Mpds (Myofacial pain dysfunction syndrome)

This is regarding etiology and management of Myofacial pain dysfunction syndrome

1. MYOFACIAL PAIN DYSFUNCTION SYNDROME SHAHBAZ ALAM SATYABAMA DENTAL COLLEGE

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. DEFINITION

3. These are localized tender areas within taut bands of skeletal muscles when stimulated by macro- micro traumatic episodes TRIGGER POINTS

4. 30 % of population suffers Female- male ratio is 3:1 Age group – 15-40 years EPIDEMIOLOGY

5. ETIOLOGY

6. 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. PATHOPHYSIOLOGY

7. Spasm of lateral pterygoid muscle Spasm of elevator muscles Spasm of lateral pterygoid and elevator muscles CLASSIFICATION

8. Cardinal symptoms of MPDS CLINICAL FEATURES Pain or discomfort Limited motion of the jaw Joint noises- Clicking, snapping Tenderness to palpation of the muscles of mastication

9. 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

10. Various masticatory muscles and their clinical effects

11. 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 Diagnosis

12. Articular or TMJ function Palpation for tenderness Grading of click or crepitation Physical Examination

13. Range of motion 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

14. 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 .

15. 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.

16. Resistance test Opening Protrusion Left excursion Right excursion

17. MANAGEMENT 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

18. 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

19. Follow – 7 R’s for occlusal rehabilitation Remove - extract Reshape - grind Reposition - orthodontia Restore – conservative dentistry Replace - prosthesis Reconstruct – TMJ surgery Regulate – control habit and symptoms

20. 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

21. PHYSICAL MEDICATION Tongue exercise Mouth opening exercise Hot packs Ultrasound Massage Electrical stimulation (TENS)

22. 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

23. 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.