Craniomandibular dysfunction (CMD)

The symptoms are extremely varied and complex: those affected have pain in various places, cracking in the jaw joints or ground down teeth. It is therefore not easy for dentists to diagnose CMD either. The causes are usually misaligned teeth, but the psyche also plays a decisive role. Misalignments of the temporomandibular joint are easily treatable – usually without surgery. However, surgical intervention is also possible if all other therapies have been exhausted.

What is craniomandibular dysfunction?

In people with temporomandibular joint disorders, the function of the temporomandibular joint, the masticatory muscles and sometimes also the muscles of the cervical spine is restricted. Dentists have coined the collective term “craniomandibular dysfunction”, which encompasses all disorders and clinical pictures. It is derived as follows: “cranium” means skull, while “mandible” means the jaw. The malfunctions are therefore located in the area between the skull and the upper and lower jaw. The temporomandibular joints and the chewing and neck muscles are also involved.

Craniomandibular dysfunction – classification

Depending on the cause, craniomandibular dysfunction can be roughly categorized as follows:

• Disorders in the chewing and neck muscles involved in the movement of the jaw. The consequences are pain, which can occur only during movements (chewing), but also permanently.
• Joint changes, either due to joint wear or certain diseases: Examples include osteoarthritis, delayed or increased growth and chronic inflammation in the temporomandibular joint. These changes can affect all structures of the temporomandibular joint: Joint capsule, ligaments, cartilage disk (discus articularis), articular cartilage or bone
• The cartilage disc in the temporomandibular joint (discus) is in the wrong position or its mobility is restricted.

Several disorders can also occur in combination, which reinforce each other. As a result, those affected often experience very unpleasant symptoms – from pain in many regions of the body (head, shoulders, neck, back, joints) to cracking noises in the jaw joint and problems opening the mouth. The causes often lie in misaligned teeth, but stress and the psyche are also key players.

Patients are often diagnosed with craniomandibular dysfunction at a late stage. Many have made countless visits to various doctors. This is also due to the large number of different symptoms. But once a diagnosis has been made, temporomandibular joint disorders can be treated well. Dentists can often alleviate the symptoms without surgery, for example with splint therapy (occlusal splint). Physiotherapy can also be helpful.

Craniomandibular dysfunction – frequency and age

Even if craniomandibular dysfunction is still largely unknown to many as a clinical picture, the Society for Dental Health, Function and Aesthetics (GZFA) estimates that around 20 percent of the population suffer from a CMD symptom that requires treatment. However, even higher figures can be found in the literature: The incidence of CMD is also stated to be around 40 percent or higher.

Most affected people experience headaches and back pain. In principle, CMD can affect people of any age. But younger people in particular seem to suffer increasingly from malfunctioning teeth, jaw joints and masticatory muscles. People who experience a lot of stress in their everyday lives and at work also have a higher risk of craniomandibular dysfunction. This is not uncommon in today’s meritocracy.

Craniomandibular dysfunction: causes and risk factors

The causes of temporomandibular joint disorders and craniomandibular dysfunction can be many and varied. There are usually several factors at work at the same time when a CMD develops. Experts believe that the basis for the malfunction is tension in the chewing, head and facial muscles involved in the chewing process. And this in turn has various causes and reasons.

Craniomandibular dysfunction: Causes are misaligned teeth

In some people, the teeth of the upper and lower jaw do not fit together properly. They do not interlock seamlessly and the bite is not right. Dentists call this malocclusion or “incorrect interlocking”. Possible reasons for misaligned teeth are

• Faulty, ill-fitting dentures, for example bridges, crowns, partial crowns
• Fillings too high or too low
• Tooth gaps due to tooth loss
• Incorrect orthodontic treatment
• Teeth grinding (bruxism): Those affected clench their teeth (usually at night) with high pressure and grind them. This causes the teeth to wear down and shorten if we do not treat the grinding. Due to the missing pits and cusps on the teeth, they no longer interlock properly.
• Genetic causes: Sometimes teeth are not set and the dentition is not formed normally; this occurs more frequently in some families.
• Sometimes: Functional disorders of the spine or pelvis that can affect the position of the teeth and temporomandibular joint

To compensate for these misaligned teeth, the muscles of the chewing apparatus, face and head become increasingly tense and cramped. This can lead to craniomandibular dysfunction.

Temporomandibular joint disorders: Stress can also be a cause

The psyche, stress and emotional strain can also play a role in temporomandibular joint disorders. People who are under a lot of pressure in everyday life, at work, in a partnership or in family life often react by grinding their teeth in their sleep at night. Some even clench and grind their teeth during the day to get rid of stress and tension or to process negative feelings and situations. The masticatory muscles become tense and craniomandibular dysfunction can develop. If CMD is already present, stress can further exacerbate the symptoms and cause them to become chronic.

Symptoms: Craniomandibular dysfunction with various signs

Temporomandibular joint disorders and craniomandibular dysfunction can cause countless different symptoms. They can affect the head and chewing apparatus, but can also occur in other parts of the body. Therefore, the diagnosis of CMD is not easy for us either. Sometimes we initially make a completely different diagnosis, because headaches and back pain are not necessarily associated with an incorrect bite, the teeth or the temporomandibular joint. They occur in many diseases.

Those affected usually feel pain due to muscle tension, which can manifest itself in many different areas of the body – not just the chewing apparatus. The most important signs that may indicate CMD:

• (Tension) headaches, migraine
• Shoulder, neck and back pain
• Toothache
• Sensitive tooth necks, loose and abraded teeth, receding gums
• Pain, cracking or rubbing in the temporomandibular joints
• Problems and pain when chewing, the mouth can only be opened to a limited extent
• Difficulty swallowing, “lumpy feeling” in the throat
• Facial pain, numbness in the face
• Muscle and joint pain
• Earache, ringing in the ears (tinnitus), cracking in the ear
• Dizziness
• Visual disturbances: Eye flickering, double vision
• Pain behind the eyes, increased sensitivity to light

These symptoms can also occur in many other diseases. There does not necessarily have to be a temporomandibular joint disorder behind it. Always consult us if you experience several of these symptoms. We specialize in the diagnosis and treatment of CMD.

Craniomandibular dysfunction: Diagnosis with us

We always start by asking you about your medical history (anamnesis). The following aspects are of interest to us:

• What symptoms do you experience?
• How pronounced are they?
• In which regions of the body do the symptoms manifest themselves?
• Are there situations in which the symptoms are particularly intense?
• Do you have any known underlying diseases?
• Do you suffer from dental or jaw disorders?
• Do you grind your teeth?
• Do you have a lot of stress in your everyday life, at work or with your family?

These and other questions provide us with initial clues for the diagnosis. This is usually followed by a so-called functional analysis, or FAL for short. It uncovers functional disorders of the teeth, jaw joints and masticatory muscles. There are different types of functional analysis:

• We first check the condition of the teeth and the dentition with our hands, palpate the masticatory muscles, determine possible noises in the temporomandibular joint and test whether there are any restrictions in chewing movements or mouth opening.
• Articulator: A chewing simulator (articulator) is used. The appliance simulates the individual tooth contacts (occlusion) and movements of the temporomandibular joints. Plaster models of the upper and lower jaw are used, which have previously been made to fit precisely. In this way, we rule out the possibility of muscle tension and reflexes of patients giving a false picture.
• Magnetic resonance imaging (MRI = magnetic resonance imaging) of the temporomandibular joints: The procedure works with strong magnetic fields. The MRI provides detailed cross-sectional images and shows the anatomy and position of the bony and soft structures of the temporomandibular joint. This allows anomalies, functional disorders, inflammation or wear and tear to be detected.
• Computer tomography of the head: X-rays are used to produce sharp, three-dimensional cross-sectional images of the jaw bones, joints and teeth.
• X-ray of the upper and lower jaw

Craniomandibular dysfunction: prevention, early detection, prognosis

There are no specific measures to prevent temporomandibular joint disorders. However, some factors are known to trigger craniomandibular dysfunction and you can influence them yourself. Above all, this includes stress and psychological strain at work and in everyday life. Good stress management can therefore be one way of preventing CMD.

Special measures for the early detection of CMD are also not known. As a general rule, you should attend regular preventive appointments with your dentist (twice a year). They can recognize problems with the teeth or the chewing apparatus at an early stage. And: Always visit us if you experience symptoms, such as pain in different parts of the body.

Progression and prognosis of craniomandibular dysfunction

The course and prognosis of temporomandibular joint disorders and craniomandibular dysfunction are generally good. The chances of recovery are high if we diagnose and treat the disease at an early stage. Then you have a good chance of getting rid of your symptoms permanently. However, you need to have a little patience and perseverance and stay on the ball with the therapy. And you have to tackle the cause, such as stress or emotional strain. The longer the CMD persists, the higher the risk of consequential damage to the teeth and the entire chewing apparatus.

Craniomandibular dysfunction: treatment is usually successful without surgery

The treatment of temporomandibular joint disorders and craniomandibular dysfunction always depends on the cause. However, the clinical picture can be very complex and it sometimes takes time for the first successes to appear. You therefore need a certain amount of stamina.

It is always important that specialists from a wide range of disciplines work closely together as a team and jointly devise and carry out the treatment. The first point of contact is usually your dentist. There are now dentists who have specialized in the diagnosis and treatment of craniomandibular dysfunction and have received special training. Depending on the findings, they involve other experts, for example from the fields of physiotherapy and psychology, or consult ear, nose and throat specialists.