Craniomandibular Dysfunction (CMD)
Craniomandibular dysfunction, abbreviated as CMD, is an umbrella term for mostly painful disorders of the masticatory muscles and the temporomandibular joints. It is about 75% muscle pain and only 25% TMJ pain. Like the more common neck, shoulder and back pain, CMD belongs to the group of musculoskeletal pain. Women of fertile age up to menopause are predominantly affected, men to a lesser extent with the same age distribution. CMD in children is rare, with an increasing incidence during puberty and adolescence up to a peak age of about 40 years, and a decreasing incidence thereafter.
In addition to age and gender, numerous psychological factors have been identified as increasing the risk of CMD (anxiety disorder, depression, post-traumatic stress disorder, etc.). At any given time, 3-10% of the population may experience symptoms of CMD, but most of these do not require treatment. Craniomandibular dysfunctions are usually benign and self-limiting, so they disappear on their own, so simply waiting is often sufficient for mild to moderate symptoms.
In some cases, however, they can lead to persistent, chronic pain. The need for treatment depends entirely on the personal assessment of the person affected.
Symptoms:
In the foreground are pains in the cheeks, temples and face. Muscle pain tends to be dull and difficult to localise, while temporomandibular joint pain usually has a bright, stabbing character and can be localised well in front of (or in) the ear. The second most important symptom can be restrictions in the mobility of the lower jaw. In the past, joint noises (cracking, rubbing) were often overestimated, which in themselves are diagnostic signs rather than a disease in their own right and should not be a cause for diagnostic or therapeutic efforts.
Diagnosis:
The most important part of the diagnosis is the taking of a detailed, pain-related medical history, followed by a brief clinical examination and a panoramic X-ray. If there are indications of psychological stress factors, an orienting examination with suitable psychometric questionnaires should always be carried out. Articulator fitting, further instrumental functional diagnostics and magnetic resonance imaging are usually unnecessary, expensive and stressful and distressing for the patient.
Therapy:
CMD disappears in most sufferers even without therapy. For this reason, therapy should only serve to help patients get over the hump. If the patient suffers from CMD and is highly affected, a multi-modal pain therapy is advisable. Success can be recorded for almost all therapeutic approaches: the more one tries, the more effect can be recorded. The therapy should therefore be non-invasive, reversible and as simple and inexpensive as possible.
These requirements are met by education, instructions for self-help (massage, heat application, specific and non-specific relaxation methods), physiotherapy, bite splint and suitable medication. Psychological pain therapy can be added and has proven to be as effective or better than some other therapeutic approaches. In general, major dental interventions such as denture replacement or orthodontic treatment are not appropriate therapies for CMD, but only burden patients with high costs and risks.
Prognosis:
CMD is a benign and self-limiting condition that usually disappears without therapy. Affected people should not be worried and optimistically trust in self-healing. In the rare cases of chronicity, a pain therapist or a doctor/dentist familiar with pain therapy should be consulted.