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Received Jan 16, 2018; Revised Mar 22, 2018; Accepted Apr 17, 2018
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1. Introduction
Chronic myofascial pain syndrome is a diagnostic and therapeutic problem for many specialists, such as dentists, laryngologists, neurologists, neurosurgeons, general surgeons, anesthetists, psychiatrists, and oncologists [1]. This indicates the interdisciplinary and complex nature of these diseases. The prevalence of dysfunctional pain syndrome is estimated at around 12% of the adult population and 50% of the elderly population; it is more frequent in women between 20 and 40 years of age [2]. The percentage of women with headache associated with temporomandibular dysfunctions reaches up to 15%, and 10% in men [3]. Pain intensity varies from dull to acute. In people gnashing their teeth at night (occlusal parafunction, bruxism), morning pain in the joint and muscles is characteristic; it intensifies while eating and disappears during the day. In people clenching their teeth during the day, the pain may be most intense in the evening [4]. Signs and symptoms associated with temporomandibular dysfunctions include the pathological wear of the teeth as a result of bruxism, increased muscle tone in the masticatory muscles, overgrowth of the masseter, tinnitus, and changes in the psychological profile [5]. Differential diagnosis of pain in the course of temporomandibular dysfunction should exclude other pathologies of the temporomandibular joint, as well as tumours of the zygomatic bone, neoplasms of the nose, mandible, and parapharyngeal area, systemic connective tissue diseases, giant cell arteritis (mandible claudication), cluster headache, and reflex sympathetic dystrophy of the face [6].
The role of occlusal and nonocclusal parafunctions is emphasized potential etiological factors, along with malocclusion, missing teeth in the lateral areas, macro- and microinjuries of the joint, stress leading to hyperactivity of the masticatory muscles, the activation of masticatory muscles by the route descending from the limbic system and reticular formation, the lack of effective contraction of both lateral pterygoid muscles, and rheumatic diseases [7].
The multiple manifestations of the symptoms lead to a multitude of treatment methods and indicate that there is still no consensus in understanding the pathophysiology of the underlying TMD mechanisms. Because of...