CMD: Symptoms, Treatment

Brief overview

  • Symptoms: e.g. pain in masticatory muscles or temporomandibular joints, toothache, restricted movement of the lower jaw, cracking or rubbing in the temporomandibular joint; possibly also headache, neck pain, back pain, tinnitus, etc.
  • Treatment: e.g. occlusal splint, dental or orthodontic corrective measures, physiotherapy and osteotherapy; if necessary, medication, psychotherapy, biofeedback, acupuncture.
  • What can you do yourself? Among other things, targeted relaxation of the jaw (e.g. in stressful situations), relaxation techniques, endurance sports, work-life balance.
  • Causes & risk factors: e.g. tooth loss, fillings or crowns that are too high, malocclusions of teeth or jaws, psychological stress, teeth grinding
  • Diagnosis: based on typical signs of CMD (such as misaligned teeth, clicking in the jaw joint, tense masticatory muscles), magnetic resonance imaging (MRI), if necessary.

CMD: Symptoms

The clearest signs of craniomandibular dysfunction (CMD) are pain and restricted movement in the head and neck region:

  • Jaw pain can occur during chewing or at rest, on one or both sides of the upper or lower jaw.
  • The temporomandibular joints and/or masticatory muscles may be sensitive to touch.
  • Toothache is also possible.

At the same time, with CMD, there are often problems opening the mouth wide – some sufferers can’t get it open really wide at all. In other cases, the jaw joints are overly mobile and “ball out” easily (lockjaw).

Often, people with CMD have a malocclusion: they cannot bring the teeth of the lower and upper jaws together in a completely fitting manner, but only in an offset manner. In addition, a cracking and rubbing in the jaw joint may be noticeable when chewing or speaking.

Many CMD patients grind their teeth (bruxism), either during the day or at night. Conversely, the risk of CMD is increased when patients grind their teeth. In doing so, they abrade the tooth enamel. As a result, the teeth react hypersensitively to hot, cold, sweet or sour things.

Accompanying symptoms

With CMD, there may also be some symptoms that at first glance do not appear to be related to the masticatory system or jaw pain (always assuming there are no diagnosed other conditions responsible for these symptoms):

  • Ear pain and/or subjective ringing in the ears (tinnitus).
  • Headache, usually in the temporal region
  • Dizziness
  • Difficulty swallowing (dysphagia)
  • Voice disorders
  • Tension and pain in the neck, shoulders or back
  • Pressure behind the eyes and in the sinuses
  • pain in women during sexual intercourse (dyspareunia)
  • emotional stress
  • anxiety disorders or depression

It is not uncommon for CMD to cause pain or discomfort in adjacent areas of the body such as the shoulders, neck or back. Tense chewing muscles cause muscles in the head and neck area to become tense as well. This spiral of tension can continue even further into the back. The muscles begin to ache (myalgias), harden (myogelosis) or even become inflamed (myositis).

What is CMD?

The term Craniomandibular Dysfunction is composed of several words or parts of words:

  • cranio: derived from the Latin word cranium, meaning skull.
  • mandibular: medical term for “belonging to the lower jaw”.
  • dysfunction: impairment of function.

This is therefore a functional disorder of the masticatory system. Several diseases are summarized under this term, which can occur individually or in different combinations:

  • disease of the masticatory muscles (myopathy)
  • disease of the temporomandibular joints (arthropathy)
  • Occlusion disorder (occlusopathy): The contact between the teeth of the upper and lower jaw is faulty – the upper and lower teeth do not meet at all or do not fit together properly.

Sometimes we also talk about myoarthropathy of the masticatory system (MAP; engl. “temporomandibular disorder”). This is a subset of CMD and refers only to disorders of the masticatory muscles and temporomandibular joints, leaving out the occlusal disorder.

CMD: Frequency

CMD: Treatment

Various diseases and complaints are part of CMD. This requires a holistic therapy. In addition to the dentist, an orthodontist, physiotherapist, osteopath and/or psychotherapist may also be involved. If you suffer from underlying diseases such as rheumatism, arthrosis or arthritis, treatment by a rheumatologist is also indicated.

Treatment by dentist and orthodontist

The goal of CMD treatment is to relax the muscles and reduce pain at the same time. For this purpose, the dentist will provide you with a bite splint (occlusal splint). He also compensates for tooth contacts that do not fit, corrects fillings or crowns that are too high, and/or renews dentures that are unusable.

Bite splint

For CMD, a splint for the teeth is the most important therapeutic measure. The dentist fits the splint to you individually, so that the teeth of the upper and lower jaw fit together properly. This prevents teeth grinding and distributes the pressure when you clench your teeth. The splint thus protects the tooth structure and the periodontium.

As standard, dentists use a Michigan-type occlusal splint. This Michigan splint is made of hard plastic and covers all the teeth of the upper jaw. However, there are other types of splints and systems consisting of several types of splints.

If you have to wear a jaw splint during the day, you should be able to speak normally after one week at the latest. If not, contact your dentist!

Sometimes individual teeth or the lower jaw shift with the occlusal splint. Therefore, regular check-ups with your dentist are important with an occlusal splint. Side effects can be detected and avoided at an early stage. The dentist must also check the fit of the splint after a visit to a manual therapy or osteopathy clinic.

Again and again, the dentist will also adjust the times when you should wear the splint to your needs. You may even be given different splints to wear in rotation. These measures prevent you from clenching your teeth because of the occlusal splint or from developing new tensions or malpositions because of the splint.

Further measures

If the bite splint improves your CMD symptoms by compensating for misaligned teeth or faulty tooth contacts, the dentist and orthodontist may take additional measures. These include:

  • Grinding in teeth
  • Closing gaps between teeth
  • reconstruction of individual teeth with crowns or bridges
  • orthodontic corrective measures

For such measures, long-term temporaries are first used to test whether the CMD complaints improve. If so, the teeth are permanently adjusted accordingly.

If the temporomandibular joints are worn and chronically inflamed (arthritic conditions), temporomandibular joint lavage (arthrocentesis) can help. In this procedure, the dentist inserts cannulas into the temporomandibular joint and carefully flushes the joint. This allows inflammatory cells to be removed, for example. Sometimes, however, surgery is required, possibly with replacement of the temporomandibular joint.

Physiotherapy and osteopathy

Physiotherapy and possibly osteopathy are also often important components of CMD treatment. They improve the effect of the dental measures.

Tense muscles can be loosened by physiotherapeutic exercises. The passive and active exercises also promote blood flow to the muscle and connective tissue and help move the jaws in a more coordinated manner.

Many exercises are more effective if you continue them at home. Have your physical therapist show you appropriate exercises.

In addition to physiotherapy exercises, CMD therapy often includes heat or cold applications and treatment with red light, microwaves or ultrasound. Pain in muscles and joints can also be relieved with jaw massages, manual therapy and osteopathic techniques.

Psychotherapy

Stress at work or in private life often contribute to the fact that sufferers grind their teeth or clench their teeth. Additionally, mental illnesses such as depression or a personality disorder can worsen CMD symptoms. Especially if dental treatment does not work or the symptoms worsen, you should consult a psychotherapist. He can help you deal with and reduce stress and treat any existing mental illnesses.

Biofeedback

Biofeedback procedures are effective for teeth grinding. Since teeth grinding and CMD are often related, it is also helpful here. Teeth grinding or clenching happens unconsciously. With biofeedback procedures, you learn with the help of electronic devices to become aware of these processes and then, for example, to specifically relax the jaw muscles. In this way, the muscle pain subsides in the long term.

Medication

In some cases, medication can also help with CMD. These include, depending on the case, for example:

  • Painkillers (analgesics)
  • Anti-inflammatories such as non-steroidal anti-inflammatory drugs or corticosteroids (“cortisone”)
  • Muscle relaxants (relax the jaw muscles and other tense muscles)
  • sleeping pills and sedatives
  • Antidepressants

Botulinum toxin

In some CMD cases, certain jaw muscles become enlarged. This can be reduced by injecting the nerve toxin botulinum toxin in a targeted manner. However, botulinum toxin is not approved for this application and can only be used for this purpose “off-label” (outside the approval as an individual healing trial).

In addition, the Botox effect wears off after about half a year. After that, the injection may have to be repeated. Accompanying physiotherapeutic exercises are therefore important.

Researchers are currently studying the effect of botulinum toxin for pain relief in CMD.

Alternative healing methods

Sometimes alternative therapies can be helpful for craniomandibular dysfunction. For example, acupuncture and acupressure can be used to try to relax muscles, reduce pain, and improve psychological influences.

Alternative methods cannot replace conventional medical treatment of craniomandibular dysfunction (CMD), but only complement it.

CMD: What can you do yourself?

CMD is a complex disease in which psychological factors also play a major role. At this point, you can become active yourself:

In addition, relaxation exercises such as progressive muscle relaxation, yoga or autogenic training can help with CMD. Endurance sports several times a week also increase your well-being.

Social contacts are also crucial: meet friends regularly and spend time with your family. And last but not least: cultivate beloved hobbies – this also promotes relaxation and well-being.

Tip: Children can also do muscle relaxation exercises. Self-assertion training can also reduce existing fears.

CMD: Causes

Many factors are involved in the development of craniomandibular dysfunction (CMD), which can also influence each other. Among others, the following factors are discussed:

  • dental accidents, tooth loss
  • excessively high fillings or crowns, unusable dentures
  • Tooth misalignments, tooth shifting or tooth migration
  • jaw misalignmentsdisturbances of tooth contacts
  • unfavorable skull growth
  • hormonal disorders
  • emotional stress
  • psychological problems (anxiety, depression)
  • unfavorable behavioral patterns
  • underlying diseases like rheumatism, arthrosis and arthritis

Teeth grinding during the day or night additionally increases the risk of CMD.

This, in turn, can result in ear pain, tinnitus, dizziness, headaches or neck tension, for example. In addition, problems in the masticatory system can aggravate spinal problems, which probably has to do with a malfunction in nerve transmission.

CMD: examinations and diagnosis

You should have possible signs of craniomandibular dysfunction (CMD) checked out promptly. So go to the dentist if:

  • chewing hurts,
  • @ the lower jaw feels stiff in the morning after waking up,
  • @ you cannot open your mouth wide,
  • you notice noises when moving the jaw joints,
  • you grind or clench your teeth more often during the day, or someone close to you tells you that you grind your teeth at night.

Also, be sure to see your dentist if you experience sudden discomfort after dental or orthodontic treatment (such as pain, a clicking sensation in the jaw joint, or the inability to open your mouth wide):

Or a major dental treatment that requires you to keep your mouth open for an extended period of time overtaxes the TMJ.

Before more extensive dental treatment, a dentist should briefly screen each patient for CMD and teeth grinding.

How CMD is diagnosed

Your dentist will perform a CMD screening in the suspected cases listed above. In doing so, he or she will check to see if you have one or more of the following indicative of CMD:

  • You cannot open your mouth wide enough.
  • You open your mouth crookedly or asymmetrically.
  • You cannot move your mouth sideways enough.
  • Some teeth of the upper and lower jaw meet each other awkwardly.
  • There are signs of teeth grinding such as teeth marks in the tongue and cheek, smoothly polished chewing surfaces, cracks and chips on the enamel, chips on the tooth structure, the tooth necks and the incisal edges or pain-sensitive teeth.
  • The jaw joints crack or rub audibly against each other.
  • The masticatory muscles and possibly also the surrounding muscles up to the neck muscles are sensitive to pressure or hardened.

In addition to the physical examination, the dentist will ask you about your psychological condition. He will inquire, for example, whether you suffer from anxiety or emotional stress.

If the information from the patient interview and the examinations confirm the suspicion of craniomandibular dysfunction (CMD), the dentist will suggest suitable therapy.