Central Sensitization and the Evolution of Chronic TMD

Written by Dr. Agatha Bis

The clinical course of temporomandibular disorders often begins with localized pain from inflammation, internal derangement, or ligamentous strain. For many patients, however, symptoms persist long after the initial mechanical problem has been identified. This transition marks the development of central sensitization, a phenomenon where the nervous system itself becomes the generator and amplifier of pain.

When nociceptive signals repeatedly bombard the trigeminal sensory complex and trigeminocervical pathways, neurons undergo neuroplastic changes. Their excitability increases, leading to a heightened pain response. At this stage, pain is no longer proportional to the degree of peripheral pathology. A mild joint strain can feel severe. Patients may also develop widespread symptoms such as headaches, tinnitus, paresthesia, and even overlapping conditions like fibromyalgia.

Recognizing central sensitization is critical for dentists. It explains why conventional treatments such as simple night guards, anti-inflammatory drugs, or muscle relaxants often fail in chronic cases. The source of the pain is no longer purely mechanical. Instead, management must adopt a multimodal approach. Orthotic therapy is still essential because it restores mandibular balance, but it must be combined with physical therapy to correct posture, exercises to re-train function, and behavioral strategies to reduce parafunction. Pharmacology may offer temporary support, but it cannot replace mechanical correction.

Dentists must also recognize when collaboration is necessary. Patients with central sensitization often require input from neurologists or physiotherapists, not because the problem is unrelated to occlusion, but because the nervous system has adapted in ways that perpetuate symptoms beyond the jaw. An interdisciplinary model is the most effective way to break the cycle.

The takeaway is clear. TMD begins as a mechanical disorder but can evolve into a chronic neurological condition if left unresolved. Understanding central sensitization ensures that we move past symptom management and deliver care that restores long-term function.

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