MPDS

Myofascial pain disfunction syndrome

Do you have Pain in cheeks, Temporal region, facial swelling, pain around the ears, radiating to neck and back muscles, jaw aches, jaw jerks, while talking, chewing for long or while chewing hard food?

well, then rule out MPDS.!

Disturbances in the Stomatognathic system (Anatomical system comprising the teeth, jaws, and associated soft tissues) cause a unique kind of pain, Muscle spasm, irregularities in Jaw regular movements which is collectively described as Myofascial pain due to certain misfunctioning.

A close association has been found between Dental occlusion, Chewing pattern, and MPDS.

Its a Syndrome which will be very uncomfortable for the sufferer and the irony which I see in my regular practice is that the patients are unaware of the dental aspect of this pain and visit all other specialties, especially Neuro and ENT.

Its a functional and structural change leading to a kind of disease related to Neural structures, Tenderness in Muscles of Mastication , TMJ arthritis, Muscle ischemia, Spasms and fatigues with over compressing of posterior teeth Periodontal Ligaments. All these leads to Prolonged Disocclusion time.

Dental Occlusion and Masticatory system thus appears to be a key causative agent for MPDS.

My patients didn't wish their pic to be put so without consent had to take this pic,👆as example, curtesy University Of Iowa Health Care

Before I proceed further let me briefly explain what are Periodontal ligaments (PDL) and its functions to make the concept easy to understand.

As described in 👆diagram, Periodontal Ligaments (PDL) have various Mechanoreceptors which collect all the Neural data, like temperature, touch, pressure, in and around the teeth to the CNS [central nervous system]

The PDL are basically striated muscles with muscle spindles located within the fibers of the Ligaments.

Its also important to mention here that within the tooth also Neural mechanoreceptors are present in the Pulp. These Pulpal mechanoreceptors together with the mechanoreceptors of the PDL carry tooth loading information like intensity of the force falling on the teeth, velocity of force and its changes, tooths movement, direction, hardness of the masticatory function to the CNS via the Trigeminal nerve ganglion. {Ganglions are the neurologic distribution center for both afferent (to CNS) and efferent (from CNS) neural pathways.}

The CNS in response controls contraction of masticatory muscles, sequence of contraction, level of contraction, resultant occlusal forces, the posture of mandible and its movements in relationship to the upper teeth. This control is purely based on the environmental Neuronal data input. 👇

Thus every function of masticatory system has a characteristic pattern that occurs within certain physiological limits.

So, any overreaching from this physiological limit can lead to MPDS. The Neural feedback mechanism is designed to protect physiological borders of chewing pattern to control masticatory mechanisms. Neural input is a sensory process but however the mandibular functional and Parafunctional movements ( exampl-Bruxism) are controlled by Motor function of Neuronal System.

The perception of the sensory input, its evaluation and reaction is an ongoing continuous function of the neural system with data stream entering the CNS from PNS {Peripheral Nervous System }(which can be conscious or unconscious) to establish postural tonus activity of the masticatory muscle fibers or even to maintain slight tension in the muscles when no function and at rest.

MPDS often results from the Hyper Contraction of the masticatory Elevator Muscles.

Spasm in one or more elevator muscles is serious enough to cause Pain, Tenderness, mandibular movement limitations, changing Temporomandibular joint (TMJ) structural alignment.

Do you know ?

A small wrongly done high or low dental filling, or a tooth loss or tooth fracture, not replaced or corrected, worn out teeth with loss of contact points

or poor orthodontic correction, or sudden mechanical trauma can alter this Neurologic input from the Neuro mechanoreceptors located in and around the teeth to significantly alter chewing pattern causing hyper contraction of the elevator muscles and finally lead to MPDS.

Yes, these are called the painful trigger points which are integral component of MPDS condition. Some trigger points may be classified Latent in that they only occur when the Muscle is pressed (Palpated) however at times Hypertrophy of the said muscles especially Masseter and Temporalis can be noticed with naked eye, which patients sometimes term as facial altered appearance or swellings which are actually Muscle Hypertrophy.

Pic curtesy Association of Oral & Maxillofacial Surgeons of India

Thus, a tiny premature contact that is not removed timely will have a sufficient excitatory level for stating a Nerve Impulse which can lead to pain and leads to stronger Nociceptive warning from the CNS to move the mandible to the opposite arch as a reflex action to lessen the pain which when becomes habitual leads to spasms on the other side. This causue Jaw Jerks

This aggregating stimuli will increase Spasms causing major etiological cause for MPDS.

Its important for the reader to understand that this nociceptive stimuli or warning may after a while cease to exist as it gets adapted, which is in fact, failure of CNS to continue to respond to the said stimuli... for example, if drinking a hot liquid experience is repeated a number of times, over a time frame, the patient's reflex response to a hot liquid will slowly disappear.

Similarly, a new Complete Denture if causes pain, the pain will be registered in patients psyche in comparison to the chewing pattern of the old worn-out denture that has been registered in the patients Memory.

Memory and pain go together here which needs to be undone.

Even when CNS does not respond to the stimuli, the intense and prolonged stimuli which continues will however irritates Neural tissue weakening and worsening leading to reduced Mandibular Vertical opening.

👇(Partial Trismus)

Muscular pain is a typical decisive symptom of MPDS due to the functional disorders in the stomatognathic system. If its not treated, pain may be present for years.

TMJ internal derangement may not be involved with MPDS but however when TMJ irregularities occur with symptoms of MPDS the complete condition should be considered as TMD

Masticatory system myofascial pain is one of the most important chronic issue encountered in daily clinical dental practice and Dental occlusion appears to be a key causative agent for MPDS because changing the faulty occlusion is the treatment for MPDS.

Occlusal Analysis has always been the important diagnostic component of the treatment effort to resolve MPDS.

T Scan

T scan is a device to precisely analyze all occlusal parameters.

Modern T scan HD recording sensor has been shown to measure 256 different relative occlusal force levels, with 95% accuracy.

Still advanced is T scan Nevous system with software 9 version which can digitally analyze occlusal forces and time of contact, occlusion and disocclusion time that can be used in chairside dental practice.

Orthodontic and Prosthodontic occlusal corrections becomes very easy with such computerized occlusal analysis.

👆 In this case the first tooth to contact is on tooth No 14 and 15 region. Disclusion time is prolonged in Lateral Excursions. Right 56% and left 43% maximum intercuspation.

DTR therapy.

Disocclusion time reduction therapy is the method to change and break the firing reaction spasm in neuromuscular loop. DTR therapy reduces Disocclusion time which lessens the time of posterior teeth that engage during excursions which thereby stops Neuronal action potential from hyperfunctioning of the Masticatory muscles. This cannot be accomplished without T scan. It requires no Splints

Disocclusion time should be 0.4 sec per excursion.

This therapy drastically reduces the volume of Periodontal Ligament mechanoreceptors compression, disrupting the neuronal trigger for occlusally induced MPDS.

It is basically Coronoplasty known as immediate complete anterior guidance development (ICAGD) under T scan guidance and Bio EMG III, (Electromyography)

The main aim of ICAGD is to reduce the posterior disclusion time to < 0.5s per excursion. with 0.41 being the mean disclusion time.

DTR therapy is based on reducing prolonged occlusal surface friction limiting posterior teeth socket compression and pulpal impacts causing Neural hyper response.

Treatment

Applying occlusal splints,

There are various types of splints in dentistry (custom, prefabricated splints, posterior splints, Anterior jig, soft and hard splints of 1 to 4mm) depending on the condition. Preliminary splint therapy is very effective, however improper splints or improper period may worsen the symptoms

Local anesthetic or Botox injections are temporary and symptomatic.

NTI TSS (Nociceptive Trigeminal Inhibition Tension Suppression System) is a small device that is designed by occlusal bite recordings.

The objective of the NTI is to relax the muscles involved.

The NTI TSS device is an anterior bite stop, worn over the front two teeth, at night ( Day versions are available too) to prevent contact of the canines and molars. It can be fabricate chairside too at Lotus clinics.

NTI TSS has been approved by the FDA for the treatment and prevention of “Bruxism, Temporomandibular disorders (TMDs), occlusal trauma, tension-type headaches and/or migraine and MPDS.

Permanent Methods

• Orthodontic treatment,

• Restorative dentistry to change occlusal relationship,

• Occlusal Coronoplasty,

• Full mouth rehab according to FMP angle,

• DTR therapy,

All these, which are aimed at the neurological causes, are the permanent treatment methods.

Vitamin B12, folic acid, Zinc and selenium deficiencies adds to worsens the MPDS condition and needs Nutritional evaluation and guidance by Nutrition Expert.

To Get evaluation of your Facial Pain, Pain around the ear and Neck and its links to Dental occlusion, and its associated links to Nutrition, as well its frank association with ENT issues at one common platform, Please book your slot, at our website dentistlotusclinics.com

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