The functional relationship between the craniomandibular system, cervical spine, and the sacroiliac joint: a preliminary investigation

Influence of the mandibular position on various postural anatomical segments

OBJECTIVE

To determine postural changes in relation to mandibular position in maximum intercuspation and at rest in adult patients of both sexes.

METHODS

: A descriptive observational clinical study was carried out in 76 patients. Using an analyzer and the Meersseman test, the necessary dermal points for postural analysis were located.

RESULTS

: The authors found significant differences in the posture adopted by the patient between maximum intercuspation and mandibular rest in the frontal, sagittal, and dorsal planes. Foot support in the right foot went from cavus to normal in 6% of the sample, and from flat to normal in 2.5% of the sample in the jaw rest position.

CONCLUSION

Postural changes were observed in various segments, with clinical and statistical significance at cervical level in the frontal plane, in the biscapular variable in the dorsal plane, and at the level of the lower limbs in the bipopliteal and bimalleolar variables.

Improvement of cervical spine mobility and stance stability by wearing a custom-made mandibular splint in male recreational athletes

OBJECTIVES

The range of motion (ROM) of the cervical spine and postural stability are important for an economical and motorically adequate adaptation of the body to any situation. Therefore, this study aims to analyze whether these two components of postural and movement control can be influenced by means of a splint in a centric position compared to habitual occlusion.

METHODS

38 recreational male athletes volunteered. Cervical spine ROM was recorded using an ultrasound system and the a pressure measuring plate for postural stability (length of center of pressure (CoP) movement, area of CoP). The two dental occlusion conditions employed were the habitual occlusion and wearing a splint in an idealized, condylar position close to the centric position. Level of significance was set at ρ ≤ 0.05.

RESULTS

The cervical spine mobility increased significantly by wearing the splint regarding rotation to the left (+3.9%) and right (+2.7%) and lateral flexion to the left (+4.4%) and right (+6.7%). Wearing the splint reduced the area of sway deflections by about 31.5% in the bipedal stance and by about 2.4% (left) and 28.2% (right) in the unipedal stance. The CoP trace was reduced in the sagittal plane by approximately 8.2% in the right single-leg stance.

CONCLUSIONS

The major findings seem to demonstrate that wearing a splint that keeps the jaw close to the centric relation may increase the cervical ROM and may improve balance stability in male recreational athletes. Changing the jaw relation in athletes can possibly aid the release of performance potentials by improving coordination skills.

Relationship between cervical angle and temporomandibular disorders in young and middle-aged population

OBJECTIVE

To verify temporomandibular disorders (TMDs) and cervical angles in a young and middle-aged population.

METHODS

Ninety participants were included, 45 of whom had TMDs. The participants were diagnosed according to the Research Diagnostic Criteria for TMDs. Lateral cervical radiographs were taken, and relevant cervical angles were measured. The general characteristics of the TMD group and control group were analyzed using chi-square analysis, and the relationship between cervical angles and TMDs was evaluated using the unpaired t-test.

RESULTS

The decrease in C2-C7 Cobb and increase in the posterior occipitocervical angle (POCA) were associated with the incidence of TMDs (p < 0.0001).

CONCLUSION

This study revealed that the cervical angle was related to TMDs. People with a long-time habit of head bending posture had a decrease in C2-C7 Cobb and an increase in the POCA. This group of people was more likely to develop TMDs.

Effects of Induced Malocclusion on Vertebral Alignment in Rats: A Controlled Study by CBCTs

Simple Summary

Nowadays, there is insufficient available evidence to validate a correlation between dental occlusion disorders and spinal curvature, and therefore, more studies are necessary to clarify how and to what extent the modifications of the occlusion might affect vertebral spine biomechanics. The following paper is a controlled study on rats that aims to induce a malocclusion in rats’ mouths by a bite-raising on the upper molars and then to check the alteration of vertebral alignment over time by a CBCT analysis. Alteration of vertebral alignment in rats with induced malocclusion could support the hypothesis of a correlation between occlusal contact and body posture and open the way for further studies on mandibular repositioning and posture control in humans.

Abstract

This study aimed to evaluate with CBCTs the alteration of vertebral alignment over time of induced malocclusion in rats. Crown pads increasing the vertical dimension of 0.5 mm were applied on the upper molars at one randomly selected side of the maxilla in rats (premature contact side) while the opposite side was left untreated (control side). Four groups were organized, ten animals each. In groups A, B, and C, the crowns were applied at time 0 (t-0). In group A, the crowns were removed after 2 weeks (t-2w) and euthanized after two more weeks, while in groups B and C, the animals were euthanized after 2 and 4 weeks (t-4w), respectively. No premature contacts were applied in group D. CBCTs were taken at t-0 in all animals before applying the crowns, at t-2w in group A before removing the crowns, and in all groups before the euthanasia. The changes in the iliac crest angle (ICA) that formed between the superior external margin of the iliac crest and the vertebral spine were evaluated. In groups A and B, after 2 weeks, the changes in ICA were statistically significant at p = 0.028 and p = 0.042, respectively. In group C, and in the control group D, the changes of ICA were not statistically significant (p = 0.058 and p = 0.414, respectively). In conclusion, the incease in monolateral occlusion in the molar region yielded a rotation of the lumbo-sacral segment towards the same side of the occlusal bite-raising.

Influence of dental occlusion on oculomotory function-A pilot study

The aim of this study was to examine the interaction between the oculomotory system and the stomatognathic system based on morphofunctional relationships between the corresponding cranial nerves, their core areas and the reticular formation as a "link" by means of optometric examinations. Test subjects (N = 100) were prospectively recruited and divided into two groups: a young-age (N = 53, age 6-16 years) and old-age group (N = 47, 23-78 years). We determined the horizontal range of convergence and divergence as well as the near convergence point. These optometrically measured parameters were recorded in both groups in the resting position, at maximal mouth opening and with bite-blocking via tin foils (0.5 mm and 1 mm), which were inserted occlusally of the first lower left molar. All oculomotory parameters were significantly altered by bite manipulation and maximal mouth opening. These effects could be observed regardless of age and gender and thus suggest an interaction between eye movement and the orofacial complex. Subjects with asthenopic symptoms showed no different reactions compared to healthy subjects. For a final statement on the correlation between the oculomotory and stomatognathic system, further investigations are necessary. An interdisciplinary cooperation between the different subject areas is recommended for further studies.

Evaluation of the three-dimensional (3D) position of cervical vertebrae in individuals with unilateral posterior crossbite

OBJECTIVE

To evaluate the three-dimensional (3D) position of the cervical vertebrae of growing subjects with unilateral posterior crossbite (UPC).

MATERIALS AND METHODS

In this cross-sectional study, cone beam computed tomography (CBCT) scans of 1455 patients were screened, and ultimately 58 scans (26 patients with UPC and 32 controls with normal occlusion) were included after imposing inclusion/exclusion criteria. Roll, yaw, and deviation of the geometric center of C1, C2, and C3 vertebrae were measured and compared between groups. A correlation between these parameters and different variables on mandibular positioning was also carried out.

RESULTS

A statistically significant difference (p < 0.05) was observed between groups for the deviation of pogonium (Pog), mandibular plane roll, and C3 roll, and patients with UPC showed higher cant or deviation. A significant correlation was reported for the roll of C2 and C3 with the deviation of Pog, a roll of the occlusal plane, and roll of the mandibular plane (p < 0.05). The greater the deviation of the Pog to one side, the greater the roll of the vertebrae with this same side up. The same tendency was observed between the roll of the occlusal plane or the mandibular plane with the roll of these cervical vertebrae.

CONCLUSIONS

There is a positive correlation between transverse occlusal changes and positional deviations of the cervical vertebrae, especially C2 and C3.

CLINICAL RELEVANCE

The study results do not allow us to infer the clinical/functional consequences of these deviations, as well as if malocclusion's treatment would result in an improvement of intervertebral relationships.

Body postural realignment in the first 2 months after orthognathic surgery

INTRODUCTION

This study aimed to assess the static posture in patients with Angle Class II and III malocclusions in the first 2 months after orthognathic surgery.

METHODS

This was a longitudinal observational study. Eligible participants were adult patients who had an indication of orthognathic surgery (bilateral sagittal split osteotomy of the maxilla and/or mandible, can be associated or not with genioplasty). Thirty-five patients were evaluated from the orthognathic surgery group (OSG) and control group (CG). Measurements in OSG were performed at 3 time points: preoperative orthognathic surgery (P0), first postoperative month (P1), and second postoperative month (P2). Static posture was evaluated using the PostureScreen Mobile (PostureCo Inc, Trinity, Fla) application in 4 views.

RESULTS

Patients with Angle Class II malocclusion in the OSG evidenced a tendency to a left hip translation at P1 with a significant difference at P2 in the anterior view (P = 0.052). In the right lateral view, patients with Angle Class II malocclusion in the OSG at P1 presented an accentuated anterior shoulder translation when compared with CG (P <0.001). At P1, patients with Angle Class II malocclusion in the OSG showed a significant anterior knee translation compared with the CG and OSG at P0 and P2 (P <0.001 for all). Patients in the OSG with Angle Class III malocclusion presented an average posterior head translation in the right lateral view at P1 when compared with those in the CG and OSG at P0, who presented an anterior translation (P = 0.0008).

CONCLUSIONS

These findings suggest a realignment of static posture in the first 2 months after orthognathic surgery.

Effect of a sports mouthguard on the functional range of motion of the spine and the upper body posture in taekwondo

Background

The aim is to investigate to what extent the different oral protections compared to the habitual occlusion affect the upper body posture in statics and during taekwondo-specific movement.

Methods

12 Taekwondoka (5 f/7 m) of German national team were measured by using a 3d back scanner and an ultrasonic distance measuring (upright stand, taekwondo attack and defense movement, two taekwondo specific combinations) in habitual occlusion, with a custom-made and ready-made mouth protection

Results

There are no significant changes in the upper body posture (p ≥ 0.05). Depending on the dynamic measurements, different significant reactions of the spinal position were found while wearing the custom made mouthguard or the ready-made mouthguard according to the conducted movement.

Conclusion

The measured changes in dynamic movements are not clinical relevant. Based on the positive responses from the participants, the custom-made mouth protection can be recommended combined with an individual analysis.

Sacroiliac Joint Dysfunction Treated Using Neural Therapy to the Temporomandibular Joint: A Case Report

Temporomandibular joint disorders (TMJD) include temporomandibular joint dysfunction and bruxism. Sacroiliac joint dysfunction (SJD) is a frequent cause of non-discogenic low back pain. Studies suggest a relationship between TMJD and SJD; however, the link remains unclear. Neural therapy (NT) utilises local anaesthetic injections to treat pain by normalising a dysfunctional autonomic nervous system held responsible for initiating or propagating chronic pain. A 31-year-old female presented with a 1-year history of mechanical left-sided low back pain and sleep bruxism. Examination revealed crepitation of the left TMJ and a trigger point in the masseter muscle. Range of motion of the spine and hip joints were normal, Patrick and Geanslen tests were positive on the left side. Spine and standing flexion tests were also positive. Magnetic resonance imaging of the lumbar spine and sacroiliac joints were normal. A diagnosis of SJD was made, and the patient was treated using NT. Injections of lidocaine 0.5% to the left TMJ, the masseter muscle and intradermal segmental injections at the level of C4 were administered. The patient's back pain and TMJ tenderness reduced and continued so throughout the 3-month follow-up period. SJD may be related to TMJD, and NT may be used in its treatment.

The prevalence of first-onset temporomandibular disorder in low back pain and associated risk factors: A nationwide population-based cohort study with a 15-year follow-up

The coexistence of low back pain (LBP) and temporomandibular disorder (TMD) has often been noted clinically. However, studies of the association between these two conditions involving a large population with longitudinal evidences are lacking. Therefore, the study aimed to investigate the association between LBP and TMD in a nationwide-matched cohort population with a 15-year follow-up.Data of 65,121 patients newly diagnosed with LBP were analyzed, along with those of 195,363 (1:3) sex- and age-matched controls. Multivariate Cox regression analysis was used to determine TMD risk between the LBP and non-LBP groups. Kaplan-Meier method was used for determining the cumulative risk of first-onset TMD between groups, with a 15-year follow-up.The LBP group was more likely to develop first-onset TMD (adjusted hazards ratio (HR) = 1.561, P < .001), after adjusting for demographic variables and comorbidities. The risk factors for TMD were LBP, young age, higher insured premium, and osteoporosis. In the subgroup analysis, the LBP group had a higher risk of TMD than the non-LBP group in all stratifications.LBP is the risk factor contributing to the development of first-onset TMD. Therefore, clinicians should be reminded to manage LBP disorders concurrently when treating TMD.

The inconclusiveness of research on functional pathologies of the temporomandibular system and body posture: Paths followed, paths ahead: A critical review

Objective: Literature on the functional pathologies of the temporomandibular system (FPTS) in its relationships with body posture is plagued with inconclusiveness. Despite being sometimes altogether disregarded, the issue is most relevant, due to its clinical implications. This paper aims for a deeper understanding of the origins of the inconclusiveness of research on such relationships by means of a critical analysis of the scientific literature on the subject, in order that clinicians may better treat patients with FPTS.Methods: Analysis of over 100 studies, published from 1918 through March 2018 in the PubMed database, using descriptors temporomandibular joint disorders and posture.Results: The analysis of the paths followed by researchers allowed for pinning down several methodological issues that may have led to the prevailing ambiguity on the matter.Conclusion: This review then proposes certain standardization of procedures in future studies, to be conducted by a proposed consortium of researchers.

Cranial Treatment and Spinal Manipulation for a Patient With Low Back Pain: A Case Study

OBJECTIVE

The purpose of this case study is to present chiropractic management of a patient with chronic low back pain by focusing on the craniomandibular system.

CLINICAL FEATURES

A 37-year-old man consulted a chiropractor for pain in the lumbosacral area with radiation down the anterolateral side of the upper left leg. The symptoms started after a fall the previous year. Examination showed a post-traumatic chronic L4-L5 facet dysfunction and left sacro-iliac joint dysfunction. Chiropractic spinal manipulation to the lumbar spine and pelvis gave only temporary relief from the pain.

INTERVENTION AND OUTCOME

A year later a bone scintigraphy was conducted, in which a lesion was found over the right sphenoid area. Cranial treatment of this area was added to the chiropractic treatment plan. After this treatment, the patient reported that he was pain free and could return to normal activities of daily living.

CONCLUSION

The clinical progress of this case suggests that for some patients, adding craniosacral therapy may be helpful in patients with low back symptoms.

Symptoms of craniomandibular dysfunction in professional orchestra musicians

BACKGROUND

Up to 80% of professional musicians are affected by playing-related musculoskeletal disorders, but data regarding the frequency of craniomandibular dysfunction (CMD) in professional orchestra musicians is scarce.

AIMS

To evaluate the frequency of CMD and its relation to musculoskeletal pain in various body regions.

METHODS

A questionnaire-based survey approach assessing CMD symptoms and musculoskeletal pain in professional orchestra players was adopted. Relative prevalence rates and prevalence ratios for different instrument groups were estimated.

RESULTS

A total of 408 musicians completed the questionnaire (response rate 57%). Playing-related pain in the teeth or jaw was reported by 19-47% of musicians and TMJ pain by 15-34%, depending on the instrument group. Current pain in the face indicating a painful CMD was reported in 6-10% and related symptoms such as teeth grinding in 25-34%, jaw clenching in 33-42% and jaw locking in 11-18% of musicians. Females were 2.4 times (95% confidence intervals (CI) 1.49-3.84) more likely to report having had orofacial pain within the last month. Musicians reporting orofacial pain within the last month were 4.8 times (95% CI: 2.83-8.02) more likely to report pain in the neck and 2.5-3.8 times (P < 0.05) more likely to report pain in other body regions, including shoulders, right wrist, left fingers and the thoracic and lumbar spine.

CONCLUSIONS

Symptoms suggesting CMD were common in this study of professional orchestra musicians and were associated with pain in the neck, shoulder and hands. There is a need to enhance awareness of CMD to optimize early medical diagnosis and treatment.

Spinal and temporo-mandibular disorders in male workers of the State Police

OBJECTIVE

The aims of this study are to evaluate the prevalence of disorders of the lumbar region and the temporo-mandibular district co-morbidity in drivers and workers of the State Police employed for different office activities.

MATERIALS AND METHODS

The study population included 103 drivers as cases and 100 police officers as controls. The study was carried out through questionnaire and clinical evaluation of the spine and temporo-mandibular region.

RESULTS

At clinical examination, the drivers were found to have a higher prevalence (p < 0.05) of both symptoms and clinical signs at the spine and temporo-mandibular joint (TMJ), when compared with the controls. The results also showed a higher prevalence (p < 0.05) of co-morbidity in the two districts among the drivers, when compared with the controls.

CONCLUSIONS

These results confirm that morbidity related to back and TMJ and increase in co-morbidity between the two districts are higher in professional drivers.

Evidence-based pain management: is the concept of integrative medicine applicable?

This article is dedicated to the concept of predictive, preventive, and personalized (integrative) medicine beneficial and applicable to advance pain management, overviews recent insights, and discusses novel minimally invasive tools, performed under ultrasound guidance, enhanced by model-guided approach in the field of musculoskeletal pain and neuromuscular diseases. The complexity of pain emergence and regression demands intellectual-, image-guided techniques personally specified to the patient. For personalized approach, the combination of the modalities of ultrasound, EMG, MRI, PET, and SPECT gives new opportunities to experimental and clinical studies. Neuromuscular imaging should be crucial for emergence of studies concerning advanced neuroimaging technologies to predict movement disorders, postural imbalance with integrated application of imaging, and functional modalities for rehabilitation and pain management. Scientific results should initiate evidence-based preventive movement programs in sport medicine rehabilitation. Traditional medicine and mathematical analytical approaches and education challenges are discussed in this review. The physiological management of exactly assessed pathological condition, particularly in movement disorders, requires participative medical approach to gain harmonized and sustainable effect.

[Dento-facial orthopedics and osteopathy]

Osteopathy has grown rapidly. Given their common action on children and adolescents, the collaboration between dentofacial orthopedics and osteopathy is increasingly common. It therefore becomes necessary and urgent to investigate whether, based on data acquired from science, there is evidence of possible interrelations between the two disciplines. After reviewing the literature, very few scientific publications demonstrate the utility of osteopathy and its relationships with other disciplines. However, the relationship between occlusion and posture seem relatively proven, especially in the sagittal direction. On the other hand, although the mobility of the cranial bones is established, the primary respiratory motion is still subject to controversy, even among osteopaths. This, even as orthodontics has long been accused of countering the primary respiratory motion of cranial bones (PRM). Today osteopaths do not reject orthodontics anymore, because the return to a physiological bite situation is considered beneficial. According to expert opinion (without proof, however), some orthodontic devices (like headgears) which block the sutures are still to be avoided and require appropriate monitoring osteopathy. The controversy over the adverse effects of orthodontic treatment is becoming more nuanced by osteopaths, and modern orthodontics claiming a «global» approach of patient, collaboration may be possible in future year.

Scoliosis and dental occlusion: a review of the literature

BACKGROUND

Idiopathic scoliosis is a deformity without clear etiology. It is unclear wether there is an association between malocclusion and scoliosis. Several types of occlusion were described in subjects with scoliosis, mostly case-reports.

OBJECTIVES

The aim of this review was to evaluate the type of occluslins more prevalent in subjects with scoliosis

SEARCH STRATEGY

All randomised and controlled clinical trials identified from the Cochrane Oral Health Group Trials Register, a MEDLINE search using the Mesh term scoliosis, malocclusion, and relevant free text words, and the bibliographies of papers and review articles which reported the outcome of orthodontic treatment in subjects with scoliosis that were published as abstracts or papers between 1970 and 2010.

SELECTION CRITERIA

All randomised and controlled clinical trials published as full papers or abstracts which reported quantitative data on the outcomes malocclusion in subjects with scoliosis.

DATA COLLECTION AND ANALYSIS

Data were extracted without blinding to the authors, age of patients or type of occlusion.

MAIN RESULTS

Using the search strategy eleven observational longitudinal studies were identified. No randomized clinical trials were recorded. Twenty-three cross-sectional studies were recorderd, and the others studies were reviews, editorials, case-reports, or opinions. The clinical trials were often not controlled and were about the cephalometric evaluation after treatment with the modified Milwuakee brace, followed by the orthodontic treatment of the class II relationship with a functional appliance. Clinical trials also included the study of the associations between scoliosis and unilateral crossbite, in children with asymmetry of the upper cervical spine. This association was also investigated in rats, pigs and rabbits in clinical trials. The other associations between scoliosis and occlusion seems to be based only on cross-sectional studies, case-reports, opinions.

AUTHORS' CONCLUSIONS

Based on selected studies, this review concludes that there is plausible evidence for an increased prevalence of unilateral Angle Class II malocclusions associated with scoliosis, and an increased risk of lateral crossbite, midline deviation in children affected by scoliosis. Also, documentation of associations between reduced range of lateral movements and scoliosis seem convincing. Data are also mentioned about the association between plagiocephaly and scoliosis.

Chiropractic management of a 40-year-old female patient with Ménière disease

OBJECTIVE

The purpose of this case report is to describe the chiropractic management of a patient with Ménière disease.

CLINICAL FEATURES

A 40-year-old woman presented with a diagnosis of Ménière disease including a 2-month history of vertigo and a 16-month history of left-sided tinnitus, low-frequency hearing loss, and aural fullness. The patient's other symptoms included left-sided neck pain, temporomandibular joint pain, and headaches. Examination revealed left-sided upper cervical joint dysfunction along with myofascial trigger points in the middle and upper trapezius muscle.

INTERVENTION AND OUTCOME

Treatment included primarily high-velocity, low-amplitude spinal manipulation to the upper cervical and thoracic spine, along with soft-tissue trigger-point therapy, and stretching exercises. Within 2 weeks of treatment, the patient's tinnitus had resolved; and all other symptoms (including vertigo) were improved. The patient's headaches, neck pain, and vertigo were subsequently resolved within 3 months of treatment. The patient experienced only 2 minor episodes of self-resolving "light-headedness" over that time. After 2½ years of follow-up, any occasional episodes of mild aural fullness and/or light-headedness are either self-resolving or relieved with cervical spinal manipulation and soft-tissue treatment.

CONCLUSION

This case report suggests that chiropractic care, including upper cervical spinal manipulation and soft-tissue therapy, may be beneficial in treating some patients with Ménière disease.

Global body posture evaluation in patients with temporomandibular joint disorder

AIM

To identify the relationship between anterior disc displacement and global posture (plantar arches, lower limbs, shoulder and pelvic girdle, vertebral spine, head and mandibles). Common signs and symptoms of anterior disc displacement were also identified.

INTRODUCTION

Global posture deviations cause body adaptation and realignment, which may interfere with the organization and function of the temporomandibular joint.

METHODS

Global posture evaluation was performed in a group of 10 female patients (20 to 30 years of age) with temporomandibular joint disc displacement and in a control group of 16 healthy female volunteers matched for age, weight and height. Anterior disc displacement signs, symptoms and the presence of parafunctional habits were also identified through interview.

RESULTS

Patients with disc displacement showed a higher incidence of pain in the temporomandibular joint area, but there were no differences in parafunctional habits between the groups. In the disc displacement group, postural deviations were found in the pelvis (posterior rotation), lumbar spine (hyperlordosis), thoracic spine (rectification), head (deviation to the right) and mandibles (deviation to the left with open mouth). There were no differences in the longitudinal plantar arches between the groups.

CONCLUSION

Our results suggest a close relationship between body posture and temporomandibular disorder, though it is not possible to determine whether postural deviations are the cause or the result of the disorder. Hence, postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with temporomandibular disorder.

[Pain drawings of patients with orofacial pain. Comparison of acceptance and gain of information]

AIM OF THE STUDY

The aim of this prospective multicentric study was to compare two different types of pain drawings in terms of acceptance and gain of information in patients with orofacial pain.

PATIENTS AND METHODS

A total of 204 patients from 9 centers, who visited their dentist or physician for orofacial pain, received two different diagrams for pain drawings in random order. One was the original pain diagram of the Deutsche Schmerzfragebogen (German Pain Questionnaire, diagram A), and the other diagram had been developed to achieve a symmetrical representation of the body and to allow computer-assisted analysis (diagram B). This diagram was larger and contained a drawing of the head. The patients' answers were analyzed for the preference between diagrams, the number and distribution of pain areas, and the concordance between the diagrams. The results were correlated with the patients' data.

RESULTS

Data from 183 patients could be analyzed: 100 of 183 patients preferred diagram B and 57 of 183 preferred diagram A, independent of gender, age, or duration of disease. Most patients reported pain in more than one area; in only 43 of 183 patients was the pain limited to the face and head. The number and distribution of pain areas were not different between the two pain diagrams.

CONCLUSIONS

Detailed head and body diagrams can be used in the diagnostic evaluation of patients with orofacial pain without fear of placing excessive demands on the patients and are useful for detecting comorbidities.