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Pain and persistent occlusal awareness: what should dentists do?

A 24-year-old man sought treatment at the Temporomandibular Disorder, Orofacial Pain, Oral Medicine and Dental Sleep Medicine Clinic at the University of Minnesota, Minneapolis. He requested an occlusal adjustment to treat his longtime occlusal complaints and his more recent jaw pain. Since the age of 14 years, he had undergone orthodontic treatment twice and multiple occlusal equilibration procedures, including coronoplasties that he performed himself by using tools found at home. His believed that his tooth contacts were “lighter” on his posterior teeth than they were on his incisors, and this difference was causing jaw pain, which started after his last orthodontic treatment when he was 22 years old. He described the jaw pain as a constant, dull aching that at its worst had an intensity of 8 on a scale of 0 (no pain) to 10 (worst pain imaginable). The pain was worse when he woke up and when he used his jaws. He took ibuprofen (400 milligrams five times per week) to mitigate this pain. In the past, to alleviate his symptoms, he had been prescribed alprazolam and cyclobenzaprine and used several stabilization appliances. These interventions provided only short-term relief. His medical history indicated headaches in the region of both temples in the morning, as well as neck and back pain. The patient had graduated from college recently, but the high degree of distress he perceived from his “uneven bite” had prevented him from beginning a career.