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Myofascial Pain Dysfunction
Syndrome
( MPDS )
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Introduction
Most common type of TMD.
Characterised by :
Regional Dull Aching pain. Localised Tenderness in one / more
masticatory muscle
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History
Costen 1934.
Schwartz 1956.
Laskin 1969.
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Definition of Important
Terms Active trigger point Latent trigger point
Referred pain
Taut band Jump sign
Twitch response
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Etiology
Muscular Hyperfunction.
Parafunctional Habits.
Mal Nutrional . Physcological Stress.
Sleep Disturbances.
Improper prosthesis.
Internal Derangements.
Degenerative joint disorders.
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Clinical Features
1> Pain :
Unilateral dull, aching pain, which increases withmuscular activity, and progressively worsens
towards the end of the day.
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Clinical Features
4> Tenderness on Palpation :
5> Headache:
Headache becomes worse while jaw movements .
6> Ear pain:
Patient notice ear pain but there are no signs of
infection.
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Clinical Features
7> Sounds:
Clicking or popping sounds, termed as crepitus,are common in patients with a TMJ disorder.
8> Dizziness:
Majority of patients report a vague dizziness or
vertigo.
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Clinical Features
9> Fullness of the ear:
Patients describes muffled, clogged, or full ears.
10> Tinnitus :
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Clinical Examination
1> TMJ :
Extent of mouth opening and lateral
excursions. Palpation for Tenderness.
Evaluation of TMJ Sounds.
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Clinical Examination
2> Muscular Examination :
Pt. examined for Active trigger point,
Latent trigger point, Taut band, Jump sign
and Twitch response .
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Clinical Examination
3> Dental Evaluation :
Occlusal Discrepancies.
Attrition. Interferrence in occlusal due to
prosthesis.
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Clinical Examination
4> Cervical Examination :
Neck muscles are palpated and
range of neck movements areexamined.
Movement of Cervical Spine.
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Diagnostic Criteria
1. Primary Findings :
. Pt. complains of pain in one or more
masticatory muscle.. Tenderness on palpation over the muscle.
. Presence of Trigger points.
. Pain aggrevated due to movement ofmandible.
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Diagnostic Criteria
2. Secondary Findings :
Restricted range of movement of
mandible. Maximum assisted opening > Maximum
unassisted opening > Pain free opening.
Range of movement increased by use ofAlkane vapocoolant.
Clinical or behavioral indications of
Hyperfunction or parafunctions.
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Diagnostic Criteria
3. Possible findings :
TMJ pain.
Joint Sounds. Inflammation.
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Management
The aim of management should be:
1. Control of factors that worsen MPDS.2. Reduction of harmful loading on the joints.
3. Restoration of jaw function.
4. Resumption of regular daily activities.
5. Pain reduction.
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Management
Management is divided into four phases:
Phase I :
Initiated upon diagnosis, and consists of:
Patient education.
Avoidance of clenching and grinding .
Soft diet.
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Management
NSAIDs , with or without a muscle relaxant.
The most commonly used agents are :
Diazepam (2-5 mg twice a day)
Ibuprofen (400 mg thrice a day).
Naproxen (500 mg twice daily) .
Moist Heat therapy +Vapocoolant Spray and stretchmassage .
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Management
Phase II :
To be initiated if Phase onetreatment fails.
Medications are continued.
Custom made oral orthopaedic acrylic appliance
(splint) is added. These include occlusal splints, bite guards and
night guards.
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Management
Phase III :
Physiotherapy of the muscle groups, includingUltrasonic therapy, Electro galvanic stimulation,Transcutaneous Electrical Nerve Stimulation
(TENS).
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Management
Phase IV :
Psychological counseling . Biofeedback.
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