Your dentist is not only responsible for your teeth
If your symptoms indicate CMD: Talk to your dentist about functional disorders!
An optimally functioning craniomandibular system (jaw, temporomandibular joints, teeth, chewing muscles) is a prerequisite for the health of the entire organism.
This quickly becomes apparent in the case of functional disorders or CMD (craniomandibular dysfunction).
Various, sometimes painful complaints can occur.
You should go to the dental practice if symptoms such as pain in the temporomandibular joints or in the face, head and neck area as well as symptoms such as teeth grinding, jaw clicking, headaches, ringing in the ears or tension along the spine remain unexplained.
With the help of manual-clinical and instrumental functional diagnostics, dentists can find a reliable diagnosis – the first step towards ending your suffering!
This is your way: Find YOUR® dentist!
Not all functional diagnostics are the same: The DIR® concept with scientifically proven treatment methods and state-of-the-art medical technology is only offered by dentists who are qualified to do so.
We therefore recommend the following procedure:
1. if you want to stay with the dentist you trust…
Are you experiencing the symptoms described above, but no doctor or therapist has been able to find the cause?
Contact your dentist now!
Ask him or her about functional diagnostics with the DIR® concept (FunktioCheck Pro® / DIR® system) at your next appointment.
2. if you are flexible and would like to see an experienced DIR® dentist…
Use the online dentist search to find a DIR® dentist near you or contact the “Gesellschaft für Funktionsdiagnostik” directly.
The clinical picture of CMD (craniomandibular dysfunction) describes the pathological condition of a functional disorder or mechanical misload of the masticatory muscles.
The clinical picture also includes the connective tissue supporting the masticatory muscles (fascia, tendon) with secondary dysfunction and damage to the temporomandibular joints, teeth, periodontium and, more rarely, the soft tissues of the oral cavity when biting the cheeks, tongue or lips.
According to current knowledge, the clinical picture must be extended to include functional disorders/damage to the neck, nape and (with restrictions) also the back muscles and the associated spinal joints.
Functionally healthy versus dysfunctional
According to epidemiological studies, around six percent of the European population live functionally healthy lives, whereas the prevalence of objective findings of CMD without evidence of subjective complaints is 85 percent.
According to this, a large proportion of the population is confronted with triggering disruptive factors and reacts with progressive and/or regressive tissue adaptations.
These structural changes can be neuronally compensated or tolerated for years and remain clinically inconspicuous in the sense of a silent CMD.
Only around nine percent of the population have developed full CMD with persistent objective and subjective symptoms.
In this group, tolerance to the disruptive factors has been lost and, as a result, the neuronal ability to compensate has collapsed.
Women more frequently affected than men
In a gender comparison, women are affected by CMD around five times more frequently than men, with the peak age being between 30 and 34 years.
The prevalence values of typical CMD complaints also increase dramatically when symptoms such as tension headaches, migraine complaints, neck and back pain, ringing in the ears or tinnitus, hearing loss, balance disorders, dizziness, swallowing difficulties, speech and taste disorders, which were previously not primarily attributed to “dental diseases” but to diseases from other specialist areas (see above), are included in the evaluation.
CMD-triggering disruptive factors
The evaluation of the relevant specialist literature regarding the etiology of CMD reveals four triggering disruptive factors, which makes the multi-causality or multifactorial genesis of the disease clear.
The following causes are described in detail, which can of course also occur in combination:
Dento-occlusal interference factors
Traumatic surgical disruptive factors
Orthopaedic disruptive factors
Psychosocial disruptive factors
Dento-occlusal interference factors
Dento-occlusal interference factors and traumatic-surgical interference factors fall into the specialist areas of dentistry, oral and maxillofacial surgery, pediatrics, speech therapy, orthopedics and manual medicine.
Dento-occlusal interference factors are classified as pre- and postnatal developmental defects of the teeth and acquired diseases of the teeth and periodontium, including periodontal remodeling processes and factors caused by dental intervention.
They therefore relate to malocclusions after tooth migration or tilting or due to sliding obstacles, supraocclusions during elongation or early contact, non-occlusions or infraocclusions due to tooth loss and tilting, incorrect jaw relationships with condyle displacements due to forced occlusions or incorrect bites for prosthetic restorations and orthodontic, conservative and prosthetic treatments.
Dental interventions during jaw and muscle growth of the two dentitions can cause much more extensive damage than corresponding treatments in adults, whose bone and muscle tissue can only be remodeled to a limited extent, due to the still pronounced biological ability of the developing organism to adapt its shape.
The problem of iatrogenic orthodontic treatment errors lies in the influence on the natural tooth angulations, whereby corrections to the axial position of the upper first molar represent the greatest risk factor for a dento-occlusal disorder, because the 6-year molar influences the angulations of all replacement and growth teeth that erupt after it, with the exception of the anterior teeth.
Therefore, the leveling of Spee’s curve, which is the aim of the straight-wire technique, must be considered a treatment error in the legal sense.
Traumatic surgical disruptive factors
The traumatic surgical disruptive factors relate to mechanical injuries and maxillofacial surgery on the jaws (especially on the ascending branch and the condyle), the teeth, the temporomandibular joint and the spinal joints as well as the associated musculature, resulting in changes in size, shape and position as well as underdevelopment (e.g. condylar asymmetries) after wound healing is complete.
Orthopaedic disruptive factors
The orthopaedic disruptive factors are located in the specialist fields of orthopaedics, manual medicine, pediatrics, speech therapy, dentistry and oral and maxillofacial surgery.
They relate to pre- and postnatal developmental defects and acquired diseases of the bones, joints and muscles of the spine with resulting postural or positional defects of the cervical spine, including developmental defects and acquired diseases of the jaws, temporomandibular joint, masticatory muscles and tongue (e.g. as growth inhibition due to thumb sucking habit resulting in persistent infantile swallowing) as well as orthopaedic surgical interventions on the spine.
Psychosocial disruptive factors
Psychosocial disruptive factors are naturally assigned to the fields of psychiatry and psychology.
Surprisingly, only very few studies have been published that deal with the question of the epidemiological distribution or demographic frequency of the named disruptive factors.
However, there is current data on the increasing dominance of psychosocial disruptive factors over the last few decades.
The mechanisms by which psychosocial stress (as a synonym for disruptive factors) can contribute to the development of CMD were described by Gameiro et al.
in a review.
According to this, stress can profoundly modulate the processes of pain conduction and perception in the sense of a psychosomatic projection (somatization or somatoform disorder).
Furthermore, bruxism and compressio dentalis (teeth clenching) can be seen as a sign of a stress management strategy and serve to protect against chronic stress-related illnesses.
The non-physiological increase in teeth grinding and clenching can be convincingly explained by Lazarus and Laurier’s transactional stress model, according to which each person has individual stress coping skills (active and passive coping).
In active coping according to the frustration-aggression theory, the aggressive reaction occurs on a somatic-muscular level as an archaic fight response.
In the passive coping strategy, frustration triggers resignation and subsequently depression.
Parafunctions
Just like the psychosocial stress factors, the three other disruptive factors also generate neuronally controlled muscle hyperactivity or hypertonization of the masticatory muscles with a lack of rest phases, which is defined by the term parafunctions and triggers primary structural and functional damage to the musculature.
These are then the cause of secondary consequential damage to the temporomandibular joints, periodontium, teeth, adjacent soft tissues, neck muscles and cervical spine joints.
Do you know what it’s like: grinding your teeth, clenching your jaw? Noises in your ears?
Complaints in the head, neck and spine area?
Did you also know that even headaches, sleep disorders and even tinnitus can have their cause in the jaw?
Are you one of those people who frequently suffer from one or more of these complaints but have not yet received a concrete diagnosis from doctors and therapists?
Then you are not alone!
There is often a malfunction of the lower jaw and jaw joints (craniomandibular dysfunction or CMD) with a “wrong bite” as a result of dysregulation, which in turn can trigger complaints throughout the body.
If you are affected, ask a specialist specializing in functional diagnostics whether you have a functional disorder.
You can use our dentist search to find DIR® dentists in your region.
Incorrect bite and CMD
Bite disorders and CMD with the symptoms described are widespread.
They are functional disorders of the craniomandibular system (jaw, jaw joints, teeth, masticatory muscles).
However, the causes can be not only functional, but also structural, biochemical or psychological (e.g. teeth grinding due to stress).
The most important functions of the craniomandibular system are chewing and speaking: Functions that we need all the time.
If there is a functional disorder, chewing and speaking, even laughing, leads to persistent overload, which can then trigger painful stress symptoms throughout the body.
A vicious circle
More than 1,500 dental contacts every day – about half of them at night – are a real challenge for your teeth.
Every person with a fully edentulous jaw has a “stress protection system”.
This stress protection system is not only used for speaking, laughing and swallowing, but also during physical activity.
If the stress protection system is disturbed by insufficient or increased tooth contact – e.g. due to incorrectly positioned crowns or old fillings – the bite is no longer optimal.
Receptors report these incorrect or interfering contacts to the brain.
The brain in turn sends the message to the masticatory muscles: Bite down harder – correct the misalignment!
The increased strain leads to overloading and pain in the neck and chewing muscles and spreads to the entire body.
The physical complaints mentioned above often occur as a possible consequence of the dysfunction.
Malfunction?
The figures speak for themselves: around 10% of the population are affected by misalignments of the temporomandibular joints, including many headache sufferers. 85% of headache patients suffer from jaw misalignment and CMD, claimed a neurologist from Essen in the “Westdeutsche Allgemeine Zeitung” (Dr. Gerhard in: WAZ, 2008).
The dentist can help!
The causes of the specific functional disorder should be analyzed individually by the dentist.
Manual-clinical and instrumental functional diagnostics (DIR® concept) are available for reliable anamnesis and treatment.
In this way, you as a patient receive truly effective treatment!
Important to know!
Every patient has a right to functional prophylaxis!
It is also generally sensible and advisable to carry out a diagnostic examination with the DIR® system before fabricating new dentures in order to ensure the “correct bite” and avoid possible complications.
Schmerzen, die vom Kiefer kommen, Kopfschmerzen, Migräne, Nacken- und Schulterverspannungen, Ohrgeräusche, Tinnitus, Kiefergelenksprobleme, HWS-Beschwerden, Probleme in der Lendenwirbelsäule- alle diese Beschwerden können eine Ursache haben: CMD (Craniomandibuläre Dysfunktion). Circa acht Prozent aller Menschen leiden an der so genannten CMD. Als Craniomandibuläre Dysfunktion bezeichnet man Beschwerden, die aufgrund von Form- und Funktionsstörungen im Schädel- und Gesichtsbereich herrühren. Ein Schmerz muss seine Ursache nicht immer dort haben, wo es weh tut. Der Mensch ist eine Einheit. So passiert es oft, dass der Ursprung des Schmerzes ganz woanders zu finden ist als der Schmerz selbst. Es ist möglich, den Biss zu diagnostizieren. Eines unserer Schwerpunkte ist die Funktionsanalyse und Therapie des Kausystems. Dr. Annette Jasper, München
Reliable DIR® diagnostics: Tracking down the functional disorder through intraoral measurement!
If a functional disorder is suspected – especially after a clinical functional analysis – dentists obtain definitive clarity about the individual situation of the craniomandibular system through further instrumental analysis.
The centric condylar position, which is considered ideal for smooth functioning of the temporomandibular joint, is also determined.
Definition of centric condylar position
The cranioventral, not laterally displaced position of both condyles with physiologic condyle-discus relation and physiologic loading of the involved tissue structures (DGZMK and DGFDT)
“In the centric condylar position, both condyles are not laterally displaced in the cranioventral section of the eminentia if the vertical dimension of the mandible to the maxilla is correct.
In this circumscribed area, the tissues involved are not subjected to excessive pressure or tension. There is freedom of movement in all three spatial directions.
The centric condylar position can be controlled and maintained neuromuscularly with minimal energetic effort.”
DIR® (DYNAMIC INTRAORAL REGISTRATION)
An intraoral measurement of the patient with the DIR® system enables the function of the craniomandibular system to be assessed.
A support pin register is used here, whereby the recording of the lower jaw movements is transferred to a medical PC in real time at any time via the DIR® System software and the dentist can observe the movements of the lower jaw.
Recording and bite encoding take place under a defined chewing force.
(ACTUAL POSITION)
The DIR® System software supports the dentist in converting the ACTUAL to TARGET position.
The physiological condyle position is the focus of the bite adjustment.
After evaluating the results, misalignments can be corrected and secured as part of the DIR® treatment concept, using the DIR® splint, among other things. It also serves to retrain the masticatory muscles. Only after correction and freedom from pain should dental treatment be continued and the TARGET POSITION reconstructed (e.g. with dentures).
Instrumental functional analysis with the DIR® system is used for
Suspicion of CMD
Setting the physiologically optimal bite position
Fabrication of new dentures
Orthodontic treatment
Patients who were not treated according to the DIR® concept (e.g. with dentures) and now have complaints
Bruxism, abrasive dentition, joint noises and other complaints
The high quality and safety of DIR® diagnostics is also guaranteed by regular training courses (refresher seminars, acquisition of current DIR® quality seals).
The manual clinical functional analysis is used to record the functional findings in the craniomandibular system, as functional disorders are often not correctly recognized without a professional analysis.
This makes it all the more important to have a basis for safe and rapid functional diagnostics in the dental practice, which should be used as a matter of course for every patient before restorative and/or orthodontic treatment planning and to differentiate between unclear jaw and facial pain and/or orofacial dysfunctions.
What does a practical method look like?
Since different causes of the complaints require different treatment approaches, a targeted and thorough diagnosis is of the utmost importance before starting treatment.
1. which diagnostic concept will get me to the desired goal?
2. what does professional functional prophylaxis look like in the practice?
3. do I need further diagnostic measures?
4 Which examinations will give me a clear and unambiguous diagnosis?
5 How can I bill for functional diagnostics?
What the dental practice needs is a basis for safe and fast functional prophylaxis that can be used as a matter of course for every patient.
It should not only consist of a subjective medical history, but must also include a clinical functional status.
This is the only way to make a reliable diagnosis that includes all important clues.
This would then fulfill the dentist’s obligation to perform a clinical functional analysis as a basic examination.
Such an analysis could serve as a well-documented decision-making basis for a possible course of treatment.
The basic examination is always in the foreground.
During CMD screening (basic CMD diagnostics), the patient undergoes a general dental anamnesis with an individually completed digital questionnaire and brief dental findings.
If there is no suspicion of a functional disorder, the functional analysis can be completed with this.
If there are indications of a functional disorder, such as
-Tension headaches, migraines, tension in the back and neck muscles, pain in the jaw joints, tinnitus, dizziness, etc.
the dental check is deepened.
The manual clinical functional analysis is used to differentiate between pain, restrictions, disorders of the stomatognathic system, joint noises and different disc displacements. It provides comprehensive results that are documented and evaluated in order to make an initial diagnosis and plan the further course of treatment.
Even if private reimbursement agencies like to refuse to cover the analogous CMD screening service or do not readily recognize the medical necessity of the service, it should not be dispensed with in view of the current case law on dental liability.
The OLG Munich (Ref.: 3 U 5039/13) of 18.01.2017 states that screening to clarify whether a hidden CMD is present or not is standard medical practice prior to prosthetic treatment.
In its ruling (5 U 64/16) of April 8, 2020, the Higher Regional Court of Cologne also came to the conclusion that a functional analysis would have been mandatory prior to the restoration.
The omission of the required screening before the start of the prosthetic restoration is considered a diagnostic error.
These questions and requirements have prompted dentists with their own practices and specialist consultants, together with the Society for Functional Diagnostics, to develop the functional prophylaxis procedure for all dentists in a practical and professional manner.
The result is the easy-to-use FunktioCheck Pro® software.
The FunktioCheck Pro® software enables you to carry out a quick and uncomplicated manual anamnesis and to make a reliable diagnosis based on the structured entries.
A really good concept as a supporting framework for a strong partner network is the result of years of development work. Good and coherent, a concept that makes it possible to use the DIR® system as a therapeutic link between dentistry and dental technology as well as complete planning from the first impression to the finished restoration (planning reliability).
The range of indications for the DIR® concept includes both the prosthetic restoration of patients with CMD syndrome and the fabrication of new dentures for functionally healthy patients.
Diagnostics
As part of the DIR® concept, the FunktioCheck Pro® software documents the preliminary dental findings.
The type of complaints and previous visits to the dentist from other specialist disciplines are recorded as part of the functional dental history.
In the brief dental findings, missing canine guidance, non-age-appropriate abrasion of the teeth in the sense of grinding facets and abrasions or The brief dental findings record missing canine guidance in the sense of grinding facets and abrasions or wedge-shaped incisions, tooth loosening, tilting and migration, gingival recessions with Still-man clefts and McCall’s garlands, pain during muscle palpation, temporomandibular joint noises as well as restrictions and asymmetrical mouth opening movements, resulting in a three-grade probability statement for the presence of a functional disorder and a recommendation for further findings.
Axis 2 diagnostics
The special functional analysis carried out in the case of a high probability of CMD, the so-called Axis 2 diagnostics, is highly relevant for the success of the subsequent therapy and is objectively assessed using a Graded Chronic Pain Scale and a pain perception scale, whereby an evaluation of the patient’s degree of psychological stress is possible in an evaluation form.
Manual-clinical diagnostics
The subsequent manual-clinical diagnostics allow an assessment of a manifest arthropathy with examination of the temporomandibular joint function to exclude or confirm the presence of a disc perforation or a disc displacement, condylar osteoarthrosis, hypermobility, capsulitis or inflammation of the bilaminar zone.
The morphological or structural remodeling processes in the hard tissues should of course be confirmed radiologically (MRI).
Manifest myopathy is assessed by performing standardized masticatory muscle examinations using the isometric tension test and muscle palpation.
Instrumental functional analysis
The manual functional analysis is followed by the instrumental functional analysis with the DIR® system, which is also carried out on functionally healthy patients as part of prosthetic planning. The electronic measuring method is based on the arrow angle or support pin registration according to Gerber with recording of the marginal movements of the mandible under physiological masticatory pressure and without reference to occlusion.
Centric position as target bite
Once the DIR® measurement has been completed, the centric position determined is encoded in the patient’s mouth as a so-called target bite by guiding the support pin into a fixation plate under defined chewing pressure. This is followed by transfer to the articulator. In the following model analysis, an occlusion analysis is performed, whereby the deviation of the habitual occlusion or the current actual state from the centric occlusion or the target bite is documented.
The appropriate therapy is planned on the basis of these results.
The DIR® concept for the treatment of functional disorders (CMD) is scientifically validated and follows a closed anamnesis and therapy principle.
Professional digital functional prophylaxis for every dental practice
The app that no dental practice should be without
Functional disorders are often not properly recognized without professional analysis.
This makes it all the more important to have a basis for safe and rapid functional diagnostics in the dental practice, which should be used as a matter of course for every patient.
FunktioCheck Pro® is software that enables you to integrate professional and scientifically based functional analysis into your practice immediately and easily.
The software guides you through a targeted anamnesis with brief dental findings in the simplest possible way.
Stay flexible
Once downloaded, you can use the FunktioCheck Pro® app individually on your devices.
Whether IOS, iMac, Android or within the browser of your practice PC.
The safe investment in the future of your practice:
Easier and safer handling
Immediate and uncomplicated integration into your practice
Precise initial diagnosis
Based on scientifically sound functional diagnostics
Forensic and legal security
For satisfied patients and safe dentistry
Amortizes within a very short time and is highly profitable
