Craniomandibular dysfunction is malfunction of the jaw. These become noticeable through different symptoms.
What is craniomandibular dysfunction?
Craniomandibular dysfunction is also known as craniomandibular dysfunction, CMD or functional pain syndrome. This generic term refers to functional, structural or psychological dysregulation of the temporomandibular joint. The dysfunctions sometimes also cause pain. The complaints are caused by disturbances in the interaction of joints, muscles and tendons. Approximately five to ten percent of all adults suffer from craniomandibular dysfunction. Jaw problems are particularly common in women who are childbearing. During menopause, the symptoms usually improve. In smaller children, however, craniomandibular dysfunction occurs only very rarely. Up to puberty, there is an increase in the number of disorders. A concrete need for treatment exists with CMD only in about three percent of the population.
Causes
Causes of a craniomandibular dysfunction is usually a misalignment between the human lower jaw (mandible) as well as the skull (cranium). If the mandibular condyle is not in its correct position within the socket, there is even a risk of jaw dislocation. Common triggers of craniomandibular dysfunction are tight jaw clenching and teeth grinding (bruxism). These problems not infrequently lead to disc displacement, osteoarthritis or myofascial pain in the temporomandibular joint. Basically, doctors suspect a variety of different contributors to the occurrence of craniomandibular dysfunction. These include developmental disorders, genetic factors, malocclusions, loss of single or multiple teeth, and hormonal or sleep disorders. Psychological reasons are also included among the causes. These can be post-traumatic stress disorder or depression. Sometimes orthodontic therapies or the use of dental crowns that are too high are also the cause of craniomandibular dysfunction.
Symptoms, complaints, and signs
Craniomandibular dysfunction leads to numerous different complaints. The primary complaint is diffuse pain, which manifests itself both during movement and at rest. The pain is usually constant and dull. In addition, the complaints can radiate to the mouth, forehead, temples, eye socket, cheeks, neck, cervical spine, shoulders and back. It is also not uncommon for sufferers to experience restricted jaw opening, as well as rubbing and cracking sounds when they open or close their jaws. Furthermore, a burning sensation in the mouth or on the tongue, tinnitus and ear pain are also possible. Some sufferers also experience increased salivation, difficulty swallowing, visual disturbances, dizziness, fatigue, and poor concentration. Movement restrictions in the cervical spine sometimes occur.
Diagnosis and therapy
Because the complaints of craniomandibular dysfunction are as numerous as they are varied, an exact diagnosis can be difficult in some patients. As a rule, the first person to be consulted for complaints of the jaw is the dentist. The dentist can determine whether the problems originate in the teeth or in the temporomandibular joint. In addition, the dentist checks for possible sources of infection in the teeth. With a kinesiography, a more precise examination can take place to determine if the jaw problems are caused by changes in jaw movements or by individual teeth. Electromyography can be used to detect cramping of the muscles. Other investigative procedures that may be considered include taking x-rays, radiological methods, or instrumental functional analysis (API/CPI). However, psychological factors can also trigger craniomandibular dysfunction. For this reason, the patient is given some questionnaires to fill out. The patient must be very patient during the diagnostic process, as it is considered to be time-consuming. As a rule, craniomandibular dysfunction can be treated well. Thus, the disease usually takes a positive course. The symptoms improve after only a few weeks.
Complications
In this disease, the affected person primarily suffers from discomfort in the jaw. This discomfort has a very negative impact on the quality of life of the affected person and can significantly reduce it. As a rule, patients suffer primarily from severe pain. The pain also occurs as pain at rest and can lead to discomfort, especially at night, and thus to sleep problems. It is not uncommon for patients to suffer from depression or to appear irritable. Likewise, the pain can spread from the jaw to the eyes or head and cause discomfort in these regions as well. This complaint also makes it difficult to take in food and liquids, possibly leading to deficiency symptoms or malnutrition. Similarly, swallowing difficulties or visual disturbances may occur. It is not uncommon for patients to be unable to concentrate and suffer from persistent fatigue. Treatment is carried out by means of various therapies. This can limit most of the symptoms. Complications usually do not occur. However, it cannot be predicted whether there will be a completely positive course of the disease. The life expectancy of the affected person is usually not limited by this dysfunction.
When should you see a doctor?
When diffuse pain occurs in the face and cervical spine, craniomandibular dysfunction may be underlying. A visit to the doctor is indicated if the discomfort does not subside on its own or if other signs of illness appear. Symptoms such as a burning sensation in the mouth and on the tongue, ear pain or difficulty swallowing require medical clarification. People who experience movement restrictions in the cervical spine or other problems with normal movements should contact their family doctor. The same applies if visual disturbances, dizziness or fatigue occur, with no specific underlying cause. If these complaints rapidly increase in intensity, it is best to consult a doctor immediately. People who suffer from a misalignment between the lower jaw and the skull, grind their teeth or suffer from osteoarthritis are particularly susceptible to the development of craniomandibular dysfunction. Anyone who is part of these at-risk groups must immediately speak with the appropriate physician when the above symptoms occur. The condition is usually treated by an orthopedic surgeon or an internist. In less severe cases, the dysfunction does not need to be treated.
Treatment and therapy
Treatment of craniomandibular dysfunction depends on the triggering cause. In principle, gentle and reversible treatment is used. To relieve the masticatory muscles and the temporomandibular joints and to align body and bite statics, the patient receives a special bite splint (occlusal splint). In addition, physiotherapy can be performed to relieve muscle tension and strengthen the muscles. Furthermore, malpositions and dysfunctions of the temporomandibular joint can be treated in this way. However, the actual benefit of an occlusal splint has not yet been clearly confirmed scientifically. There are several studies with different test results that are either in favor or against the effectiveness of the splint. In the case of chronic pain, the patient usually receives medication that has an analgesic, anti-inflammatory, sleep-promoting or muscle-relaxing effect, which leads to an improvement in the quality of life. The use of transcutaneous electrical nerve stimulation (TENS) is also considered useful. This electrical stimulation current therapy is used to treat pain as well as to stimulate the muscles. The alternating current used has a low frequency. The effect of trigger point infiltrations, in which different active substances are administered into the muscles to relieve the symptoms, is still under discussion. Self-treatment measures by the patient are also possible. They include the use of heat, cold, stretching, stress management, relaxing exercises, and the consumption of soft foods.
Outlook and prognosis
If the sufferer of craniomandibular dysfunction takes advantage of the medical options available, there is a good chance for relief of the symptoms experienced as well as long-term recovery. In collaboration with a physician, a treatment plan is created and various therapies are applied.In many cases, the therapies used are without further side effects. In addition, the patient receives instructions on how to chew without complaints in the future. If the doctor’s instructions are followed, patients usually report relief from their symptoms after a short time. If, contrary to expectations, side effects occur, this can contribute to delays in the healing process. Optimization of the treatment plan is necessary. Clarification of the cause is essential for a good prognosis. This may be difficult to identify due to the symptoms and may take some time. If the affected person decides that he or she does not want to take advantage of medical treatment, an increase in impairment is to be expected. Existing pain may become more intense and spread. The chewing process deteriorates over a longer period of time and consequential damage or further illnesses occur. Spontaneous healing is not to be expected with this dysfunction. Although an intake of soft foods results in short-term relief, health deteriorates over the course of several months.
Prevention
Prevention of craniomandibular dysfunction is possible by inserting an occlusal splint. In this way, the loss of substance of the teeth can be counteracted. The use of relaxation methods is also considered useful.
Aftercare
Craniomandibular dysfunction, or CMD for short, requires consistent aftercare due to the complexity of the clinical picture. Here, the orthodontist as well as physicians from the relevant specialties, such as orthopedists or neurologists, are involved in often interdisciplinary collaboration. Physiotherapists also frequently accompany this process after acute treatment. Active cooperation of the patient is often a decisive factor in the aftercare of CMD. The malocclusion that led to the symptom complex of CMD can be prevented during aftercare by using special bite splints. In addition, regular dental or orthodontic check-ups are important. If psychological problems lead to nocturnal teeth grinding, these should also be addressed in the best possible way during aftercare. In this context, stress can be reduced by relaxation methods such as Jacobsen’s Progressive Muscle Relaxation, autogenic training or a visit to a psychologist. Yoga is also often helpful here. Physical complaints such as neck tension, back pain and headaches, which are triggered by CMD, can often only be improved in a long-term process. Therefore, it is also important in the aftercare of craniomandibular dysfunction to build up weak muscles, stretch shortened muscles and do something good for tense muscles through massage. For upright spine posture, which is especially important in CMD, targeted gymnastics for the back or attending back school can be helpful.
What you can do yourself
With craniomandibular dysfunction, severe pain can occur in the jaw area, extending into the back and abdomen. The everyday life of those affected by craniomandibular dysfunction is often severely restricted as a result, and their quality of life suffers. In the area of self-help in everyday life, all measures that take the tension out of the jaw are therefore useful. Wearing appropriate bite splints can be a first step towards relief. A physiotherapist specializing in craniomandibular dysfunction can show sufferers exercises and massage techniques that they can also use at home. A common cause is constant tight clenching of the teeth. This usually happens unconsciously. Stress and permanent tension in everyday life are causal factors here. Those affected must therefore learn certain relaxation techniques and individual stress management in order to take pressure off themselves and their jaws. Exercises such as yoga, which are regularly integrated into everyday life, provide relief for many patients. The process of a temporomandibular joint starting to hurt is usually a long one. Accordingly, it can take a while for self-help measures in everyday life such as stress reduction, relaxation exercises and wearing splints to have a lasting effect. It is therefore important that these measures are implemented consistently.
