 Hello everyone. Welcome back to a new session on dentistry and more. So today we have two syndromes. It is myofascial pain dysfunction syndrome or MPDS or burning mouth syndrome or BMS. So it is a continuation of our various syndromes last three sessions we have covered various syndromes. So today's session also we will be covering these two syndromes. There are actually various syndromes present in our oral pathology subject but we are focusing only on the syndromes the main syndromes which have been asked for university exam. So the idea is to give you some tips about each syndrome so you can easily memorize this and write it for the exam. So let's see what is MPDS and what is BMS. So we will begin with burning mouth syndrome. It is a burning sensation without any detectable cause. So it is nothing but burning painful or itching sensation located in oral mucosa and the tongue is the most affected part followed by lips and palate. So it is a problem seen in oral cavity especially the tongue lips and palate without any detectable cause that is burning mouth syndrome. So usually we know ulcers and other lesions which causes burning sensation but this is without any particular cause. So the clinically no apparent alterations are present in patient's mouth. So what are the epidemiological features of this disease. This is most commonly seen among women that is it is increased with age and it is like 6 is to 1 prediction compared to males that is female prediction is almost 6 times compared to the males. And it is seen among women after menopause that is 3 to 12 years after menopause. It is commonly seen and it is very rare before 30 years. So that is something related to the epidemiology of BMS. Now let's see the classification. So it is classified into 3 type 1 type 2 and type 3. It is based on the symptoms present when a person awake or upon waking that is type 1. There is no symptom upon waking but it increases throughout the day. Type 2 is the symptoms present when upon waking and it is throughout the day it is present and this is the most common type that is type 2. Type 3 there is no regular pattern and it is the least common one. And let's see what are the etiological factors. Actually it is not confined to any particular factor. We cannot say that this course is burning mouth syndrome. There are many factors which can cause the burning sensation in mouth. So those are we can classify that into local and systemic factors. The local factors involves oral candidiasis like in planus allergy or allergy like in planus oral candidiasis and systemic factors involves hormonal changes, vitamin B12, folic acid or iron deficiency, diabetes malitis maybe the side effect of few medications, few autoimmune diseases and salivary gland disorders and some medications like AC inhibitors and even trauma and psychiatric problems. So local factors like danger problems also could be there like ill-fitting, interinsicile space and vertical dimension problems and maybe the median rhomboid glossitis, hypersensitivity to certain food materials like in planus I mentioned already and also oral habits like tongue thrusting and even carcinoma and maybe the prolonged use of chlorxidine mouthwash also could be a etiological factor. Some disorders like chagrin's syndrome also could be a factor because it is associated with dry mouth and dry eyes. So burning can be seen in these patients. So these are the etiological factors associated with burning mouth syndrome and what are the clinical features? So the most common clinical feature is burning sensation especially the anterior part of tongue and dyscusia and dysesthesia. So that is dyscusia is the altered taste and dysesthesia is itching or pain sensation and it is especially present on the anterior one-third of the tongue. And what are the treatment options? There is no particular treatment options. If it is a milder case we can go for psychological counseling and the moderate to severe cases should go for drug therapy like amy-triplein and alpha-lipoic acid. So burning mouth syndrome is very peculiar because we have many diseases many conditions many lesions which can result in burning mouth but without any specific course without any clinical manifestation the presence of burning is actually known as burning mouth syndrome and it is most commonly seen with women especially postmenopausal period and we have three classification and n number of etiological factors. So now let's move on to myofascial pain dispension syndrome or MPDS. So it is a pain disorder which starts from trigger points in myofascial structures. So what are these trigger points? These trigger points are within the skeletal muscle which is triggered by macro or micro trauma happening to these skeletal structures. So it is a pain disorder as the name suggests it is a pain disorder which is starting from few or many trigger points which is present in the myofascial structures. So these trigger points are elicited or responded by the macro or micro trauma happening to these structures. So it is 30% of the total population is affected and the females are most affected 3 is to 1 predilection and it is most commonly seen in middle age group that is 15 to 40 years. So we have a cycle of events in this etiology. So this is a cycle of events that is stress is causing muscular hyperactivity. Again the dental irritation is also causing muscular hyperactivity. So what happens when there is hyperactivity of muscle the muscle fatigue. So muscular fatigue which leads to myofascial pain dysfunction syndrome. At the same time muscular over contraction can also leads to MPDS. Muscular over extension can also leads to MPDS. So what happens due to MPDS there is contracture, there is degenerative arthritis, there is internal derangement and there is occlusal disharmony. So due to occlusal disharmony and internal derangement the chewing pattern is changed and also due to the degenerative arthritis and contracture the again the chewing pattern will be changed. So chewing pattern is changed due to all these reasons that is MPDS affect the degenerative arthritis it causes contracture, it causes occlusal disharmony and it changes the internal structure that internal derangement. So all these results in chewing pattern. So what happens once the chewing pattern is changed it will again cause MPDS. So it is a vicious cycle. So it starts with stress, muscular hyperactivity and dental irritation goes to muscle fatigue and muscular over contraction and muscular over extension. MPDS goes to arthritis, internal derangement, occlusal disharmony. It results in chewing pattern. It itself goes back to MPDS. So in pathophysiology what happens when the etiological factors so all the etiological factors which leads to micro or macrotrauma to the musculoskeletal system to muscle spasm. So all these etiological factors which causes trauma that is micro or macrotrauma on the musculoskeletal system which leads to muscle spasm. So what happens? So this hyper tonicity may lead to muscle fatigue. So this is what I was explaining hyper tonicity there will be muscle fatigue and accumulation of lots of metabolic byproducts such as lactic acid, prostaglantin, radicanin and histamines. So due to this hyper tonicity and muscle fatigue there will be byproducts that is metabolic byproducts such as lactic acid, prostaglantin, radicanin and histamine. So what happens? The accumulation of these pain mediators lowers the pain threshold to mechanical and chemical stimuli which leads to MPDS. So it is a cycle, etiological factors, micro or macrotrauma, muscle spasm what happens? Then there is byproducts, metabolic byproducts such as prostaglantin, radicanin, histamine, lactic acid which goes pain threshold lowering the pain threshold to mechanical and chemical stimuli which leads to MPDS. So the classification, spasm of lateral to regoid either or it is spasm of elevator muscles or it is spasm of lateral to regoid and elevator muscles. So clinical features includes pain, discomfort, limited jaw movements, the clicking and other jaw noises and who are tendon. So in clinical features so there are basically four categories. So we can express these clinical features in four categories that is neurologic, otologic, gastrointestinal tract and musculoskeletal. In neurological there is tingling, numbness, blurred vision and lacrimation in otologic, tinnitus, ear pain, dizziness and vertigo. In GI tract, nausea, vomiting, diarrhea or constipation, musculoskeletal, there is fatigue, tension, tiredness, weakness and joint pains. So how do we diagnose MPDS? The most common four criteria is the unilateral pain, muscle tenderness, the clicking and limited jaw movements. So these are the four criteria for diagnosing MPDS, unilateral pain, muscle tenderness, clicking and limited jaw movements. And how do we treat this? The treatment is basically we go for seven hours occlusion rehabilitation. So it starts with seven hours. So that is the first one is remove extraction of teeth, second one is reshape, grinding of any occlusion, high points or such things and reposition that is doing using orthodontic treatment and restore any conservative feeling or conservative treatment, replace that is using processes, reconstruct that is TMJ surgery and the last one is regulate that is regulating the habits and symptoms. So remove, reshape, reposition, restore, replace, reconstruct and regulate, extraction, grinding, orthodontic treatment, conservative treatment, processes, TMJ surgery and control of habits that is seven hours. So seven hours involved with this seven hours involved with management of myofascial pain dysfunction. So that's all about MPDS. So this isn't a complete details of any long essay. This might be asked for a long essay, but it is to give a very brief idea and a pilot view. So I would say a pilot view that is what are the basic features, what are the striking features of any syndrome. So you can easily build up the content while writing the exam. So syndromes, we have completed syndromes which are being asked mainly for unicity papers. So I will come up with a different topic in oral pathology. So hope you understood all the syndromes we covered so far, we finished it in four sessions. So anyway, I will come up with new topics in oral pathology. Thank you.