Craniomandibular dysfunction

introduction

The craniomandibular dysfunction (short: CMD) is a Masticatory system disease, which is usually through a Misalignment of the lower to the upper jaw is triggered.

Especially hit when biting upper jaw and Lower jaw not in the ideal position on each other, one follows from this strong overload and improper use of the Masticatory muscleswhich can lead to pain and swelling.

Causes of Craniomandibular Dysfunction

in the ideally aligned teeth hit the teeth of the Upper and lower jaw like gears on top of each other. This will make the Temporomandibular joints, teeth and the entire masticatory muscles equally stressed.

If this harmonious interaction is disturbed, it comes to Overloading or improper loading one or more of these anatomical structures, Pain and irritation are often the result.

Can cause such craniomandibular dysfunction

• genetic predisposition and psychological stressthat is in a Overload of the masticatory muscles expresses
• traumatic effects on the jaw
• badly fitted crowns and or bridges
• too high fillings
• extreme misaligned teeth be

Craniomandibular dysfunction can be the cause of many other diseases.

• That's how it works Occurrence of tinnitus in approximately 30 percent of the cases attributed to craniomandibular dysfunction
• Incorrect loads in the head area can have far-reaching effects on the rest of the musculoskeletal system
• more pronounced Overshot to misalignments of the head and the Cervical spine
• Blockage of the head joints can block the joints of the pelvis

Symptoms of craniomandibular dysfunction

The majority of affected patients reported on

• moderate to severe pain in the chewing and facial muscles and des Temporomandibular joint
• severe grinding of teeth
• from a certain point in time Tooth loosening and Tooth displacements inside the jaw
• frequent dizziness
• Earache or Ringing in the ears (Tinnitus)
• nocturnal breathing disorders and snoring

That too Appearance of teeth can in many cases indicate the presence of craniomandibular dysfunction.
Badly worn, nicked teeth are a clear symptom and should be discussed with the dentist immediately.

Since in the course of craniomandibular dysfunction there is a Misuse and overuse of various muscle groups can come too Shoulder, neck and back pain be a sign of the presence of this condition.

The wrong load of the Temporomandibular joint however, usually leads to strong a headache up to migraine-like Symptoms.

Furthermore, many affected patients suffer because of the pain and psychological stress that craniomandibular dysfunction brings with it Mood swings and or depressions.

Tinnitus

Tinnitus is a noise in the ear that can be triggered by many different causes. In the context of CMD, it occurs in just under a quarter of those affected. The exact mechanism of its formation is still unknown. In most cases, the noise in the ear increases in the context of the CMD when the teeth are pressed together or the mouth is opened.

Treatment of craniomandibular dysfunction

For the treatment of craniomandibular dysfunction, an ideal interaction between dentist, orthodontist, orthopedic surgeon, physiotherapist and osteopath is necessary. A specialist alone will not be able to ideally help the affected patient.

• In the course of the therapy, the dentist is responsible for adjusting crowns, bridges and / or fillings so that an ideal bite (occlusion) can be guaranteed. Any unevenness that hinders proper jaw closure should be removed if possible.

After all risk factors have been eliminated, the affected patient can in many cases be helped with a so-called functional splint or bite splint.

Read more on the topic: Bite splint and crunch splint

Such a splint can be removed from the patient's mouth and should be worn at night if possible. It is usually possible to counteract the effects of craniomandibular dysfunction by wearing the functional splint and restore the even strain on the masticatory muscles.

The splint is usually made for the lower jaw and covers the entire row of teeth. Since, as already described, the muscles of different body regions interact, wearing a functional splint in patients with craniomandibular dysfunction has a positive effect on the entire body statics.
For this reason, the treatment must urgently be coordinated with a physiotherapist and / or orthopedic surgeon.

Heat and cold therapies can be used to relieve pain. Various manual treatments, acupuncture and learning relaxation techniques are also pain relievers for most patients.

A bite splint is made at the beginning of therapy. This is initially worn at night for two to three months and checked weekly by the doctor and changed if necessary. If the symptoms improve, a definitive solution can be considered. This consists of the crowning of the teeth in order to achieve the desired position without a splint.

Manual therapy for crandiomandibular dysfunction

Manual therapy is prescribed by the dentist and carried out by the physiotherapist. There are special therapists with additional training who know the head and neck area exactly. A prescription is usually issued for 10 appointments of 20 minutes each. The aim of therapy is Relaxation of the Musculature as well as the tissue. At the same time, exercises for relaxation should be learned, which can also be used at home.

The physiotherapist takes an anamnesis to find out the exact symptoms. Only then does he know exactly which muscle groups to start treatment on. The chewing muscles and the muscles of the cervical spine are (almost) always affected. In some cases the disease can spread to the whole organism and cause discomfort in the back or knees. These have to be improved by other (physio) therapeutic measures.

However, the focus should be on eliminating the cause. If left untreated, manual therapy is only treating a symptom.

Self help

Because the emergence of craniomandibular dysfunction in many cases due to stress is, compensatory employment and that Learning certain relaxation techniques be helpful.
Patients who often deal with the Grind your teeth and / or the Jaws too tight together can bite yourself with it To remedy the situation, the Tongue aimed at the roof of the mouth to lay.

This makes them relax Masseter muscles, the lower jaw moves a bit away from the upper jaw and pain relief occurs relatively quickly.

Helpful exercises

Since the CMD is a complex clinical picture, there are special exercises that can be used for the various symptoms. It is important that these exercises initially only under instructions should be carried out by an appropriate therapist. The correct technique must be adhered to, as complaints cannot improve with incorrectly performed exercises. Sometimes it just makes them worse. The exercises are used several times a day (morning-noon-evening).

At home you should check yourself regularly in front of the mirror to avoid mistakes. After a few weeks, sometimes even after a few days, successes can be seen. Relaxation exercises are particularly important for night crunching. A walk before going to bed or a real "workout" through sporting activities is helpful here. Massaging the masticatory muscles can also help.

To do this, use your index and middle fingers to perform circular movements over the stressed jaw muscles. Furthermore there is Stretch-, Stabilization- and Strengthening exerciseswhich help the muscles and the joint. A more detailed description of the exercises is dispensed with due to the points listed above.

What is the use of an occlusal splint?

An occlusal splint against the CMD can be useful in many cases if the dentist has chosen the right type of splint. One must distinguish here whether the CMD through stress or by one wrong bite is conditional.

If stress is the trigger, one can JIG rail, i.e. a splint with a bite block in the region of the front teeth can be useful. Here the nocturnal crunch can be reduced. If a wrong bite is the trigger, a special splint must be made to properly compensate for the bite. In most cases, the symptoms can be reduced if the splint is worn regularly. On average, there is an improvement in symptoms, especially the pain achieved by approx. 60%.

homeopathy

Herbal remedies, which can be used against CMD, are primarily aimed at reducing or even eliminating the nocturnal crunching, also known as bruxism. A positive side effect can be that the associated toothache also disappears. Homeopathic globules such as Belladonna C9 or Chamomilla C9which reduce nervousness. For example, against pain Stramonium or Asa foetida help. However, one should never take homeopathic remedies lightly. If one struggles with the pain for too long and waits for cause-related therapy, the original disease can always progress. If there is no improvement, the doctor must be consulted!

Which doctor treats craniomandibular dysfunction?

The CMD can theoretically be treated by a normal dentist, since every dentist has been trained in this area through his studies. However, there are special advanced training courses in this area that dentists can complete as advanced training. However, this is not a specialist, such as an ophthalmologist.

Rather, it is a normal general dentist with a specialization. Since the clinical picture of CMD is a very complex clinical picture, which can be accompanied by many different symptoms and is often treated incorrectly, it is advisable to visit a dentist with special training.

Treatment cost

The costs of treating the CMD are only partially covered. There is no uniform regulation on this. However, those with statutory health insurance often bear the costs themselves. CMD requires diagnostic procedures that can only be carried out by specialists.

The subsequent therapy must also be precisely tailored to the disease and is only possible in close consultation between the doctor's practice and the dental laboratory. The costs therefore depend on the diagnostic effort and the type of therapy; exact figures cannot be given here. However, you should apply to the health insurance company in advance to cover the costs and, if necessary, confirm this in writing.

Craniomandibular dysfunction and toothache

In some cases, a toothache can also occur. These can be triggered by overloading individual teeth or groups of teeth. A Overload occurs when certain teeth meet their opponent before all other teeth and so must absorb all force first. Mainly at night when you are unconscious Crunches or press your teeth together, teeth with previous contacts are extremely stressed. After a while, pain develops.

On the other hand, nerve irritation can occur. Here a nerve pathway that supplies the teeth is damaged or irritated in its course. In this case, the tooth that actually hurts is not the actual cause of the symptom. The situation is similar, for example, with the Trigeminal neuralgia. Here the trigeminal nerve is damaged at some point and then triggers spontaneous pain attacks.

Craniomandibular dysfunction and headache

Very often, patients suffering from CMD also complain of a headache. The cause of this is the muscles. In the head and neck area in particular, the muscles of the jaw and neck are very closely linked. A persistent malposition or movement of the jaw can then spread to the entire system and cause discomfort. Since the muscles are partially attached to the back of the head or to the temple, this can create a feeling of headache.

Influence of the CMD on the lymph nodes

Lymph nodes are a so-called filter station for the lymph. The lymph describes a body fluid that is located in the lymph channels. It contains electrolytes, proteins and white blood cells. There are many of these knots in the head and neck area. When there is inflammation, these are enlarged as they try to fight off the disease. The CMD does not necessarily have to be accompanied by an enlargement.

However, since tooth inflammation, sore throat, joint diseases or other complaints are also associated with this, it is not uncommon for the lymph nodes to swell. As a precaution, you should have this symptom clarified with your doctor so that no other disease is overlooked.

Osteopathy

Osteopathy deals with the treatment of the cause of the disease, a holistic view of the person is carried out here. The aim is to find connections between the CMD complaints and individual organs and other (pre-) diseases so that the cause of the complaints can be targeted. An osteopath can specifically dissolve blockages between bones and other tissues and thus alleviate symptoms. However, since osteopathic training is not legally regulated in a uniform manner, a doctor cannot yet draw up any prescriptions for it. It is a purely private service.

Are there any operations to treat CMD?

If conservative methods, i.e. manual therapy or the incorporation of a splint, fail, it can make sense to think about an operation. As acute therapy here is the Lavage, also Joint irrigation called to cite. She will be in general anesthetic carried out and is intended to ensure that inflammatory cells and pain messengers are flushed out of the joint. If nothing helps and the joint even grows together with the base of the skull, only one can open temporomandibular joint surgery help.

Here the joint is shown through a cut in front of the ear, any connections are separated and in some cases a cartilage disc or similar is inserted. This material should then prevent adhesions from occurring again. This procedure represents the so-called "ultima ratio" and should only be used in really urgent cases without improvement.