Management of muscular hyperactivity

A treatment plan for jaw pain and dysfunction due to muscular hyperactivity can only be formulated after the exclusion of systemic disease or an inflammatory condition as a possible cause thorough physical examination of the head and neck and the study of an appropriate radiographic survey. The treatment plan should consist of a series of progressively graded stages which must be fully explained to the patient. This will reduce the problem of overtreatment and maintain the confidence of the patient in the dentist should the early conservative measures by unsuccessful. The level at which a patient will be entered upon the treatment ladder will vary with the severity of the presenting symptoms. The usual stages will include the following: (a) elimination or neutralization of the cause, (b) initial conservative treatment involving prescription of a mild anti- inflammatory analgesic, soft diet, rest, moist heat and where indicated an anxiolytic drug such as Valium, (c) exercise to stretch muscles and remobilize the joint, (d) physical therapy including diathermy, (e) stress control treatment and relaxation training and, finally (f) referral to a centre for chronic pain relief. Advice is given on the management of a patient who either discontinues treatment or for whom complete remission os symptoms is not possible.