Myofascial Pain Dysfunction Syndrome

Myofascial Pain Dysfunction Syndrome or myofascial pain disorder is one among the triad of disturbances that is encompassed within the umbrella term, TMJ disorders. Due to a lack of consensus on definitive symptoms and mode of diagnosis, it continues to remain an elusive entity for clinicians working with head and neck disorders and dentists alike. Additionally, There is a general lack of simplification in literature to enhance understanding and this is further complicated by the use of multiple descriptive terminologies to refer to the disorder. It is the objective of this chapter to provide a comprehensive overview of the subject for the reader, to clarify the various nuances of diagnosis, treatment planning and management modalities in addition to throwing light on the evolving terminologies, causative mechanisms and recent trends in MPDS management. The author has also highlighted the importance of a multi modality management approach, psychological rehabilitation with long term patient follow up. The authors personal experience with the use of specialised splints has been elucidated with relevant clinical case scenarios.

Efficacy of Low-Level Laser, Hard Occlusal Appliance and Conventional Pharmacotherapy in the Management of Myofascial Pain Dysfunction Syndrome; A Preliminary Study

Introduction: Myofascial pain dysfunction syndrome (MPDS) is a common temporomandibular joint disorder. Due to its multifactorial etiology, treatment usually involves more than one modality to obtain complementary results. The purpose of this study was to compare the combined effect of a low-level laser, a hard occlusal appliance, and conventional pharmacotherapy with pharmacotherapy only in the management of patients with MPDS. Methods: In this study, 15 patients with MPDS were diagnosed and randomly assigned to 3 groups (n=5). Subjects in Group 1 were treated with pharmacotherapy (PT); Group 2 received the diode laser (940 nm gallium arsenide) every other day for a total of 10 sessions, plus pharmacotherapy (PTL) and Group 3 were given hard occlusal splint 12 h/day for 4 weeks, plus pharmacotherapy (PTO). The intensity of pain was measured using the visual analog scale (VAS) prior to the treatment, 2 and 4 weeks after the onset of treatment and 2 weeks later. The maximum painless mouth opening and pain intensity at muscle palpation were also recorded. Comparisons were made between the groups via repeated measure analysis of variance (ANOVA) (P<0.05). Results: Pain relief in the subjective VAS was observed in both laser and appliance groups in the third and fourth examination sessions (P<0.05). No statistically significant reduction in pain was noted using pharmacotherapy only. The maximum painless mouth opening and muscle tenderness were not significantly different between the 3 groups (P>0.05). Conclusion: Both the laser and the occlusal appliance combined with pharmacotherapy proved to be effective for pain reduction in patients with MPDS. All groups, however, failed to result in a significant improvement in the maximum mouth opening or tenderness in masticatory muscles.