A Unifying Concept of the TMJ Pain-Dysfunction Syndrome

Abstract

Pain, muscle tenderness, clicking, or alteration of mandibular movement are cardinal symptoms of the temporomandibular joint (TMJ) pain-dysfunction syndrome (PDS). Controversy still exists over the origin of the syndrome and what is the best treatment for it. One group holds that occlusion is the major etiologic factor; another that psychological and muscle factors are of the greatest etiologic importance. A number of investigators now hold that occlusal and psychologic factors operate together to produce the PDS. A theory is offered here that muscle hyperactivity associated with PDS is not a generalized hyperactivity but one in which activity of certain motor units is increased disproportionately. Treatment should combine psychologic and physiologic modalities. Pain and tension should be controlled, and spasm eliminated. However, if symptoms continue, occlusal treatment should be instituted. A full-coverage splint may serve either as the sole occlusal treatment or as a preliminary to equilibration or restorative procedures. Pain, muscle tenderness, clicking, or alteration of mandibular movement are cardinal symptoms of the temporomandibular joint (TMJ) pain-dysfunction syndrome (PDS). Controversy still exists over the origin of the syndrome and what is the best treatment for it. One group holds that occlusion is the major etiologic factor; another that psychological and muscle factors are of the greatest etiologic importance. A number of investigators now hold that occlusal and psychologic factors operate together to produce the PDS. A theory is offered here that muscle hyperactivity associated with PDS is not a generalized hyperactivity but one in which activity of certain motor units is increased disproportionately. Treatment should combine psychologic and physiologic modalities. Pain and tension should be controlled, and spasm eliminated. However, if symptoms continue, occlusal treatment should be instituted. A full-coverage splint may serve either as the sole occlusal treatment or as a preliminary to equilibration or restorative procedures.