April 30, 2019

Dr. Rios explains in this post how a bad dental occlusion can be the cause of a constant headache.

“Every day I see patients who present this alteration. Many are referred from other specialists because they began their journey in the family doctor who referred them to the neurologist, who in turn referred them to the neurophysiologist, from here they went to the otolaryngologist and even to the cardiologist or traumatologist, until someone diagnosed them with Orofacial Pain Syndrome, a Costen Syndrome, a Temporomandibular Dysfunction Syndrome, a TMJ Pathology or any of the other different collars for the same dog…”.

Without getting into further discussions, I’ll stick with Orofacial Pain Syndrome (ODS). It is nothing more than arthritis or osteoarthritis (depending on the degree) that is complicated by myofascial (muscular) pain. Let’s take an easy example: if I injure my knee, I won’t be able to walk well. In fact, I will probably overload the other leg more so as not to force my damaged joint. It also seems logical that, if I don’t walk well, my hip can suffer some displacement to adapt to my new position, and with it also my back. In the end I will suffer contractures and pains in the back, waist and the other leg if I do not remedy the injured knee. This is something that any physiotherapist or osteopath will be able to talk to us about for a long time… And all this because of having broken the postural balance due to not walking properly!

Well, now it’s time to explain how the mouth joint, called the temporomandibular joint (TMJ), works. Imagine a door with its frame and two hinges.

The door, when it closes, must fit perfectly into its frame. If it doesn’t, it can happen that it crashes and doesn’t close, dislodging the hinges if we force it, or that it does the forced closing rubbing the frame and wearing it out.

So basically, this is how the ATM works, as a door with two hinges (which would be the jaw), and if closing does not fit well with its frame (the upper jaw) will cause wear on the teeth and crowding or will dislodge the joint.

Faced with these disorders, the joint is not completely defenseless, but has mechanisms to protect itself. These mechanisms are diverse, but the main one is based on muscular protection. The musculature will change and adapt to the new situation trying to keep the joint in place, which causes an overwork muscle, responsible for fatigue and muscle contractures that are those that hurt. This is known as myofascial pain.

And this is where the dentist comes in, who treats this problem by rehabilitating the occlusion (the fitting of the door into the frame). This can be done through orthodontics, prosthetics, selective carving or by making a discharge splint.

 As a final note, I must say that all this is much more complex and often requires the collaboration of other specialties such as maxillofacial surgery, physiotherapy, psychiatry, speech therapy … The truth is that in the end the success of this treatment is in the teamwork.