Occlusion As An Eliological Agent In Head, Neck and Facial Pain

Head, neck and facial pain is reported by 39 million people in a study done by Jarnes Lipton based on a National Health Interview Study done in 1989 (6). Up to 25% of visits to primary healthcare providers is for the diagnosis and treatment of head, neck and facial pain. In the Journal of the American Medical Association John Hopkins researchers reported on episodic tension type headaches that 43% of the respondents reported that their work suffered as a result of headaches and another 8% reported missing work due to headaches (7). Despite the fact that the National Headache Foundation has an extensive categorization of dozens of sources of head, neck and facial pain and many different medical and dental specialists focus on treating head, neck and facial pain, there is even more controversy now than ever before (8).

The purpose of this article is to focus on one source of head, neck and facial pain. That is the pain that can be proven to result when a conflict between the biting surfaces of the teeth force the jaw to accommodate by being malpositioned in the joint socket, creating muscle hyperactivity, muscle spasm and ultimately pain. The pain that can be proven to result when occlusal imbalance triggers muscle hyperactivity is called Temperomandibular Joint Dysfunction (TMJ ds.). Based on this definition, if the pain can be linked to occlusal imbalance, it is TMJ ds. If the pain cannot be directly linked to occlusal imbalance, then it isn't TMJ ds. This specific and limited definition of TMJ ds will make it possible to specifically identify at least one source of a patients pain and then direct appropriate treatment to the identified cause (9, 10).

Whether we like it or not, the first diagnosis is always made by the patient themselves. Sometimes they get help from ffiends, family, Readers Digest and now the Internet, but this initial diagnosis is what sets the trend for much the patients medical experience (11).

Since there are so many potential causes of head, neck and facial pain, along with an equal number of specialists dedicated to their treatment, it is statistically likely that the patient will not select the appropriate doctor for the condition they actually have. Many studies have been done to confirm the fact that patients in pain are usually less than satisfied by the results they achieve. In addition studies have also shown that patients with head, neck and facial pain often see multiple types of practitioners along their journey through the medical system (12).

In the field of dentistry alone there is much disagreement on the relationship between occlusion and head, neck and facial pain. In addition even among the various schools who do agree that occlusion can be a factor in some head, neck and facial pain, there is often severe disagreement about how to solve the problem. In surveying the literature on occlusion and head, neck and facial pain, the LD Pankey staff did an extensive literature search in 1995. The results of that search reveals that the problem is not so much a disagreement of treatment as it is a disagreement of diagnosis (13).

In fact, much of the literature is in agreement on what to do for a patient once the correct diagnosis has been made. The problem is that. if the diagnosis is incorrect and an

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