This is regarding etiology and management of Myofacial pain dysfunction syndrome

1. 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.

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

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.

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

8. Cardinal symptoms of MPDS
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

12. 
1. Articular or TMJ function
2. Palpation for tenderness
3. Grading of click or crepitation

13. 
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

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. 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
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

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.