Mar 27, 2009
MYOFASCIAL PAIN DYSFUNCTION
When the harmony of the teeth, the facial muscles, and the Temporomandibular joints no longer exist symptoms of
what has been described as TMJ/MPD arises. Some of the clinical symptoms are:
• Headaches • Sensitive and sore teeth • Facial pain
• Neck and shoulder aches • Ringing in the ears • Jaw pain
• Ear congestion • Clicking/ popping of the jaw • Worn down teeth
• Clenching/ bruxing • Limited opening of the mouth • Cervical/ neck problems
• Loose teeth • Tingling in the fingertips • Dizziness/ vertigo
Patients suffering from these symptoms often have to learn to live with pain. They wander from specialist to specialist, depending on the type of pain and problems they experience. When competent clinicians cannot find an organic basis for these symptoms, they often suggest it might be psychogenic. As the wanderers are told and retold that there seems to be no organic basis for their pain, that the cause is psychogenic, their anxiety mounts. When physical findings remain obstinately in abeyance, patients may begin to suspect a brain tumor, turn to drugs to alleviate their symptoms, or on rare occasions, even contemplate suicide.
“Misdiagnosis is rather the rule than the exception with MPD”
What is the cause? “You can’t catch it”
It is a chronic degenerative disease which often takes years to develop. There are many contributing factors. Every person has a unique personality; this is why we must consider many different aspects of the individual when discussing the cause. The aspects can be divided into three groups:
All of these components are disturbed to some extent when a person suffers from MPD, but seldom are they affected to an equal extent. Hence, it is important, when diagnosing MPD, to assess the relative impact of each of these components. Many patients may remain oblivious of any symptoms until one day they wake up with, for example, an excruciating headache. It is like filling a cup with water to the rim and one keeps adding droplets until all of the sudden there is a spill over. Similarly, many different lifestyles can combine which could aggravate MPD – such as structural imbalance, stress, fatigue, certain foods and even a simple routine visit with the hygienist for a cleaning. Any one of these is a single drop in the bucket.
The one aspect that is always present in MPD is structural imbalance. This structural imbalance in the jaw is also termed “mal-occlusion” (“bad bite”), which means that the upper and lower teeth do not close together in the right way. Just as a chair needs four legs in order for one to sit on without falling over, all teeth need to fit firmly together to support the muscles in the face for chewing and swallowing. Teeth are an extension of the skeletal system. It is held to the skull via the Temporomandibular joints (TMJ) and the muscles. Both the position of the TMJ and the muscles are determined by the way upper and lower teeth fit together. When teeth are together they are in occlusion. The occlusion dictates the relation of the jaw to the skull also known as the cranio-mandibular relationship.
Simply stated mal-occlusion is when the skeletal system is in disharmony with the neuromuscular system. This means that the teeth or occlusion is forcing the TMJ’s and muscles into a strained position. Hence, the natural demand to the muscle and nervous system increases beyond their capacity and places them in a spasm cycle. It is just like walking with a pebble inside your shoe. After a few yards the pain becomes annoying and you will twist and torque your hip into all kind of different positions to avoid walking on the pebble. After a mile the pebble feels like a stone and your foot, leg and body hurts. This is the same thing that happens to the muscles of the face and jaw (oro-facial muscles) when they are forced into an unnatural position because of the bite. Eventually the muscles become strained and painful. This strain on the oro-facial muscles causes an alteration in their shape. To compensate for this the other muscles such as the neck, head and back have to compensate for this unnatural position. This in turn places these muscles into strain and spasm. Muscles that are under constant strain can develop “trigger points”, which feel like knots or nodules, and are painful when pressed on them. Trigger points can be the source of referred pain, which means pain is felt in another part of the body other than where it originated.
To correct this, the jaw must be brought back into a neuro-muscularly balanced position.
“Muscles under constant strain are in pain”
For a long time it was believed that MPD was a psychosomatic (psych=mind, soma=body) illness, starting in the mind and manifesting itself in the body. Some examples of psychosomatic illnesses are ulcers and hypertension. It is of significance to realize that even though the problem begins in the mind, the physical symptoms themselves are very real.
It is believed, however, that for most part MPD has its origin from a structural imbalance or somatopsychic. The resulting pain in the muscles (soma) causes a feeling of anxiety, tension and stress (psyche). There have been numerous studies on how the impact of being sick affects us mentally and emotionally. For instance emotional reactions when having a headache could include:
• Inability to perform up to ones personal and public expectations
• Fear of the unknown
Thus, it is apparent how coping with a chronically painful condition such as MPD can place someone under tremendous amount of emotional stress. Mind and body is a complex interconnected highway, so that even though the problem may stem from a structural imbalance in the jaw, the resulting discomfort will affect the mind as well.
The human body and mind has certain arsenal to its possession. When in pain and in stress it prepares itself for either “fight or flight”. These are short-term positive coping mechanism in the presence of stress. Unfortunately when in pain and under stress at the same time we tend to add to the problems by adopting less favorable habits such as:
• Drug and alcohol consumption
• Not exercising
Soon the body adapts itself to long term chronic stress. In this second stage, the body’s defense hormones operate in an above-normal rate. In addition to the aforementioned ill-habits, just like your car would eventually run out of fuel, the body will soon be depleted from its natural fuel supply.
At the third stage, exhaustion sets in and the body breaks down. This is where chronic diseases such as MPD will occur.
With MPD the body is placed in constant stress. The extent and severity differs from individual to individual. Some people may have an occasional click in their temporomandibolar joints and some suffer from constant, severe, daily pain. In either case, the body prepares itself to fight against the stressor. Biochemical changes occur to provide the body with energy to compensate and adapt. This energy is limited however, and eventually will be depleted at a faster rate depending on the ill-habits we take on during that time, thereby adding additional stress, pain and discomfort.
“It is important to know the person who has the disease
as to know the disease the person has.”
--- Sir William Osler