69. 69.
    Dubner R, Ren K: Endogenous mechanisms of sensory modulation. Pain 1999, Suppl 6:S45-S53.PubMedGoogle Scholar
  70. 70.
    Lautenbacher S, Rollman GB: Possible deficiencies of pain modulation in fibromyalgia. Clin J Pain 1997, 13:189–196.PubMedGoogle Scholar
  71. 71.
    Plesh O, Wolfe F, Lane N: The relationship between fibromyalgia and temporomandibular disorders: prevalence and symptom severity. J Rheumatol 1996, 23:1948–1952.PubMedGoogle Scholar
  72. 72.
    Hedenberg-Magnusson B, Ernberg M, Kopp S: Symptoms and signs of temporomandibular disorders in patients with fibromyalgia and local myalgia of the temporomandibular system. A comparative study. Acta Odontol Scand 1997, 55:344–349.PubMedGoogle Scholar
  73. 73.
    Korszun A, Papadopoulos E, Demitrack M, et al.: The relationship between temporomandibular disorders and stress-associated syndromes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998, 86:416–420.PubMedGoogle Scholar
  74. 74.
    McDermid AJ, Rollman GB, McCain GA: Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification. Pain 1996, 66:133–144.PubMedGoogle Scholar
  75. 75.
    Lautenbacher S, Rollman GB, McCain GA: Multi-method assessment of experimental and clinical pain in patients with fibromyalgia. Pain 1994, 59:45–53.PubMedGoogle Scholar
  76. 76.
    Rollman GB, Lautenbacher S: Hypervigilance effects in fibromyalgia: pain experience and pain perception. In Progress in Fibromyalgia and Myofascial Pain. Edited by Vaeroy H, Merskey H. Amsterdam: Elsevier; 1993:149–159.Google Scholar
  77. 77.
    Lautenbacher S, Rollman GB: Somatization, hypochondriasis, and related conditions. In Handbook of Pain Syndromes: Biopsychosocial Perspectives. Edited by Block AR et al. Mahwah, NJ: Lawrence Erlbaum Associates; 1999:613–632.Google Scholar
  78. 78.
    Riley JL, III, Robinson ME, Kvaal SA, Gremillion HA: Effects of physical and sexual abuse in facial pain: direct or mediated? Cranio 1998, 16:259–266.PubMedGoogle Scholar
  79. 79.
    Fillingim RB, Maixner W, Sigurdsson A, Kincaid S: Sexual and physical abuse history in subjects with temporomandibular disorders: relationship to clinical variables, pain sensitivity, and psychologic factors. J Orofac Pain 1997, 11:48–57.PubMedGoogle Scholar
  80. 80.
    McCreary CP, Clark GT, Oakley ME, Flack V: Predicting response to treatment for temporomandibular disorders. J Craniomandib Disord 1992, 6:161–169.PubMedGoogle Scholar
  81. 81.
    Lentz MJ, Landis CA, Rothermel J, Shaver JL: Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women. J Rheumatol 1999, 26:1586–1592.PubMedGoogle Scholar
  82. 82.
    Fricton JR, Olsen T: Predictors of outcome for treatment of temporomandibular disorders. J Orofac Pain 1996, 10:54–65.PubMedGoogle Scholar
  83. 83.
    DeNucci DJ, Sobiski C, Dionne RA: Triazolam improves sleep but fails to alter pain in TMD patients. J Orofac Pain 1998, 12:116–123.PubMedGoogle Scholar
  84. 84.
    Feige B, Voderholzer U, Riemann D, et al.: Independent sleep EEG slow-wave and spindle band dynamics associated with 4 weeks of continuous application of short-half-life hypnotics in healthy subjects. Clin Neurophysiol 1999, 110:1965–1974.PubMedGoogle Scholar
  85. 85.
    Lobbezoo F, Lavigne GJ: Do bruxism and temporomandibular disorders have a cause-and-effect relationship? J Orofac Pain 1997, 11:15–23.PubMedGoogle Scholar
  86. 86.
    Dao TT, Lavigne GJ: Oral splints: the crutches for temporomandibular disorders and bruxism? Crit Rev Oral Biol Med 1998, 9:345–361.PubMedGoogle Scholar
  87. 87.
    Demitrack MA, Crofford LJ: Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Ann N Y Acad Sci 1998, 840:684–697.PubMedGoogle Scholar
  88. 88.
    Jones DA, Rollman GB, Brooke RI: The cortisol response to psychological stress in temporomandibular dysfunction. Pain 1997, 72:171–182.PubMedGoogle Scholar
  89. 89.
    Flor H, Birbaumer N, Schugens MM, Lutzenberger W: Symptom-specific psychophysiological responses in chronic pain patients. Psychophysiology 1992, 29:452–460.PubMedGoogle Scholar
  90. 90.
    Ohrbach R, Blascovich J, Gale EN, et al.: Psychophysiological assessment of stress in chronic pain: comparisons of stressful stimuli and of response systems. J Dent Res 1998, 77:1840–1850.PubMedGoogle Scholar
  91. 91.
    Foreman PA: The changing focus of chronic temporomandibular disorders: management within a hospital-based, multidisciplinary pain centre. N Z Dent J 1998, 94:23–31.PubMedGoogle Scholar
  92. 92.
    Brooke RI, Stenn PG, Mothersill KJ: The diagnosis and conservative treatment of myofascial pain dysfunction syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1977, 44:844–852.Google Scholar
  93. 93.
    Crider AB, Glaros AG: A meta-analysis of EMG biofeedback treatment of temporomandibular disorders. J Orofac Pain 1999, 13:29–37.PubMedGoogle Scholar
  94. 94.
    Flor H, Birbaumer N: Comparison of the efficacy of electromyographic biofeedback, cognitive-behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain. J Consult Clin Psychol 1993, 61:653–658.PubMedGoogle Scholar
  95. 95.
    Schwartz SM, Gramling SE: Cognitive factors associated with facial pain. Cranio 1997, 15:261–266.PubMedGoogle Scholar
  96. 96.
    Turk DC, Zaki HS, Rudy TE: Effects of intraoral appliance and biofeedback/stress management alone and in combination in treating pain and depression in patients with temporomandibular disorders. J Prosthet Dent 1993, 70:158–164.PubMedGoogle Scholar
  97. 97.
    Dworkin SF, Turner JA, Wilson L, et al.: Brief group cognitivebehavioral intervention for temporomandibular disorders. Pain 1994, 59:175–187.PubMedGoogle Scholar
  98. 98.
    Turner JA, Whitney C, Dworkin SF, et al.: Do changes in patient beliefs and coping strategies predict temporomandibular disorder treatment outcomes? Clin J Pain 1995, 11:177–188.PubMedGoogle Scholar
  99. 99.
    Massoth DL: Psychological factors influencing treatment of temporomandibular disorders. In Handbook of Pain Syndromes: Biopsychosocial Perspectives. Edited by Block AR et al. Mahwah, NJ: Lawrence Erlbaum Associates; 1999:213–233. An examination of medical and biopsychosocial models of TMD with implications for the treatment of patients with inappropriate conceptions of their disorder.Google Scholar
  100. 100.
    Marbach JJ: Temporomandibular pain and dysfunction syndrome. History, physical examination, and treatment. Rheum Dis Clin North Am 1996, 22:477–498.PubMedGoogle Scholar
  101. 101.
    Hathaway KM: Evaluation and management of maladaptive behaviors and psychological issues in temporomandibular disorder patients. Dent Clin North Am 1997, 41:341–354. A clinician’s guide to the pretreatment evaluation of oral habits, pain and stress management skills, compliance, attitude, and expectations, with implications for physical, emotional, and cognitive treatment.PubMedGoogle Scholar
  102. 102.
    Vallon D, Nilner M, Soderfeldt B: Treatment outcome in patients with craniomandibular disorders of muscular origin: a 7-year follow-up. J Orofac Pain 1998, 12:210–218.PubMedGoogle Scholar
  103. 103.
    Marbach JJ, Raphael KG: Future directions in the treatment of chronic musculoskeletal facial pain: the role of evidencebased care. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997, 83:170–176.PubMedGoogle Scholar
  104. 104.
    Forssell H, Kalso E, Koskela P, et al.: Occlusal treatments in temporomandibular disorders: a qualitative systematic review of randomized controlled trials. Pain 1999, 83:549–560.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • Gary B. Rollman
    • 1
  • Joanne M. Gillespie
    • 1
  1. 1.Department of PsychologyUniversity of Western OntarioLondonCanada

Personalised recommendations