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One of the most prominent symptoms of craniomandibular dysfunction is pain in the facial area, especially in the cheeks, jaw joints and temples.

This can be caused either by overloading the masticatory muscles and/or the temporomandibular joints. In most cases, it is not the intensity of the pain that is the main problem, but its duration and the uncertainty as to when and whether it will finally stop. The situation becomes even more complicated when several causes of pain coexist and when the place where the pain is felt no longer corresponds to the place where it originated; this is referred pain.

Fortunately, sophisticated multi-stage functional diagnostic examination systems are now available, which we can use to identify the cause of existing pain – including transferred pain. Without such a functional diagnostic basis, targeted functional therapy is not possible – says the relevant guideline.

Normally, the temporomandibular joints move without making any noise. Patients with craniomandibular dysfunction, however, sometimes develop temporomandibular joint noises as a typical symptom. These can take the form of cracking or rubbing.

Jaw joint clicking is usually caused by a misalignment of the joint head (mandibular condyle), which prevents the joint cartilage (articular disc) from sliding normally and ultimately causes it to move jerkily – the result is clicking. In some cases, the cracking changes over time and at some point is no longer perceptible. In this case, the situation is more advanced and the articular cartilage (discus articularis) no longer manages to reach its correct position. A cracking noise alone is no cause for concern. However, these often occur in combination with other symptoms; in these cases, a more precise diagnosis is indicated.

Restrictions in mouth opening are a typical symptom of craniomandibular dysfunction (CMD).

Normally, the upper and lower jaws can be opened without obstruction. A distance of around 4 centimeters is usually achieved between the upper and lower front teeth. Opening times below this distance are referred to as mouth opening restrictions and are a typical symptom of craniomandibular dysfunction. The cause can lie either in the muscles of the masticatory organ (craniomandibular system) or in the temporomandibular joints. Both tissues are often involved and support each other, which complicates the situation.

A special examination is required to determine the cause of mouth opening restrictions (clinical functional analysis). If necessary, further differentiating examination techniques are added (manual structural analysis). In special cases, we also arrange for a special radiation-free imaging examination (magnetic resonance imaging) to rule out the presence of abscesses and other neoplasms.

Teeth that do not meet evenly impair the function of the occlusal surfaces (occlusion). This is a typical sign of craniomandibular dysfunction (CMD).

Normally, human teeth are arranged in such a way that they meet evenly and provide stable support for the rows of teeth against each other. If the chewing surfaces of the teeth do not meet evenly at the same time, this normal function is not possible; instead, individual teeth are overloaded and the chewing muscles and temporomandibular joints may also be overloaded.

At the same time, the shape and position of the anterior teeth ensures that the anterior teeth prevent the contact of the posterior teeth when chewing; in this way, nature avoids excessive force being exerted on the posterior teeth and the temporomandibular joints. However, if the anterior teeth are positioned incorrectly or have lost their shape and function prematurely due to tooth wear, this leads to overloading of the posterior teeth and/or the temporomandibular joints.

The extent to which the teeth are evenly supported on each other and the lateral teeth are relieved during jaw movement can be determined by means of functional analysis examinations. This is based on a special examination without instruments, the clinical functional analysis. If necessary, we supplement this with additional examinations based on the production of jaw models and the measurement (registration) of the jaw position and jaw movement. On this basis, we can then check to what extent there is a malocclusion and – if so – how corrective functional therapeutic treatment should be carried out.

Teeth that react sensitively when biting together or to heat or cold stimuli are a typical symptom of craniomandibular dysfunction (CMD).

Normally, teeth do not react sensitively to tooth contact or heat or cold. This is different for teeth that are overstimulated as part of a CMD, be it due to teeth clenching and/or teeth grinding. The teeth are mechanically overloaded and the sensory organs within the teeth (pulp) and in the periodontium react with a kind of fault signal. This can escalate into considerable pain. This also applies to cases in which the inside of the hard tooth substance is no longer protected by the enamel due to loss of substance (tooth wear). It is therefore important to find out and eliminate the individual causes through appropriate examinations.

The diagnosis initially involves a thorough examination, clinical functional analysis and recording of tooth wear. If necessary, further examinations are carried out to recreate the shape of the teeth in the form of special jaw models and the tooth contacts in the model in order to evaluate these and their cause – the basis of an individual and structured functional therapy.

Tinnitus is a complex symptom, the cause of which is not really clear. If craniomandibular dysfunction (CMD) is present in addition to tinnitus, there may be starting points for therapy.

In these cases, there is sometimes a connection in the form that increased muscle tension in the masticatory organ indirectly triggers an effect in the auditory organ and thus influences the tinnitus. In these cases, it is important to precisely identify the type of muscular overload in the masticatory organ in order to subsequently find a way to eliminate this overload.

Various dental and functional diagnostic examinations are therefore required for diagnosis. These include a clinical functional analysis as well as an examination of the masticatory muscles and temporomandibular joints under load, the manual structural analysis. In the textbook co-edited by our founder PD Dr. Ahlers, a separate chapter is devoted to this topic. Prof. Dr. Peroz, Charité Universitätsmedizin Berlin, wrote and updated it. The contents form the guideline for our work in this area in our specialized practice.

The situation is even more complex with dizziness: Dizziness is not part of craniomandibular dysfunctions (CMD), but in patients with dizziness and CMD, the dizziness sometimes improves drastically after successful treatment of the CMD.

First of all, the vestibular organ and the masticatory organ are separate systems. In some patients, however, the successful treatment of craniomandibular dysfunction improves dizziness to an astonishing degree – apparently a reduction in muscular dysfunction plays a part in this.

We cannot promise such an improvement, but if, in addition to dizziness, there is a CMD that requires treatment anyway, it makes sense to treat it in a particularly structured way.

Orthodontic treatment corrects the position of the teeth. Before orthodontic treatment, it should therefore be checked whether craniomandibular dysfunction (CMD) is present. If CMD is present, it is advisable to use dental functional therapy to calm the masticatory muscles and stabilize the jaw position before orthodontic treatment.

The aim of orthodontic treatment is to optimize the position of the teeth within the scope of what is individually possible and to completely stabilize the function of the chewing organ. It is important that the orthodontic treatment is carried out in accordance with the orthodontist’s aims. Existing craniomanbular dysfunction (CMD) is often an obstacle to this, because dysfunctional masticatory muscles tend to become more functionally derailed by additional orthodontic influence on the masticatory organ. Existing misalignments of the temporomandibular joints are not automatically improved by orthodontic correction alone.

Before orthodontic treatment, it should therefore be checked whether CMD is present. The CMD brief findings developed by PD Dr. Ahlers or the CMD screening, which he co-developed, are used for this purpose. If this shows that CMD is present, it makes sense to first carry out a functional diagnostic examination before orthodontic treatment and, if necessary, to improve the initial situation for orthodontic treatment by means of structured functional therapy. If orthodontic treatment is then carried out after functional therapy pre-treatment – and in accordance with the results of this treatment – it has significantly better conditions for a proper and successful outcome.

We therefore work together with numerous orthodontists on a basis of trust and treat their patients on referral prior to the planned orthodontic treatment. And we are on hand during and after orthodontic treatment to intervene to correct any functional abnormalities.