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Glossary

You will find the definitions of keywords used in orthodontics here.

CMD

This is an abbreviation for Craniomandibular Dysfunction which is usually an umbrella term for painful disorders of the chewing muscles or the temporomandibular (jaw) joints. This usually involves about 75% muscle pain and only about 25% pain in the jaw joints. Like most common neck, shoulder and back pain, CMD belongs to the category of musculoskeletal pain. It usually affects women from child-bearing age up to the menopause and is less common in men at the same age. It’s rare in children but it shows an increasing incidence through puberty and adolescence up to an age limit of about 40 after which it decreases again. In addition to age and sex, it is generally recognized that there’s a number of psychological factors that can increase the risk of CMD, e.g. anxiety, depression, post-traumatic stress disorder. At any given time, CMD symptoms can be found in about 3% – 10% of the population but usually no treatment is required. Craniomandibular dysfunctions are usually benign and self-limiting, so they also disappear by themselves. With mild to moderate symptoms it is often sufficient to simply wait and with a little patience the will disappear without treatment. In some cases, however, they can also lead to persistent, chronic pain. Whether or not any treatment is necessary depends entirely on the judgement of the person affected.

Symptoms: First and foremost, these include pain in the area of the cheeks, temples and the face. The muscle pain here is usually dull and difficult to pinpoint, whereas pain associated with the jaw joints is usually felt as a sharp, stabbing pain and is generally centered either just in front of or actually in the ear. The second most important symptom may be the restricted movement of the lower jaw. In the past, the significance of any joint noises such as cracking or rubbing were often over-estimated and considered in isolation rather than as diagnostic indicators of a disorder in its own right and were not regarded as a reason for any kind of diagnostic or therapeutic intervention.

Diagnosis: The most important part of the diagnosis is to take a comprehensive, pain-related patient history, followed by a short clinical examination and a panoramic X-ray. If any psychological stress factors are identified, a focused examination should follow in addition to appropriate psychometric questionnaires. Articulator mounting, instrumental functional diagnostics and MRT procedures are usually not called for as they are expensive and both unsettling for and a strain on the patient.

Treatment: In most patients, CMD disappears without any treatment. For this reason, treatment should only actually be used to get the patient through a difficult patch. A multimodal pain therapy makes sense if patients suffer from high impairments.

Just about any therapeutic approach can be successful here: the more that is done, the more noticeable the effect is. Accordingly, any treatment should be non-invasive, reversible and as simple and cost-effective as possible. These criteria are fulfilled by the following – education (of the patient), providing self-help guidance (e.g. massage, heat treatment and any kind of relaxation techniques), physiotherapy, bite splints and appropriate medication. Psychological pain therapy can also be included and has proven to be better or more effective than other kinds of treatment. Normally with CMD, any major procedure on the teeth such as renewing enamel or orthodontic treatment is not appropriate and just involves more expense and risk for the patient.

Prognosis: CMD is a benign and self-limiting disorder which normally disappears without treatment. People who are affected by it should not be worried and should remain optimistic that it will get better on its own. In rare cases where it becomes chronic, a pain therapist should be consulted – or a doctor or dentist who is familiar with pain therapy.