CMD diagnosis and treatment is something for specialists!
Craniomandibular dysfunctions (CMD) are disorders of the function of the chewing organ between the skull (cranium) and lower jaw (mandible). Specifically, the interaction between the temporomandibular joints, the masticatory muscles and the teeth is disturbed. This results in either pain or functional impairment in the affected tissues.
Symptoms of CMD with involvement of the temporomandibular joints
According to the definition of the DGFDT as the responsible professional association, the following symptoms indicate that you are suffering from CMD:
- Disorders in the course of the jaw opening movement, especially when speaking, singing or chewing;
- Mouth opening restrictions (mouth no longer opens as well and as wide as it used to);
Jaw joint noises in the form of joint cracking or rubbing noises; - Pain in the facial area;
- Temporomandibular joint pain (easily confused with – supposed – “earache”).
Symptoms of CMD with involvement of the muscles
Pain in the facial area, especially in the cheeks and temples, is often an indication of muscular dysfunction in the sense of CMD. In some cases, this pain does not occur at the location of the muscles, but deviates from them (“referred pain”):
- Pain in the teeth, at rest or when chewing, in the upper and lower jaw;
- Disorders in the occlusion at rest and/or when the teeth rub against each other;
- Headaches or neck pain.
Video animation: Development of CMD overloading of the masticatory muscles and the resulting pain within the masticatory muscles and – as transferred pain – beyond the muscle bellies (Video: PD Dr. Ahlers/Alila Medical)
Self-test for the presence of CMD
Would you like to test yourself whether you suffer from CMD?
A team from the CMD-Centrum Hamburg-Eppendorf led by PD Dr. Ahlers developed the CMD brief assessment (CMDcheck) over 20 years ago. This has now become the dental standard for CMD screening; case law requires it before treatment with dentures (OLG Munich II, judgment of 18.01.2017, Ref.: 3 U 5039/13). You can find a version for patients on the Initiative ProDente website.
Who treats CMD - and when do you need specialists?
In simple cases, CMD is limited to overloading of the masticatory muscles and resolves itself or improves after dental treatment with a normal “grinding splint”.
The situation becomes more complicated if the pain does not go away on its own or after treatment with a grinding splint, or if there are additional functional disorders, such as movement disorders of the temporomandibular joints or even blockages of the mouth opening, or if the teeth are unevenly supported.
For such situations, there are CMD specialists with special knowledge in the diagnosis and treatment of craniomandibular dysfunctions who are certified by the German Society for Functional Diagnostics and Therapy (DGFDT) as the responsible specialist society.
CMD diagnostics: special examination procedures
CMD specialists have special examination procedures at their disposal. These can be used to determine the individual situation very precisely as the basis for a qualified treatment decision. Most of these procedures are now covered by guidelines or scientific reports from professional associations. Almost all of them have been developed with the participation of PD Dr. Ahlers as a specialist from the CMD Center Hamburg-Eppendorf (marked with an * below). Textbooks describe the exact procedure for specialists.
- Clinical functional analysis*^
- Manual structural analysis*^
- Assessment of orthopaedic and psychological co-factors using special tests*^
- Cranial transfer of the upper jaw position*
- Jaw relation determination in habitual occlusion*
- Centric jaw relation determination*^
- Condylar position analysis for comparative measurement of the different jaw positions*^
- Condylar movement recording for individual adjustment of chewing simulators*
- Computer-assisted condylar movement analysis to assess movement coordination*
- Evaluation of magnetic resonance tomograms of the temporomandibular joints with special positioning templates
Computer-aided diagnostic evaluation ^
Legend
* Procedures are described in current guidelines with the participation of PD Dr. Ahlers from the CMD Center Hamburg-Eppendorf;
^ Procedures are described in standard textbooks from our team.
CMD therapy: individual, depending on the situation
Individualized functional therapy is only possible on the basis of the respective examinations. At the CMD Center Hamburg-Eppendorf, we have all modern treatment methods at our disposal, sometimes in cooperation with specialists from other institutions.
These include the following procedures
- Occlusal splints – in all kinds of different designs, made of various materials with flat or specially adjusted occlusal surfaces and set in jaw positions determined in advance by diagnostics;
- the accompanying monitoring of the jaw position and functional status assumed with the occlusal splints and, if necessary, their adjustment;
- specially adapted physiotherapy and manual therapy;
- Orthopaedic stabilization therapy to reduce muscle tension in the masticatory organ;
- Speech therapy to modify pathological tongue activity;
- Biofeedback and relaxation exercises to reduce the tone of the masticatory muscles;
- Injection of local anesthetics to temporarily eliminate muscle tension or botulinum toxin (“Botox”) for long-term reduction of muscle tension in the masticatory muscles;
- oral surgical interventions for the treatment of therapy-resistant joint inflammation;
- in rare cases, additional dental-restorative and/or orthodontic treatment to adjust the occlusion and tooth position to the changed settings of the temporomandibular joints.
You are at one of the first professional addresses with us: The current scientific communication on functional therapy has been developed under the coordination of Dr. Imhoff, Cologne, and PD Dr. Ahlers, CMD-Centrum Hamburg-Eppendorf.
Where can you find CMD specialists?
The DGFDT maintains a directory of qualified CMD specialists on its website. The first DGFDT-certified CMD specialist for functional diagnostics and therapy in northern Germany was PD Dr. M. Oliver Ahlers, founder of the CMD-Centrum Hamburg-Eppendorf after many years as head of the CMD consultation at the University Medical Center Hamburg-Eppendorf. More about PD Dr. Ahlers
The CMD Center Hamburg-Eppendorf is now one of the leading institutions in the diagnosis and treatment of CMD, teeth grinding (bruxism) and tooth wear. The team not only works according to current guidelines – it has helped to shape them! And the location opposite the University Medical Center Hamburg-Eppendorf is not only easy to reach, it also enables close cooperation with colleagues at the head center there, especially in dental prosthetics, orthodontics and the clinics for oral surgery, neurology and radiology.
In addition to PD Dr. Ahlers, the team of specialists now also includes colleagues Tim Petersen, Dr. Lukasz Katzer and Jakob Röhl – all of whom have moved to the CMD Center from the UKE. As specialists, they examine and treat significantly more CMD patients than the consultation hours of large university clinics, with patients from Luxembourg to Lithuania. The practice equipment at the CMD Center is optimized for this purpose, supplemented by state-of-the-art measuring instruments and special software – both of which the team is constantly developing as part of its own research projects.
Arrange an appointment for an examination
If you suffer from CMD, bruxism or tooth wear (abraded teeth), make an appointment for a detailed initial examination.
The practice rooms are located exactly between the ICE train station Dammtor and Hamburg International Airport and can be reached from there in 15 minutes by cab (airport) or bus (free of charge from the train station with the CityTicket). If you arrive by car, you will find a public parking garage in the building.
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