Chewing
and speaking - the “craniomandibular gadget” is accountable for those crucial
obligations. It includes the higher and decrease jaw, the masticatory muscle
mass and the temporomandibular joints. If the machine does now not run easily,
doctors refer to this disorder as craniomandibular disorder (CMD). By this they
imply a malfunction inside the location between the cranium (cranium) and the
jaw (mandible) as well as all proceedings that can be attribute.
According
to the Society for Dental Health, Functions and Aesthetics (GZFA), around 20
percentage of the population suffer from CMD signs and symptoms that require
remedy. Mostly it's miles approximately ordinary good sized illnesses such as
headache or lower back ache, which can be brought about inside the jaw region.
Although more and more human beings, specifically younger people, are affected
by the malfunction, the CMD is infrequently noticed through the general public.
Even professionals from time to time do now not properly classify the symptoms.
Because the
chewing equipment is one in every of our maximum complex systems inside the
frame. It is carefully related to the pinnacle, backbone, brain and a few
organs via muscular tissues and nerves. Functional issues inside the chewing
system can therefore cause troubles in other areas of the organism and vice
versa. And because of this, the signs of CMD often amplify past the place of
the jaw and head.
Because
of this complex history, humans with CMD frequently have a doctor's marathon of
years at the back of them earlier than they simply get assist. Who goes to the
dentist with again troubles? A few extraordinary signs and symptoms convey the
ones affected to a selected expert institution - and docs on the incorrect
music. Learn how CMD manifests itself, how the ailment is located, and which
doctor to touch.
Symptoms of craniomandibular dysfunction
CMD is hidden behind a wide variety of symptoms. Which may
extend from head to foot , depending on the age of
the person concerned vary :
- unclear facial pain, especially
tight cheeks
- headache
- Neck pain and tension
- Shoulder and back pain
- Knee pain
- Attacks of dizziness
- Tinnitus
- Pain in the ear area, especially
when moving the mouth
- Popping noises in the ear
- loose or abraded teeth
- Toothache
- Temporomandibular joint pain
- hypersensitive teeth
- Visual disturbances
- difficulties swallowing
- Voice changes
- Numbness in the arms and fingers
- restricted mouth opening
For
most CMD patients, headache is the main symptom - classically as a tension
headache that starts at the back of the head and also affects the neck and
shoulder area. At the dentist, those affected often report pain in the
facial area. It is typical, however, that there is no “normal” explanation
for the pain. Classic treatments remain ineffective and do not bring
lasting success.
Unfortunately, the patient's long history of suffering is also typical. If
the interaction between the teeth of the upper and lower jaw is disturbed, this
has immense effects on many parts of the body. Those affected therefore
often have an odyssey of years behind them in search of the cause of their
complaints. To make matters worse, CMD can severely reduce the quality of
life. Chronic pain, dizziness or even tinnitus put a strain on both
professional and relationship life.
If any of the symptoms seem familiar to you, then you should see a CMD
specialist and get examined. Because the sooner the causes are combated,
the better the chances of recovery. Theoretically, cracking noises,
restricted movement and pain can improve on their own, but this does not always
succeed. If, on the contrary, the symptoms worsen, in the most unfortunate
case this leads to the fact that at some point the mouth can no longer be
opened normally. At this stage at the latest, the disease is then very
difficult to treat.
Diagnosis of craniomandibular dysfunction
The
complex symptoms make it difficult to diagnose craniomandibular dysfunction. Some
of them are difficult to associate with the bite, teeth or jaw joint. CMD
patients therefore often receive treatment that targets individual complaints,
but does not target the correct cause.
So if you suspect that you may have CMD, you should consult a specialized
dentist. He will take various measures to test whether you actually have a
CMD. A simple quick test already provides the first information.
To
do this, the doctor places two simple wooden spatulas on the left and right of
the lower row of teeth and lets the patient bite slightly. If both
spatulas are in the same plane, the contact between the teeth of the upper and
lower jaw is likely to be synchronous. If the spatulas differ, however,
this could indicate a wrong bite.
In this case, the bite check is followed by a clinical and manual functional
analysis (FAL). It provides information about which treatments may be
necessary. Because a wrong bite, a so-called an occlusion disorder, is
often a reason for CMD. The FAL comprises various measures that do not
require technical instruments.
In numerous individual examinations, pain symptoms and
misalignments of the teeth are recorded, the medical history is recorded, the
masticatory muscles and joint structures are scanned, and chewing movement,
mouth opening and jaw joint noises are examined. The current life
situation of the person concerned is also queried. Is the patient very stressed ? Have there been any stressful events
in the past? Such questions can also provide clues as to the cause of the
CMD.
Clinical and manual diagnostics do not involve any risks and are completely
painless. If this confirms the suspicion that you may have CMD, your
doctor may order further examinations. With an instrumental functional
analysis, the first results can be secured and further knowledge about the
causes can be gained. Technical instruments are used to identify faults in
tooth contact, tooth position or jaw position.
A chewing simulator, a so-called articulator, is used. It imitates the
tooth contacts in different temporomandibular joint positions without reflexes
or muscle tension distorting the picture. This allows the contacts of the
teeth during normal clenching and the effects on the craniomandibular system to
be analyzed.
In the case of certain questions, imaging procedures also facilitate the
diagnosis. An x-ray is commonthe first means of
choice to rule out surgical causes of disease. But magnetic resonance
tomography is also used more often. Because this procedure is able to map
both the soft tissue and the bony structures in the temporomandibular joint. Inflammatory
and degenerative changes can be detected as well as functional disorders of the
joint.
Depending on the dentist's findings, visits to other specialists may also be
necessary. Especially orthopedic specialists with special knowledge in
rehabilitation medicine and pain therapy can help. They examine the
position of the (cervical) spine, shoulders and hips because they have been
shown to contribute to CMD symptoms. Doctors for psychosomatic medicine
are familiar with psychosocial influences and examine whether stress, anxiety
or depression favor CMD.
It is important to know that functional analyzes are not part of the services
provided by statutory health insurance companies. For privately insured
patients, they are included in the insurance cover, depending on the tariff.
Causes of Craniomandibular
Dysfunction
The
starting point of the CMD is always a tension in the chewing, head and face
muscles. Very different factors can be responsible for this tension. From
the point of view of dentists, two risk factors are usually to blame:
misaligned teeth and psychological stress.
Risk factor 1: misaligned teeth
Some
misalignments have genetic causes and occur more frequently in one family. Mostly,
however, tooth gaps and incorrectly adjusted crowns or fillings are the reason
why the bite is not right. Even with those affected who have been treated
by an orthodontist and who have worn braces, the lower jaw may have assumed a
new position when closing. The misalignment of the jaw ensures that the
teeth are unevenly stressed and that the chewing, head and face muscles tighten
in order to compensate for the new position.
Another cause of CMD is clenching and grinding your teeth: bruxism. Because
the teeth are worn out as a result, the bite on the front and canine teeth is
no longer harmonious. Blockages on the spine, problems with the pelvis,
old accidents or postural problems can also set the stone rolling and affect
the position and function of teeth and joints.
Because the jaw is connected to the middle ear, head, cervical spine and back
via a complex system of nerve cords, muscles and ligaments, the high pressure
on the teeth leads to symptoms throughout the body. Conversely, changes in
these regions can cause our jaws to tense up and trigger various CMD symptoms.
Risk factor 2: stress & emotional distress
Psychologists
and doctors agree: We are under significantly more stress today than previous
generations. If we are very stressed in the family or at work, our chewing
system often also reacts to this pressure. Especially at night we “grind
our teeth” or “do we clench our teeth” and thus process unpleasant feelings.
By subconsciously grinding our teeth, we favor CMD or even ensure that the
symptoms become chronic. The interaction of the teeth of the upper and
lower jaw is also disturbed by the grinding and pressing or by the wear and
tear that it entails. The result is an incorrect bite position, which in
turn puts an unnatural strain on the muscles and causes tension.
Treatment of CMD
CMD is curable -
that's the good news. The bad thing is that healing depends a lot on how
early treatment begins and how well the various specialists work together. Because,
as with many diseases, the symptoms of CMD can solidify over time. And: As complex as the clinical
picture of CMD is, the path to a life without symptoms is often just as complex.
Specialists should therefore work together to develop a tailor-made treatment
strategy in which various specialist areas are involved. Your dentist is
responsible for the examination and treatment. If necessary, he will
involve a physiotherapist, osteopath, ENT doctor, orthopedic surgeon,
psychologist or specialist in psychosomatics.
Splint therapy
The
first stage of treatment is usually a "grinding splint". It is
removable, does not change the teeth and is mainly worn at night. The
splint protects the teeth from abrasion, but does not work against the cause of
the grinding and crushing. If the masticatory muscles have not relaxed
significantly after a few weeks, the doctor can therefore prescribe a bite
splint.
It not only has a protective, but also therapeutic effect. Bite splints
take the position of the lower jaw into account and bring it into a new position. The
aim is to calm the overactive masticatory muscles and relieve the jaw joint. Bite
splints are individually adapted and are complex to manufacture. Since the
jaw position can change in the course of the treatment, the splint must be
carefully checked and readjusted again and again.
After
the splint therapy, your dentist will adjust the crowns and fillings in such a
way that excessive forces can no longer act selectively when grinding. Comprehensive
dental restorations, on the other hand, are rarely done today. Their
usefulness has not been scientifically proven.
physical therapy
In
addition, physiotherapeutic measures such as cold and heat applications,
massages and stretching exercises are helpful with CMD. In manual therapy,
special handles are used to relieve pain and eliminate movement disorders. Physiotherapists
examine the joint mechanics, muscle function and the coordination of jaw
movements. Blocked or restricted joints are mobilized with both passive
techniques and active exercises.
Medication
There
is also the option of accompanying the treatment with medication. Painkillers,
anti-inflammatory drugs or drugs that relax the muscles can relieve acute pain
and support functional therapeutic treatment. However, they are no
substitute for a careful search for the causes of the symptoms. In any
case, leave the choice of the appropriate agent and its dosage to your doctor. These
drugs have side effects and can be addictive if taken for too long.
Surgical treatment
Surgical
therapy can only be considered if all conservative treatment measures have been
unsuccessful. So-called joint irrigation, for example, is used as a
minimally invasive surgical method. The upper part of the
temporomandibular joint is punctured with two thin needles and rinsed with
fluid. In this way, fine scars should be loosened and inflamed cells or
proteins should be washed out.
Another procedure is TMJ arthroscopy. It is used when clinical and imaging
procedures do not allow an exact diagnosis or when non-invasive therapies have
not led to any improvement. To do this, a type of microscope is inserted
into the temporomandibular joint. It shows changes in cartilage, bones,
ligaments and the mucous membrane enlarged. Arthroscopy not only gives a more
precise picture of the location, it also allows therapeutic measures. For
example, cartilage surfaces can be smoothed or adhesions loosened.
Open maxillofacial surgery is only performed in rare, severe cases to relieve
the temporomandibular joints. They are only recommended as a last resort
and only after careful consideration.
Treatment costs
The
costs for diagnosis and therapy of a CMD are not borne by the statutory health
insurance companies. Most of the services have to be paid for by the
patients themselves. How high the costs are depends on the scope of the
treatment.
If the first suspicion of CMD is confirmed, extensive examinations are carried
out as part of the clinical functional diagnosis. Here all costs between
700 and 900 euros. This is often followed by an instrumental functional
diagnosis, which costs between 1700 and 2500 euros.
Once the analysis has been completed, it usually involves a permanent change in
the bite position. The costs associated with this therapy are so
individual that the exact amount cannot be estimated across the board. It
depend on the actual work load and the level of difficulty. Private and
supplementary insurances reimburse certain parts of the diagnosis and
treatment, depending on the contract.
