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What are craniomandibular disorders

03-21-2017 11:30 AM CET | Health & Medicine

Press release from: Pressetherapeut

/ PR Agency: Der Pressetherapeut
Dr. med. dent. Stefanie Morlok, dentist and MSc in orthodontics, specialist in dental functional therapy and CMD

Dr. med. dent. Stefanie Morlok, dentist and MSc in orthodontics, specialist in dental functional therapy and CMD

Report from a CMD clinic (clinic for gnathology, dental function disorders, bite problems, craniomandibular disorders - dentist, orthodontist) in Munich and Utting am Ammersee, Dr. med. dent. Stefanie Morlok, dentist and Master of Science in orthodontics.

Which patients can benefit from a CMD treatment?

a. Patients suffering from chronic pain (head, face, mouth, teeth, jaw, neck, shoulder, arms, hands as well as patients experiencing pain in other body parts, who have tried everything without success and wish to try out the bite correction or splint therapy option), and children suffering from chronic pain

b. Patients suffering from dizziness

c. Patients with ear problems, hearing disorders tinnitus

d. Patients suffering from neurological problems (e.g., patients ailing from Tourette, Parkinson's disease, MS, epilepsy) and movement disorders

e. Children with ADS, ADHS

f. Patients with unexplained and untreatable eye problems

g. Patients with unexplained and untreatable orthopedic problems

h. Patients with unexplained and untreatable ENT problems (ear, nose, and throat - see above)

i. Patients with unexplained nervous conditions, sleep disorders, etc. combined with teeth clenching or grinding at night or with a forced bite splint.

j. Whiplash patients (whiplash injury of either the cervical spine or mandibular joint)

k. Patients hoping for better performance in sports by using a splint

l. Patients with sleep apnea syndrome or obstructive snoring, bite disorders, and rejection of a CPAP treatment (mask treatment)

What are the symptoms of a CMD?

Please refer to the images added for this article. These show the possible symptoms that may appear in the mouth or on the face, head, eyes, ears, psyche, neck, throat, and other parts of the body.

As the name implies, craniomandibular disorders (CMD) are not illnesses as such. The term is derived from cranium, the skull and mandible, the lower jaw, whereby there is a distinct malfunction of how the two fit into each other. CMD are usually evident since one's early years. At this early age, the body is still able to compensate well for all problems resulting from the bite disorders or jaw deformity and one therefore does not develop any symptoms. Diseases that result from a CMD are mostly due to weaknesses or illnesses in three areas and often at different levels. These three areas are: structure (including the teeth, jaw, temporomandibular joints, the soft tissue, the cervical spine, and other downward or nearby structures), the metabolism, and the psychosocial situation. CMD treatments must consider all these 3 aspects at the same time, which is the reason I focus a lot on the hormonal situation of my patients. I came to find that CMDs are more common in women than in men. As a result, I devoted my master thesis to studying the relationship between CMDs and hormones. This showed that hormone fluctuations or hormone losses often trigger the symptoms of a CMD. The sex hormones, estrogen and progesterone, hereby play a key role and a deficit can lead to problems in the jaw area. The jaw area, the temporomandibular joint area, and the neck area have numerous hormone receptors for estrogen and progesterone. In case of a deficiency in both hormones, patients with a pre-existing CMD condition tend to develop symptoms. The testosterone hormone, which is significantly more in men, appears to fight against CMD symptoms. However, a hormone deficit can also cause CMD symptoms in men as well since testosterone decreases with age in both men and women. Unfortunately, very little medical research has been dedicated to understanding the relation between hormonal deficits and CMD. My work was only limited to scientific literature comparison on this subject.

There are tests that can be performed to identify whether one is suffering from a CMD. An example is a quick test that is performed to check if the mouth opening is asymmetrical or restricted, if there any joint noises or noises caused by pre-contact on the teeth, if the chewing musculature is sensitive when touched, or if the mouth opens awry. If any two of these cases are true, CMD could be conceivable whereas if any three are true, CMD is highly likely. I recommend a more detailed and differentiated test that can be found on my homepage It should however be noted that CMD treatment is only possible upon special examination and diagnosis. These include manual examinations of the masticatory apparatus, electromyography of the masticatory muscles and the accessory masticatory muscles, cinematography of the joint actions, both manual and electronic bite analysis, and the models for orthodontic and functional analysis. An orthodontic analysis using photos and radiographs provides a three-dimensional overview of the causality of the disorder. In addition, a body analysis is also necessary for the diagnosis.

What is the procedure of a CMD treatment?

The first step is a conversation where I try to identify the problems of the patient. I obtain a dental report and require a panoramic view, and a manual functional analysis. I also measure the bite force ratios and create dental imprints. This is followed by another consultation 1-2 weeks later where I discuss the findings with the patient as well as explain the treatment plan and the costs. The patient receives a comprehensive cost plan. The treatment cannot be generalized since it is specific for each patient and depends on the findings and diagnoses. Many patients are first treated using bite remedies such as splints, etc. whereas for others, splints are used to help against snoring or apnea if these are identified as additional findings. Some patients require parallel orthodontic treatment or other dental procedures. I usually work with body therapists from other disciplines. These include osteopathic practitioners, physiotherapists, manual therapists, and specialists in other special massage techniques, Cranio, exercises, yoga, proprioceptive soles, sporting activities, nutritional advice and guidance, coaching and life counseling, relaxation therapy, biofeedback, metabolic regeneration, and if necessary, substitution of missing hormones (not just limited to the sex hormones), which must be done by a medical doctor. Many of these adjunct therapies are beyond the dental field, which is why interdisciplinary coordination is very important.

Are splints used in all CMD treatments?

CMDs do not only entail mispositioned the teeth, jaws, and jaw joints. In many CMD cases, head joints and the cervical spine are also positioned incorrectly. Many patients often experience clenching moments in the jaw joints and the cervical spine. This structural problem also causes the soft tissue i.e. the muscles (which are mostly distorted, shortened, and wrongly placed), skin, adipose tissue, blood vessels, nerves, lymph vessels, connective tissue, fascia, etc. to be placed incorrectly, and this since a very long time. In addition, someone suffering from a CMD has one pronounced symptom from the ones mentioned above. This can vary greatly among different patients. If we want to eliminate the symptom, mostly by identifying cause, one must work on both the causative structural defect as well as use appropriate therapies to remedy the aforementioned symptom. Only by using a splint can this structural defect be decoupled to an optimal position. This splint must be checked and readjusted regularly through physical therapy since the soft tissue and the joints must be allowed to ease up and adapt to the new situation. At the same time, the use of a splint can also relieve other symptoms such as tensional pain, lymph blockage, etc. So yes, CMD treatment usually requires a splint therapy at first. I personally prefer working with two splints, one for use at night, which is designed to relieve and harmonize the soft tissue as well as align it symmetrically and in the right position in three dimensions. The other splint should be used during the day and is designed for bite correction. The duration of the splint therapy depends on various factors. These include the severity of the symptoms, age of the patient, constitution of the patient, condition of the head joints, the extent of the teeth and jaw deformity, and cooperation of the patient. In optimal cases, an improvement or elimination of the symptoms can be achieved within 3-6 months. However, this can also drag on for up to 2 years in difficult cases. There are also situations where the disorders fail to improve.

If the therapy is successful, a follow-up treatment is extremely necessary. A relapse is very likely if you simply remove the splint without any follow-up treatments. The bite should be stabilized, and this can be achieved through dental prosthesis and orthodontic treatments. I personally advise my patients to use a relaxing night splint after the bite stabilization to ensure the results remain stable.

Which other physicians or therapists are needed in CMD treatment?

For the functional analysis and diagnosis, I usually transfer patients to X-ray scanning for examination of the jaw and head joints, including the soft tissue. Sometimes, I refer patients to a sleep laboratory in case I detect sleep apnea. Once a splint is ready, I send the patient to an osteopath and then to an ENT, neurologist, internist, orthopedist, sleep laboratory, respiratory therapy, speech therapy, eurythmy therapy, ergo-therapy, psychotherapist, physiotherapist, metabolic specialist, podoorthesiologist, endocrinologist, etc. depending on the medical history and course of treatment.

The CMD treatment can also be supported by naturopathic methods.

I perform tests through kinesiology and Electroacupuncture according to Voll (EAV), I use homeopathy, isopathy, bio-resonance therapy, phytotherapy, orthomolecular therapy, detoxification measures, intestinal refatting, nutritional advice, life guidance, counseling on one's bed and sleeping hygiene, magnetic field therapy, posture analysis and improvement (posturology), craniosacral therapy for the head and face, TENS (transcutaneous nerve stimulation), biofeedback therapy for relaxation and harmonization of the autonomous nervous system, bio-stimulation according to Nazarov for relaxation of the masticatory muscles. The improvement in metabolism and/or the energy situation is also always desirable with CMD. Since I am also a trained anthroposophist dentist, I use many anthroposophist homeopathic remedies with which I have had great successes in the treatment of the masticatory muscles, temporomandibular joints, dental inflammations, etc. Homeopathic and bio-resonance therapies are particularly interesting when it comes to focus and substance tests. In case of negative results, there is a stage that can be remedied using regulatory measures. This means that homeopathy and bio-resonance can under certain circumstances lead to improvement of a focus problem or better tolerance to a substance e.g., which I may need to use urgently for dental treatment.

Dr. med. dent. Stefanie Morlok, dentist and MSc in orthodontics, specialist in dental functional therapy, gnathology, treatment of CMD (craniomandibular disorders), Munich and Utting am Ammersee.

Private Zahnarztpraxis Dr. Morlok
Dr. Stefanie Morlok

Praxis 1: Zur Aussichtswarte 15
86919 Utting

Praxis 2: Landsberger Str. 511
81241 München

Telefon: 08806 / 958630

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