Masticatory muscle pain: diagnostic considerations, pathophysiologic theories and future directions

The importance of developing a correct and accurate diagnosis cannot be overemphasized. This principle applies to all areas of medicine and dentistry, but even more specifically to temporomandibular disorders (TMD) for which the proper diagnosis can be enigmatic and elusive. Since muscle related pain is the most common TMD diagnosis, misdiagnosis may result in the patient undergoing inappropriate invasive and irreversible interventions resulting in potential negative outcomes. This will only lead to practitioner frustration and patient dissatisfaction. Hence, an understanding of the muscle pain theories, appreciating the various diagnostic classification systems, and being knowledgeable of the various pathophysiologic theories of muscle related pain will assist the well-intentioned practitioner in avoiding the consequences of misdirected treatment. Ultimately this approach will result in prudent and properly targeted patient care. Discussion of future directions for both diagnosis and management of muscle related TMD pain will afford the reader the opportunity to enhance and objectify the diagnostic process related to masticatory muscle pain. Finally, this presentation is intended to stimulate further investigation resulting in an enrichment of our abilities to provide TMD patients with the best available evidence-based scientific management options for improvement of their condition.