Mpds (Myofacial pain dysfunction syndrome)

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This is regarding etiology and management of Myofacial pain dysfunction syndrome

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Mpds (Myofacial pain dysfunction syndrome)

  1. 1. SHAHBAZ ALAM SATYABAMA DENTAL COLLEGE
  2. 2. MPDS is a pain disorder, in which unilateral pain is referred from the trigger points in myofacial structures, to the muscles of head and neck.
  3. 3. These are localized tender areas within taut bands of skeletal muscles when stimulated by macro- micro traumatic episodes TRIGGER POINTS
  4. 4.  30 % of population suffers  Female- male ratio is 3:1  Age group – 15-40 years
  5. 5. All Etiological factors leads to micro or macro trauma to musculoskeletal system leading to muscle spasm This hyper tonicity may lead to muscle fatigue and accumulation of metabolic byproducts such as Lactic acid, prostaglandins, bradykinins, histamine The accumulation of these chemical pain mediators, lowers pain threshold to mechanical and chemical stimuli leading to MPDS.
  6. 6.  Spasm of lateral pterygoid muscle  Spasm of elevator muscles  Spasm of lateral pterygoid and elevator muscles
  7. 7. Cardinal symptoms of MPDS Pain or discomfort Limited motion of the jaw Joint noises- Clicking, snapping Tenderness to palpation of the muscles of mastication
  8. 8. Associated symptoms of MPDS Neurologic Tingling Numbness Blurred vision Twitches Lacrimation Otologic Tinnitus Ear pain Dizziness Vertigo Diminished hearing Gastrointestinal tract Nausea Vomiting Diarrhea Constipation Dry mouth Musculoskeletal Fatigue Tension Tiredness Weakness Joint pain
  9. 9. Various masticatory muscles and their clinical effects
  10. 10. Laskins Diagnostic criteria Four cardinal signs • Unilateral pain • Muscles tenderness • Clicking- clicking or popping noise in the TMJ • Limitation of jaw movement Negative characteristics • No radiographic evidence • No tenderness in TMJ area on palpation via the external auditory meatus
  11. 11.  1. Articular or TMJ function 2. Palpation for tenderness 3. Grading of click or crepitation
  12. 12.  Range of motion a) Vertical opening – check for hypo mobility ( Normal range for an adult is 40-50 mm) b) Deviation while opening and closing c) Protrusive deviation and movement – normal range is 10mm d) Lateral excursion – Normal range is 10mm
  13. 13. Palpation for tenderness The area responsive to palpation are called “Trigger points”. The muscles are palpated bilaterally and simultaneously with firm but gentle pressure lasting for 1-2 mins Middle finger is used for palpation For larger area adjacent fingers can be used.
  14. 14. Grading of click • Early , immediate or wide open zones of condylar excursion are noted • It should be noted whether the sound is on opening , closing or both.
  15. 15. Resistance test Opening Protrusion Left excursion Right excursion
  16. 16. Goal of treatment : • 1.TrP inactivation • 2.Prevention of recurrence • 3.Correction of perpetuating factors Prognosis depends on : • Correct diagnosis • Early and proper treatment • Acute MPS good prognosis
  17. 17. • To educate and empower patients to understand and manage the symptoms of MPDS and to regain and maintain normal function with as much independence as possible
  18. 18. Follow – 7 R’s for occlusal rehabilitation 1.Remove - extract 2.Reshape - grind 3.Reposition - orthodontia 4.Restore – conservative dentistry 5.Replace - prosthesis 6.Reconstruct – TMJ surgery 7.Regulate – control habit and symptoms
  19. 19. Pharmacotherapy Pain control – mainly used analgesics Salicylates (aspirin 2 tabs 0.3- 0.6 gm/4 hourly) Tranquilizers – provides calming effect in anxiety state and relieves tension, fear and produces a sense of well being (Diazepam 2-5 mg at bedtime) Antidepressants – these are mood elevators like lithium carbonate and caffeine Sedatives & Hypnotics – reduces excitement and produces sleep
  20. 20. PHYSICAL MEDICATION Tongue exercise Mouth opening exercise Hot packs Ultrasound Massage Electrical stimulation (TENS)
  21. 21. ANESTHESIA •Muscle and fascia (trigger point) •TMJ (Intracapsular and extracapsular) – 0.5 ml of 0.5% Xylocaine in conjugation with injection of hydrocortisone •Refrigerated spray – vapocoolant spray, such as ethyl chloride or fluoromethane is used to reduce muscle spasm
  22. 22. Other therapies Hypnotherapy – here patient cooperation is must and should follow hypnotist suggestions. It provides muscle relaxation Acupuncture – it is a simple, effective and conservative pain control modality. But this therapy is used only to give relief from pain and will not remove basic cause. Surgery – various surgical procedures like eminectomy, zygomectomy, menisectomy, high condylectomy are advocated.

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