If there is a dysregulation between the muscles and joints of the lower jaw (lat. Mandibula) and the cranium (lat. Cranium), one speaks of the sequelae in the collective term of craniomandibular dysfunction (CMD).
Dr. Dr. Manfred Nilius, a specialist in oral and maxillofacial surgery, explains in an interview why these different malpositions of the jaw and teeth can also be the cause of headache and back pain and how to treat a CMD.
How is a CMD created?
Nilius: When you ask about the causes of a CMD, there are four different areas of the body that can cause problems:
- the chewing 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, it often affects the other areas of the jaw system.
Specifically, for example, misaligned teeth, jaw muscle tension or nerve disorders can trigger a whole range of symptoms that can be attributed to CMD.
Can stress also trigger a CMD?
Nilius: Yes, emotional stress can often favor a CMD. When we are under stress, the sympathetic nerve, the sympathetic nervous system, is more active than usual. It is strongly connected to the lower jaw via individual nerves. We straighten our shoulders, literally cramp and bite our "teeth together".
This can lead to a shortening of the masticatory muscles, which in turn can lead to headaches and jaw malpositions. If you grit your teeth at night, you try to reduce stress in your sleep.
What symptoms could indicate a CMD?
Nilius: There is a wide range of symptoms associated with CMD. When patients come to me and report pressure or pain in the jaw toward the ears, it can be assumed that such a jaw dysregulation is present.
Other symptoms that speak for a CMD are:
- a headache
- Sore muscles in the jaw
- Jaw cracking when opening the jaw
- abraded teeth
- abraded canines
- Gentleness of the jaw
- Pelvic Tilt
- Shoulder inconsistency
- Pressure and / or pain in the temporomandibular joint
When does a CMD have to be treated?
Nilius: Anyone who wonders only about the cracking of the temporomandibular joints and feels no impairment in everyday life, does not necessarily have to do something against the jaw dysregulation.
Anyone who has pain in the jaw or has to fight tooth decay, should definitely talk to the attending physician, which options there are to treat the CMD individually.
Which doctors can diagnose a CMD?
Nilius: Because CMD can affect many parts of the body, it depends on the area of the body that causes the pain or problems. Not only the dentist can be the right contact, but also an orthopedist, a surgeon or even a psychotherapist.
How is a CMD diagnosed with a dentist?
Nilius: First, you have a dental history. It is learned whether teeth have been pulled, whether there is a uniform bite of the teeth or whether one can observe a loss of support zone in the molar area between the two jaw halves.
In addition, one can look at the facial structure of the patient and, if necessary, feel it: How does the musculature run? Are there any irregularities in the jaw muscles?
In case of doubt, the activity of the muscle can be measured with an electromyogram to find out whether it is a muscular or a nervous cause of CMD.
Also, the diagnosis of permanent neck and neck muscle spasm may contribute to the further assessment of the extent of CMD.
Who can treat a CMD except a dentist?
Nilius: If there is tension in the muscles of the jaw, for example, a family doctor can prescribe medication to relax the muscles.
If there are problems with the spine, an orthopedist or, in severe cases, a maxillofacial surgeon can be consulted.
If too much emotional stress in the patient's everyday life is the trigger for CMD, a psychotherapist can also help to solve the stress.
What types of treatment of a CMD are there?
Nilius: For a dentist, the simplest thing to do is to make a crunch bar to relieve the burden of nocturnal crunching on your teeth. The plastic splint prevents abrasion of the teeth and can thus protect against further consequences of a CMD. The bite splint, however, does not solve the problem of crunching. This can only targeted relaxation exercises and long-term stress reduction.
Alternatively, so-called "table-top veneers", a kind of cemented partial crown, can be applied to the occlusal surface of the tooth, thereby preventing further tooth wear.
If muscle hardening is present, Botox can also be injected into the jaw musculature, leading to relaxation of the jaw.
If there is already an inflammation of the temporomandibular joint (arthritis), it can be treated with anti-rheumatic drugs as well as with movement and stretching exercises.
If the arthritis passes into osteoarthritis (joint wear and tear), surgery may be necessary.
Are there any alternative healing methods that can be used?
Nilius: In many cases, acupuncture or moxibustion, a warming therapy from Traditional Chinese Medicine, can help.
Alternatively, pain and cramping in the jaw can also be treated with homeopathy. Here, the respective means and their dose should be individually assembled by a homeopath. The main approach here is the relaxing component for the jaw musculature.
It is always advisable to regularly move the whole body in general, but also the jaw in particular to relax the masticatory muscles. In some cases, a targeted physiotherapeutic treatment, such as muscle shortening of the facial muscles, to relieve the symptoms may be useful.
When will surgery be necessary?
Nilius: Only in the rarest cases a surgical procedure is needed. If the articular ligament tears in the temporomandibular joint partially or completely, this can be remedied with a ligament recovery or a band renewal.
Minimally invasive procedures for the treatment of CMD include the so-called lavage ("wash"), in which an attempt is made to rinse the cause of inflammation out of the temporomandibular joint.
What can one do as a patient against a CMD?
Nilius: First, you should try to change your lifestyle and take the warning signs of overloading the body seriously. The first priority is to reduce emotional and physical stress.
In addition, the following tips can help prevent or improve a CMD:
- Pay attention to your posture: Imagine that a thread attached to your occiput would pull you into an upright position - even if a small double chin is created.
- Pay attention to how and how long you are sitting in front of the computer. The best solution is to sit straight up and position the screen at eye level so you do not have to look forwards and tilt your head back too much.
- Adjust your glasses regularly to your eyesight. Those who are not optimistic tend to stretch their heads towards the screen or the book and lose their healthy posture.
- Relax the jaw consciously: Loosen your jaw muscles frequently and occasionally massage your jaw and jaw joint to relax your jaw muscles.
- Sleep on a rather flat pillow. If you are lying on a pillow that is too high, it overstrains your neck muscles.
- Try to do sports regularly. Sport also helps muscles to relax better, and can also reduce emotional stress.
So who leads a healthy lifestyle and tries to avoid stress, can optimally counteract an existing CMD or prevent its formation even.
Can a CMD be completely cured?
Nilius: If a CMD is detected early, the success rate with the right therapy is around 80 percent. It is therefore worthwhile to contact the dentist or family doctor if you have jaw and neck complaints.
What happens if you do not treat a CMD?
Nilius: In the worst case, there is a CCD, a cranio-cervical dysfunction. This shortening of the neck muscles must be treated by an orthopedist and is usually associated with severe pain.
When it comes to osteoarthritis, severe joint disease and cartilage loss are not uncommon.
Anyone who does not take action against CMD for a long time runs the risk of becoming a chronic pain patient. A dentist is then often powerless. In a pain therapy then followed by treatments with minimal doses of analgesics or antidepressants, which mitigate the pain perception. The dysregulations around the jaw system can only be curbed, not reversed.