The terms Craniomandibular Dysfunction
(CMD) or Temporomandibular Disorders
(TMD) refer to a set of pathologies and clinical situations that have in common the ability to cause pain or functional disturbances of the masticatory system, mainly in the Temporomandibular Joints (TMJ) and the craniocervical associated muscles.
The most common causes of this disease include dental occlusion alterations, craniofacial traumas, psychological disturbances (anxiety, stress or depression) that occur with bruxism (grinding or clenching of the teeth), and more widespread diseases such as rheumatoid arthritis or fibromyalgia.
The treatment of CMD is diverse and multidisciplinary, being able to apply different techniques: Re-education and behaviour modification, dento-maxillary orthopaedics using inter-dental splints, rehabilitation, physiotherapy, injections, pharmacotherapy and, in some cases, surgical treatment of the TMJ through arthrocentesis, arthroscopy or open surgery.
Although drugs used for therapeutic injections are usually anaesthetics and corticosteroids, in recent years, new treatments have emerged:
- Botox® (commercial name for botulinum toxin type A used in cosmetic treatments) has proven to be an effective therapy to relieve some painful conditions associated with excessive muscle contraction. In Clinica Kranion we use this new therapy to improve certain areas of musculoskeletal pain (e.g. Craniocervical myofascial pain) and to control chronic neurovascular pain associated with some variants of tension headaches or migraines.
- The intra-articular injections with hyaluronic acid or growth factors (obtained from the patient’s own blood) have been shown to be capable of stabilising the cartilaginous matrix of the TMJ, helping to stabilise the osteoarthritic articular processes.
- Muscle and joint injections with ozone have also shown significant anti-inflammatory and regenerative properties, with few side effects.
The dentist specialising in dental-orofacial pain (see curriculum guidelines recommended by the European Academy of Craniomandibular Disorders – www.eacmd.org
, the American Board of Orofacial Pain - www.abop.net
and the American Dental Association - www.aaop.org
) can provide a high percentage of clinical improvement in patients with TMD, ranging from 90% in relation to pain and functional limitation, and 70% in relation to internal derangement of the TMJ.
It is important not to forget that the orofacial pain specialist may also be helpful in the diagnosis and treatment of neurovascular pain (certain types of headaches such as a migraine) or neuropathic pain, including a typical toothache, characterised by persistent pain and burning that occurs after a dental intervention on a tooth, resulting in certain similarities to phantom limb syndrome.