Management of Masticatory Muscles

Question 1

What causes functional disturbances in the masticatory system?

Answer 1

• Headache
• Ear pain
• TMJ Pain
• Muscle pain
• tooth mobility
• Pulpitis
• Tooth wear

Question 2

Trauma

Answer 2

• Greater impaction intracapsular disorders (vs muscle disorders)
• Macrotrauma
• Microtrauma

Question 3

Define Microtrauma

Answer 3

• small force applied to loading tissues repeatedly
  
  • tooth
  • joint
  • muscles

Question 4

Emotional Stress

Answer 4

• Hypothalamus, Reticular system, Limbic system=Emotional Stress
• Stress activates HPA axis (Hypothalamic-Pituitary-Adrenal axis)
  
  • prepares the body to respond to stress via ANS
• ⇡ gamma efferent activity (ANS)→ muscle spindles contract

Question 5

What is stress? (From our bodies perspective)

Answer 5

• Energy generated w/in our body that needs to be released

Question 6

How is stress released from our body?

Answer 6

• External Mechanism:
  
  • shouting
  • cursing
  • throwing objects
• Internal Mechanism
  
  • IBS
  • HTN
  • arrythmias
  • Asthma
  • ⇡ Head & Neck M. Tonicity
• ⇡ Non-functional activity
  
  • clenching
  • bruxism

Question 7

What is constant deep pain?

Answer 7

• Deep pain from local structures
  
  • Teeth
  • Ligaments
  • joints
  • tendons

Question 8

Masticatory Muscle Activity: Functional vs Parafunctional Activity

Answer 8

• Functional:
  
  • Chewing
  • Speaking
  • Swallowing
• Parafunctional: can happen subconsciously
  
  • Clenching
  • grinding
  • cheek biting
  • tongue thrusting

Question 9

TMD: A patient may present with:

Answer 9

1. Muscle disorder Only
2. Intracapsular disorder only
3. Primary intracapsular + Secondary Muscle
4. Primary Muscle + Secondary Intracapsular
5. Both→ indépendant of each other

Question 10

What is the most common symptom of TMD?

Answer 10

• Masticatory Muscle pain

Question 11

TMD: Event

Answer 11

• interruption of normal muscle function
• Local:
  
  • tooth fracture
  • restoration in supraocclusion
  • tissue damage from injection
• Systemic:
  
  • Up regulation of ANS:
    
    • ⇡ emotional stress
  • Down regulation of descending inhibitory system
    
    • Systemic disorder
    • Illness
    • Fatigue
    • Diet

Question 12

Protective Co-Contraction: General

Answer 12

• Masticatory M. 1st response to an event
  
  • Normal CNS reflex to injury or threat of injury
• Antagonistic m. groups fire to protect injured parts
  
  • Open Mouth: ⇡ elevator m. activity
  • Close mouth: ⇡ Depressor m. activity

Question 13

Protective Co-Contraction: Etiology

Answer 13

Altered Sensory or Proprioceptive input

• Change occlusal condition
  
  • poorly fit crown→high occlusal contact
• Constant Deep pain
  
  • chronic cheek biting
• ⇡ emotional stress

Question 14

Protective Co-Contraction: Clinical Presentation

Answer 14

• ⇣ ROM
• minimum pain at rest
• Pain during function
• Muscle Fatigue

Question 15

Protective Co-Contraction: Treatment

Answer 15

• do NOT treat the muscle (PCC=normal CNS response)
  
  • TREAT the etiology
• Supportive Therapy:
  
  • restrict use of mandible w/in painless limit
  • Soft diet
  • NSAIDs
  • Physical self regulation

Question 16

Local Muscle Soreness: General

Answer 16

• Non-inflammatory myogenous Pain disorder
• Muscles 1st response to continued PCC
  
  • initial response to muscle overuse/fatigue

Question 17

Local Muscle Soreness: Etiology

Answer 17

• continued PCC
  
  • secondary to alteration in local structures
• Continued constant deep pain
• Local tissue trauma
• Unacustomed see of muscle
  
  • delayed onset local muscle soreness
• ⇡emotional stress

Question 18

Local Muscle Soreness: Clinical Presentation

Answer 18

• ⇣ Mandibular ROM
  
  • can’t achieve Full ROM
• Minimum pain at rest
• ⇡ pain w/fxn
• Actual muscle weakness
• Muscle tenderness to palpation

Question 19

Local Muscle Soreness: Treatment

Answer 19

• Eliminate source of deep pain input
• restrict use of mandible to painless limits
• soft diet
• cognitive awareness
• stress management
• NSAIDs
• stabilization appliance

Question 20

Myofascial Pain: General

Answer 20

• Regional myogenous pain
• Trigger Points: local areas of firm, hypersensitive bands of muscle
  
  • Active:
    
    • always tender/painful
    • compressed=pt recognize pain
    • prevent fulll lengthening of muscle
    • weakens muscle
    • produces local twitch response when stimluated
  • Latent:
    
    • clinically quiescent (silent)
    • pain only when palpated
    • have taut muscle band
      
      • stiff muscle
      • restricted ROM

Question 21

Myofascial Pain: Etiology

Answer 21

Unclear

• continued deep pain input
• ⇡ emotional stress
• Sleep Disturbance
• Local factors:
  
  • habits
  • posture
  • muscle strians
• Systemic factors:
  
  • ntr deficiencies
  • poor physical condition
  • fatigue
  • viral infection
• idiopathic trigger pt mechanism