The Association Between the Cervical Spine, the Stomatognathic System, and Craniofacial Pain: A Critical Review

Aims: Craniofacial pain is a term that encompasses pain in the head, face, and related structures. Multiple etiologies and factors may be related to craniofacial pain; however, the association between the cervical spine and its related structures and craniofacial pain is still a topic of debate. The objective of this critical review was to present and analyze the evidence of the associations between the cervical spine, stomatognathic system, and craniofacial pain. Methods: A search of the databases Medline, PubMed, Embase, Web of Sciences, Cochrane Library, Cinahl, and HealthStar was conducted for all publications related to the topic in the English and Spanish languages. Relevant information was also derived from reference lists of the retrieved publications. The key words used in the search were cervical spine, cervical vertebrae, neck pain, neck injuries, neck muscles, craniofacial pain, orofacial pain, facial pain, temporomandibular joint pain, and temporomandibular joint disorders. Results: The search provided information referring to the biomechanical, anatomical, and pathological association between craniofacial pain, the stomato-gnathic system and the cervical spine. Conclusion: The information provided by this review suggests an association between the cervical spine, stomatognathic system, and craniofacial pain, but most of this information is not conclusive and was derived from poor-quality studies (levels 3b, 4, and 5 based on Sackett's classification). Better designed studies are needed in order to clarify the real influence that the cervical spine has in relation to the stomato-gnathic system and craniofacial pain. Keywords: cervical spine, craniofacial pain, neck, neck pain, temporomandibular disorders