Manifestations of pain symptoms in reduced occlusion
Authors: Nidzelsky M Ya , Sokolovskaya V M 
Published: November 2018

This article presents the analysis of the relevant literature highlighting the mechanisms of the development of malocclusion and pain symptom at the reduced occlusal vertical dimension. In this case, the key complaint presented by patients is permanent steady pain described as dull, stabbing, or compressing by its character. Most often, the pain is localized within the paratoid-masticatory area as well as buccal, temporal and frontal areas, and irradiates to the upper and lower jaw or the teeth that often leads to performing unnecessary dental manipulations; to the region of the temporomandibular joint (TMJ); to the ear that sometimes is accompanied with fullness and tingling in the ears. In some cases this pain can irradiate to the hard palate and tongue. Many patients note the growing intensity of pain when chewing. Some patients experience episodic increase in pain when there are pain attacks described as compressing or stabing in the background of steady dull pain. The pain gets more intense even at the slightest movements of the head, lower jaw, or when speaking. The duration of the pain attack is approximately 20–30 minutes. A few minutes before the onset of the attack, all patients notice the emergence of somes forerunning symptoms, e.g. hyperlsalivation, paresthesia, toothache. The attacks can be provoked by conversation, overcooling, and emotional tension. It has been experimentally proven that a prolonged muscle contraction, which is often observed during emotional stress, can cause pain in the regions mentioned above. But whether will it arise or not and to what extent, it depends on the state of adaptive capacity of the body and dentofacial system. When the adaptive capacity of the body and the dentofacial system as its part are weakened, the local background for the occurrence of pain symptoms in the maxillofacial area may be: affective states (depression, anxiety), prolonged chewing load, and prolonged neck muscle tension during dental manipulations.
Among the local factors that can cause pain, malocclusions rank the leading place. For example, a hyperbalancing contact is a sign of impaired muscle activity and coordination during the maximal closure of teeth in the lateral position of the mandible, and occlusal contacts on the balancing side affect the distribution of muscle activity during parafunctional closure, and this redistribution can impact on the temporomandibular joint (Andres K. H. et al.).
Occlusion abnormalities may result from reduced occlusal vertical dimension, deformation of the dentitions caused by periodontal disease, partial loss of teeth, pathological tooth wearing, as well as due to improperly inserted fillings, unfit inlays, onlays, crowns.
Reduced occlusal vertical dimension can also cause otalgia and some other otorhinolaryngological problems, pathogenesis of which is quite debatable and controversial in current literature. J. S. Costen considered hearing loss, tingling and other ear symptoms are associated with pressure produced by the head of the mandible joint onto the auditory tube. Reducing the vertical occlusal dimension results in increasing pressure of the head of the mandible joint onto the subtle bone arch of the articular fossa, which separates the cavity of the joint from the dura mater; this can trigger dull pain in the spine.
It is important to remember that pain is a symptom that most often makes patients to search for a dental care. Pain is one of the first clinical manifestations of the body decompensation. Patients with TMJ dysfunction who experience the pain symptom is to a greater or lesser extent make up a group of patients who require a special integrated approach in their treatment.