Myofascial pain syndrome—a diagnostic challenge for dental practitioners

Abstract

This case report describes the unusual presentation of chronic temporomandibular joint (TMJ) dysfunction in a young girl and highlights the effectiveness of a multidisciplinary approach in managing her condition. A 15-year-old female presented to the dental clinics at the Aga Khan University Hospital with a one-year history of restricted mouth opening, severe bilateral preauricular pain, and audible TMJ clicking. The pain, initially dull had progressed to spontaneous, sharp, and radiating discomfort unresponsive to conventional analgesics. A significant psychosocial stressor was identified as the precipitating factor. Clinical examination revealed marked tenderness across multiple craniofacial and cervical muscles, with features consistent of myofascial pain syndrome. A comprehensive management plan was implemented, involving pharmacologic therapy (anti-inflammatories and muscle relaxants), non-pharmacologic strategies (TENS, moist heat, cervical manipulation), and psychological support. A bilaminar occlusal splint was fabricated and adjusted periodically. Over 15 sessions, her VAS pain score improved from 8/10 to 5/10, followed by complete resolution of symptoms and improved mouth opening to 45 mm within six weeks.

Keywords: Myofascial pain syndrome, Trigger points, Referred pain, Temporomandibular disorders.