Dear Sir,
Myofacial Pain Dysfunction (MPD) is a musculoskeletal dysfunction involving a mal-relationship among the neuromuscular system, temporomandibular joints, and dental occlusion. The disease affects children and adults of all ages and both sexes. Patients complain of pain and / or dysfunction in the mandible, temporomandibular joints, ears, oral cavity, head, and neck. The temporomandibular joint (TMJ) is a paired synovial joint capable of both gliding and hinge movements, articulating mandibular condyle, articular disk, and squamous portions of the temporal bone; and temporomandibular disorders (TMD), as defined by the American Academy of Craniofacial Pain, are a number of clinical problems that involve masticatory muscles, the temporomandibular joint (TMJ) or even both. The etiological factors contributing to TMDs include trauma, anatomical factors, systemic factors, muscular hyperactivity, intra-articular pathology, and psychosocial factors.[ 1 ] The most common symptoms of TMJ / TMD include: Headaches (often misdiagnosed as migraines), pain (shoulder, neck, or back), trigeminal neuralgia, Bell's palsy, locking jaw, cracked teeth, numbness in the arms and fingers, facial pain, jaw pain, clicking or popping jaw, clenching or grinding teeth, ringing ears (tinnitus), vertigo, and congested ears. The diagnosis of TMDs includes precise clinical examination, medical and dental history, radiographs, cephalometric views, Computerized Axial Tomography (CAT) scan, and even Magnetic Resonance Imaging (MRI), to visualize more structures including TMJ disk and other soft tissues, dental models, and biometrics. In recent years much attention has been focused on neuromuscular dentistry — a new tool for diagnosing and treating TMD. Neuromuscular dentistry is the science of dentistry that embodies accepted scientific principles of pathophysiology, anatomy, form, and function. It objectively evaluates the complex relationship between teeth, temporomandibular joints, and the masticatory muscles, in order to achieve an occlusion that is based on the optimal relationship between the mandible and the skull — a neuromuscular occlusion. The goal of neuromuscular dentistry is to relax the muscles controlling the jaw position, to establish a true physiological rest position upon which treatment considerations are based.[ 2 ] The primary element that sets neuromuscular dentistry apart from traditional dentistry is that neuromuscular dentistry considers the nerves and muscles and the correct positioning of the jaw, whereas, traditional dentistry focuses on just the teeth and joints. The result is a more complete approach, which can resolve painful conditions such as temporomandibular joint disorders, and it provides more comfortable and longer lasting solutions to other dental needs such as dentures and smile makeovers. Neuromuscular dentistry utilizes modern technology to precisely determine the proper positioning of the jaw. It uses computerized instrumentation to measure the patient's jaw movements, via Computerized Mandibular Scanning (CMS) or Jaw Motion Analysis (JMA), muscle activity via electromyography (EMG), and temporomandibular joint sounds via Electro Sonography (ESG) or Joint Vibration Analysis (JVA), to assist in identifying the joint derangements.[ 2 ] Surface EMGs are used to verify pre-, mid- and post-treatment conditions before and after ultra-low frequency Transcutaneous Electrical Nerve Stimulator (TENS). By combining both CMS and JMA with ultra-low frequency TENS, the dentist is able to locate a ‘physiological rest’ position as a starting reference position to find a relationship between the upper and lower jaw along an isotonic path of closure up from the physiological rest position, in order to establish a bite position. We still require additional research that would lead toward the evidence necessary for choosing the appropriate treatment techniques. Most pain problems presented to dentists respond to treatment or resolve on their own. However, when pain is chronic and especially if it is associated with significant disability, it is important that the treating dentist screen for psychosocial factors that may affect the patient's pain, functioning, and response to treatment, regardless of the diagnosis and objective findings. Substantial evidence exists that psychosocial dysfunction is prevalent among patients with chronic orofacial pain, most commonly TMD. For chronic orofacial pain, just as for other chronic pain conditions (e.g., tension-type headache, low back pain), psychosocial variables have been found to be more strongly associated with pain intensity and activity interference than have clinical examination findings. Dentists may improve the quality of care provided to patients with oro-facial pain through psychotherapeutic management by referring patients with psychosocial counseling.[ 3 ]
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