Precision occlusal splints and the diagnosis of occlusal problems in myogenous orofacial pain patients

Precision occlusal splints and the diagnosis of occlusal problems in myogenous orofacial pain patients 
Glenn M. Kidder, DDS, FAGD and Roger A. Solow, DDS, General Dentistry, 2014 Mar/Apr; 62(2):24.

ABSTRACT:
Myogenous orofacial pain is a common nondental pain. There is an unresolved debate on the etiology of this problem. Research has shown that occlusal interferences affect masticatory muscle comfort, coordination, and function. Resolution of these problems with precise occlusal correction indicates that dental occlusion is a causative or contributory factor in myogenous orofacial pain. However, some studies fail to confirm this and instead conclude that occlusion is unrelated to masticatory muscle pain or dysfunction. An explanation for this discrepancy in findings is that these nonconfirmatory studies had not documented any pretreatment or corrected occlusion. Diagnostic casts mounted in centric relation and precision occlusal splints are accurate modalities to diagnose the occlusal problem and its correction in a patient with myogenous orofacial pain. Computerized digital occlusal analysis provides objective data of occlusal contact time and force to accurately assess diagnosis and treatment. The rationale and requirements for proper occlusal splint fabrication with a verified therapeutic occlusion re presented.

"Patients cannot avoid the effect of traumatic occlusal contacts without dental treatment. Many myogenous orofacial pains do not follow a natural course of remission. A treatment approach based on accommodation to symptoms is not optimal if a structural cause is not identified and treated. Ignoring progressive nonpainful damage to teeth such as wear, fracture, and abfraction is not ethical when OS [occlusal splint] or OA [occlusal analysis] can limit that damage. Dentists are the only health care professionals trained to diagnose and treat myogenous orofacial pain that is related to occlusion. A default decision that pain or dysfunction is a psychological problem without ruling out a physiological cause is presuming a diagnosis."

Discussion:
Studies by Kerstein et al established the importance of objective occlusal analysis in TMD diagnosis and treatment.7,64-73 They proved a scientific rationale for anoptimal occlusion to prevent adverse force
on restorations and treat myogenous orofacial pain. These studies span 22 years; to date there is no literature that refutes the physiological model for masticatory muscle pain, the validity of the T-Scan
technology, or the documented clinical results. Computerized occlusal analysis objectively quantifies forces without relying on subjective and inaccurate patient input. Dentists can use this technology
to document and deliver an optimal OS occlusion.

Conclusion:
Occlusal correction may play a significant role in the treatment of myogenous orofacial pain when a structural problem is confirmed with objective occlusal analysis. There is extensive literature showing
adverse occlusal forces are not beneficial to the patient and should be corrected as part of optimal care. It is the dentist’s responsibility to assess the structural component of each patient’s problem set.
Precision OS therapy can assist this evaluation and preview the effect of definitive occlusal correction.