If there is a misregulation between the muscles as well as joints of the lower jaw (lat. Mandible) and the skull (lat. Cranium), one speaks of the subsequent diseases in the collective term of a Craniomandibular Dysfunction (CMD). Dr. Dr. Manfred Nilius, a specialist in oral and maxillofacial surgery, explains in an interview why these various malpositions of the jaw and teeth can also be the cause of headaches and back pain and how CMD can be treated.
How does CMD develop?
Nilius: When you ask what causes CMD, there are four different areas of the body where the problems can originate:
- The masticatory and mimic muscles.
- The temporomandibular joints
- The teeth and the periodontium
- The nervous system
If one of the four areas is overstressed, resulting in dysregulation, this often affects the other areas of the jaw system. So specifically, for example, misaligned teeth, tension in the jaw muscles or nerve disorders can be triggers for a whole range of symptoms that can be attributed to CMD.
Can stress also trigger CMD?
Nilius: Yes, emotional stress can often promote CMD. When we are under stress, the sympathetic nervous system, or nervus sympathicus, is more active than usual. It is strongly connected to the lower jaw via individual nerves. We tense our shoulders, tense up and literally “clench our teeth.” This can lead to a shortening of the chewing muscles, which in turn can lead to headaches and jaw misalignment. So those who grind their teeth at night are trying to relieve stress while they sleep.
What symptoms might indicate CMD?
Nilius: There is a wide range of symptoms that can be related to CMD. When patients come to me and report pressure or pain in the jaw toward the ears, it can be assumed that such jaw dysregulation is present. Other symptoms that may be indicative of CMD include:
- Headache
- Sore muscles in the jaw
- Joint cracking when opening the jaw
- Abraded teeth
- Abraded canines
- Gentle posture of the jaw
- Pelvic obliquity
- Shoulder obliquity
- Pressure and/or pain in the temporomandibular joint
- Earache
When does CMD need to be treated?
Nilius: If you are only wondering about the cracking of the jaw joints and do not feel any impairment in everyday life, you do not necessarily have to do something about the jaw dysregulation. Anyone who has pain in the jaw or is struggling with tooth loss should definitely talk to their doctor about what options are available to treat CMD on an individual basis.
Which doctors can diagnose CMD?
Nilius: Because CMD can affect many parts of the body, it depends on the area of the body from which the pain or problems originate. Not only the dentist can then be the right contact, but also an orthopedist, a surgeon or even a psychotherapist.
How is CMD diagnosed by a dentist?
Nilius: First, you take a dental history. One finds out whether teeth have been extracted, whether there is an even bite to the teeth or whether one can observe a loss of support zones in the molar region between the two halves of the jaw. In addition, one can look at the patient’s facial structure and, if necessary, palpate it: How does the musculature run? Are there irregularities in the course of the jaw musculature? If in doubt, an electromyogram can be used to measure the activity of the muscle and find out whether the cause of CMD is muscular or nervous. A diagnosis of persistent cramping of the neck and cervical muscles can also help further assess the extent of CMD.
Who can treat CMD besides a dentist?
Nilius: If there is tension in the muscles of the jaw, for example, a primary care physician may prescribe medication to relax the muscles. If there are problems with the spine, an orthopedist or, in severe cases, an oral surgeon may be consulted. If excessive emotional stress in the patient’s daily life is the trigger for CMD, a psychotherapist can also help relieve the stress.
What are the types of treatment for CMD?
Nilius: The easiest thing for a dentist to do is to make a grinding splint to relieve the teeth of the stress of grinding at night. The splint, made of plastic, then prevents teeth from grinding and can protect against further consequences of CMD. However, the bite splint does not solve the problem of grinding itself. Only targeted relaxation exercises and long-term stress reduction can do that. Alternatively, so-called “table-top veneers“, a type of cemented partial crown, can be placed on the occlusal surface of the tooth to prevent further tooth wear. If there is a hardening of the muscles, Botox can also be injected into the jaw muscles, leading to relaxation of the jaw. If there is already inflammation of the temporomandibular joint (arthritis), it can be treated with anti-rheumatic medications and exercise and stretching. If the arthritis progresses to osteoarthritis (wear and tear of the joint), surgery may be necessary.
Are there also alternative healing methods that can be used?
Nilius: In many cases, acupuncture or moxibustion, a heat therapy from traditional Chinese medicine, can also help. Alternatively, pain and spasms in the jaw can also be treated with homeopathy. In this case, the respective remedies and their doses should be individually composed by a homeopath. The approach here is primarily the relaxing component for the jaw muscles. Always advisable is the regular movement of the entire body in general, but also of the jaw in particular to relax the masticatory muscles. In some cases, specific physiotherapy treatment, for example, of muscle shortening of the facial musculature, may also be useful to relieve discomfort.
At what point is surgical intervention necessary?
Nilius: Only in the rarest cases is surgical intervention necessary. If the articular ligament in the temporomandibular joint tears partially or completely, it can be repaired with ligament tightening or ligament replacement. Minimally invasive procedures in the treatment of CMD also include a procedure called lavage (“washing”), which attempts to flush the cause of inflammation from the temporomandibular joint.
What can patients do themselves to treat CMD?
Nilius: First, you should try to change your lifestyle and take the warning signs of overloading your body seriously. The first place to do this is to reduce emotional and physical stress. In addition, the following tips can help prevent or improve CMD:
- Pay attention to your posture: imagine a string attached to the back of your head pulling you into an upright position – even if that creates a little double chin.
- Pay attention to how and how long you sit in front of the computer. A straight sitting position and a positioning of the screen at eye level are best, so you do not have to look strongly forward and tilt your head back too much.
- Adjust your glasses regularly to your visual acuity. If you do not see optimally, you tend to stretch your head towards the screen or the book and lose the healthy posture.
- Consciously relax your jaw: loosen your jaw muscles often and massage your jaw and jaw joint occasionally to relax the jaw muscles.
- Sleep on a rather flat pillow. If you lie on a pillow that is too high, you overuse the neck muscles.
- Try to exercise regularly. Sports also help the muscles to relax better, and can also reduce emotional stress.
So if you lead a healthy lifestyle and try to avoid stress, you can optimally counteract an existing CMD or even prevent its development.
Can a CMD be completely cured?
Nilius: If CMD is detected early, the success rate with the right therapy is around 80 percent. So it’s worth talking to your dentist or family doctor about it if you have jaw or neck problems.
What happens if you don’t treat CMD?
Nilius: In the worst case, CCD, or craniocervical dysfunction, occurs. This shortening of the neck muscles must be treated by an orthopedist and is usually accompanied by severe pain. When osteoarthritis occurs, severe joint pain and cartilage loss are not uncommon. Those who do nothing about CMD for a long time run the risk of becoming chronic pain patients.A dentist is then often powerless. Pain therapy is then followed by treatments with minimal doses of painkillers or antidepressants that weaken the perception of pain. The misregulations around the jaw system can then only be contained, but not reversed.
