HISTORY OF ORIGIN OF THE PAIN.
PHYSICAL EXAMINATION AND DIAGNOSIS
TREATMENT AND DRUGS
The Myofacial Pain Dysfunction Syndrome (MPDS) is a pain disorder,
in which unilateral pain is referred from the trigger points in myofascial
structures, to the muscles of the head and neck. Pain is constant, dull in
nature, in contrast to the sudden sharp, shooting, intermittent pain of
. Myofascial pain syndrome typically occurs after a muscle has been
contracted repetitively. This can be caused by repetitive motions used in
jobs or hobbies or by stress-related muscle tension.
MPDS is the most common cause of masticatory pain & limited function for
which patient’s seek dental consultation & treatment.
the source of the pain & dysfunction is muscular with masticatory muscle
developing tenderness and pain as a result of abnormal muscular function on
This abnormal muscular function is frequently but not always associated with
daytime clenching on nocturnal bruxism.
The cause of MPD is controversial although it is generally considered to be
The MPDS can be visualized as a vicious cycle of several contributing factors such
as :1. Muscular hyper function.
2. Bruxism secondary to stress & anxiety with occlusion.
3. Internal Joint Problems such as Disk Displacement disorders or Degenerative
4. Physical disorders.
5. Injuries to the tissues.
6. Para functional habits.
8. Nutritional problems.
9. Physiological stress.
10. Sleep disturbances.
Signs and symptoms of MPDS may include:-
Cardinal symptoms of MPDS :1.
Pain or discomfort anywhere about the head or neck.
Limitation of motion of the jaw.
Joint noises– grating,clicking,snapping.
Tenderness to palpation of the muscles of mastication.
Myofascial pain syndrome is caused by a stimulus, such as
pressure, that sets off trigger points in your muscles. Factors that
may increase your risk of muscle trigger points include:
Muscle injury. An acute muscle injury or continual muscle
stress may lead to the development of trigger points. For example,
a spot within or near a strained muscle may become a trigger
point. Repetitive motions and poor posture also may increase
Stress and anxiety. People who frequently experience stress and
anxiety may be more likely to develop trigger points in their
muscles. One theory holds that these people may be more likely
to clench their muscles, a form of repeated strain that leaves
muscles susceptible to trigger points.
Physical examination consists of an evaluation of entire masticatory system
along with head and neck region :• Articular
Amount of oral opening and the excursions..
Extent of movement
i) ROM – Range of motion
ii) AROM – Active range of motion
iii) PROM – Passive range of motion
Palpation for tenderness.
Grading of click or crepitation- noises evaluation.
Auscultation(stethoscopic evaluation),if needed.
Systemic palpation of the muscles and their tendons is the best
way to ascertain both subclinical and clinical existing levels of
dysfunction. The areas responsive to palpation have been called
trigger points. The muscles are palpated bilaterally and
simultaneously with frim but gentle pressure lasting for 1 or 2
It is helpful for the following:
1. Location of muscle pathology.
2. Evaluation of muscle tone.
3. Location of trigger points.
4. Evaluation of temperature change.
5. Location of swelling.
6. Identification of anatomic landmarks.
•Gross occlusal diskrepancies, prematurities or interferences shoud be noted.
open bite, collapsed bite, cross bite, reduced vertical
dimension, etc. should also be noted. Attrition, wear facets, mobility of
malocclusion, skeletal, dentofacial deformities should be looked for.
Here, the neck group of muscles are palpated and neck range of motion should
also be checked.
Shoulder & neck muscles are palpated as they control anteroposterior & lateral
position of the head.
A few examinations that are done are as follows :1. Hyoid bone palpation
2. Radiographic evaluation : it is helpful in diagnosis of the following
i) Intra-articular pathologies.
ii) Osseous pathological process.
iii) Soft tissue pathologies.
3. Panoramic radiography.
5. Transcranial radiographs.
II. Computed radiography (CR).
III. Computed Tomography (CT) scan & Magnetic Resonance Imaging
IV. Bone Scintigram—nuclear imaging
V. Single Photon Emission Computerized Tomography (SPECT).
Complications associated with myofascial pain syndrome may
Sleep problems. Signs and symptoms of myofascial pain
syndrome may make it difficult to sleep at night. You may have
trouble finding a comfortable sleep position. And if you move at
night, you might hit a trigger point and awaken.
Fibromyalgia. Some research suggests that myofascial pain
syndrome may develop into fibromyalgia in some people.
Fibromyalgia is a chronic condition that features widespread pain.
It's believed that the brains of people with fibromyalgia become
more sensitive to pain signals over time. Some doctors believe
myofascial pain syndrome may play a role in starting this process.
Treatment for MPDS typically includes medications, trigger point injections
or physical therapy.
Medications used for MPDS include :1. Aspirin
: 2 tabs 0.3 to 0.6gm/ 4 hourly.
2. Piroxicam : 10 to 20mg /3 to 4 times a day.
3. Ibuprofen : 200 to 600mg/3 times a day.
4. Pentazocine : 50mg /2 to 3 times a day.
5. Valium/librium : 5 to 10mg /2 to 3 times a day.
6. Methocarbamol : 500mg/2 to 3 times a day.
: 10 to 25mg/ 3 times a day or at bedtime.
Massage with counter-irritants & vibrators.
Use of vapocoolent spray.
Tetanizaing & sinusoidal currents.
Transcutaneous electronic nerve stimulator (TENS).
Active stretch exercises.