Abstract
This study reports a case of myofascial pain dysfunction syndrome under 5 year-follow-up observation in which one month of guidance for masticatory patterns led to symptomatic improvement.
The case was that of a 61-year-old housewife. Her chief complain was right masseter pain on mouth-opening. She developed a pain in the right masseter region when opening her mouth wide in January, 1991. There was also trismus and right temporomandibular murmur.
She became very busy caring for, her mother after the latter was hospitalized in June, 1992. The above right masseter pain became stronger on mastication and opening from this time, and she came to our department for examination on July 20, 1992.
X-P finding: The orthopantomogram and orbitocondyle projection revealed no morphological abnormality of the teeth and the temporomandibular formation. Schulle's method revealed that the right mandibular head would not go beyond the articular tubercle on opening and a limited ROM. The left mandibular head was normal.
This diagnosis corresponded to myofascial pain dysfunction syndrome, as proposed by Laskin, D. M.
The guidance for masticatory patterns was made according to the manual prepared by our department, involving the slow and appreciative mastication of a mouthful of boiled rice 20 times prior to swallowing.
The right masseter pain on opening disappeared two weeks after the start of the guidance, but then reappeared 2 months later. Her mother had died by this time, and the pain disappeared 6 months thereafter. The trismus right temporomandibular murmur and stiffness and tenderness of the bilateral masseter disappeared, respectively, 1 month, 2 months and 1 year, after the start of guidance. Inquiries were also made about the rough masticatory habits and jaw fatigue due to long mastication, tiredness after work, etc. The rough masticatory habits disappeared 2 weeks after the start of the guidance, and the jaw fatigue after one month of guidance. Fine masticatory habits, appreciative eating sound digestion, a healthy natural appetite combined with sensible moderation in the choice of food and good brushing were all maintained for 1 month thereafter. As described above, in addition to the establishment of fine masticatory habits through guidance on masticatiry patterns, there was both symptomatic improvement to the temporomandibular arthrosis a marked improvement to the health of the whole person, including dietary and living habits. A psychosomatic profile was obtained. The pathogenesis of the present disease was thought mainly to involve the disuse or degenerative lesions of the masseter group due to rough masticatory habits.
