{"id":3897,"date":"2024-06-05T11:36:28","date_gmt":"2024-06-05T09:36:28","guid":{"rendered":"https:\/\/dir-system.de\/cmd-a-complex-clinical-picture\/"},"modified":"2024-11-07T08:45:49","modified_gmt":"2024-11-07T07:45:49","slug":"cmd-a-complex-clinical-picture","status":"publish","type":"post","link":"https:\/\/dir-system.de\/en\/cmd-a-complex-clinical-picture\/","title":{"rendered":"CMD: A complex clinical picture"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-vertically-aligned-center is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-video aligncenter\"><video height=\"720\" style=\"aspect-ratio: 1280 \/ 720;\" width=\"1280\" autoplay=\"\" loop=\"\" src=\"https:\/\/dir-system.de\/wp-content\/uploads\/2024\/06\/iStock-1911354307_2.mp4\"><\/video><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-dir-darkest-grey-color has-text-color has-link-color wp-elements-73ab67530ce2d87d7027e83cddc15a8b\">The clinical picture of CMD (craniomandibular dysfunction) describes the pathological condition of a functional disorder or mechanical misload of the masticatory muscles.\nThe 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. <\/p>\n\n\n\n<p class=\"has-dir-darkest-grey-color has-text-color has-link-color wp-elements-b8c81a32438457062c9febe70d157a76\">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.<\/p>\n<\/div>\n<\/div>\n\n<div style=\"height:19px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<h3 class=\"wp-block-heading has-dir-blue-color has-text-color has-link-color wp-elements-dd956fa49be83e1aa17993a418613370\" id=\"h-funktionsgesund-versus-funktionsgestort\">Functionally healthy versus dysfunctional<\/h3>\n\n<p>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.<\/p>\n\n<p>According to this, a large proportion of the population is confronted with triggering disruptive factors and reacts with progressive and\/or regressive tissue adaptations.\nThese structural changes can be neuronally compensated or tolerated for years and remain clinically inconspicuous in the sense of a silent CMD.\nOnly around nine percent of the population have developed full CMD with persistent objective and subjective symptoms.\nIn this group, tolerance to the disruptive factors has been lost and, as a result, the neuronal ability to compensate has collapsed.   <\/p>\n\n<h3 class=\"wp-block-heading has-dir-blue-color has-text-color has-link-color wp-elements-23d79ea3439dca7089601b08cd6e0c5c\" id=\"h-frauen-haufiger-betroffen-als-manner\">Women more frequently affected than men<\/h3>\n\n<p>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.\nThe 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 &#8220;dental diseases&#8221; but to diseases from other specialist areas (see above), are included in the evaluation. <\/p>\n\n<h3 class=\"wp-block-heading has-dir-blue-color has-text-color has-link-color wp-elements-d0740f89b804323f72fd87b626ff0ee6\" id=\"h-cmd-auslosende-storfaktoren\">CMD-triggering disruptive factors<\/h3>\n\n<p>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.\nThe following causes are described in detail, which can of course also occur in combination: <\/p>\n\n<ul class=\"wp-block-list has-dir-darkest-grey-color has-text-color has-link-color wp-elements-9d1949db0699c9dd6cb954b93d7bc75c\">\n<li>Dento-occlusal interference factors<\/li>\n\n\n\n<li>Traumatic surgical disruptive factors<\/li>\n\n\n\n<li>Orthopaedic disruptive factors<\/li>\n\n\n\n<li>Psychosocial disruptive factors<\/li>\n<\/ul>\n\n<h3 class=\"wp-block-heading has-dir-blue-color has-text-color has-link-color wp-elements-7f098afbc9b477fe44bbcebc106d4128\" id=\"h-dentookklusale-storfaktoren\">Dento-occlusal interference factors<\/h3>\n\n<p>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.  <\/p>\n\n<p>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.\nThey 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.   <\/p>\n\n<p>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.\nThe 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.\nTherefore, the leveling of Spee&#8217;s curve, which is the aim of the straight-wire technique, must be considered a treatment error in the legal sense.  <\/p>\n\n<h3 class=\"wp-block-heading has-dir-blue-color has-text-color has-link-color wp-elements-bafe0f7fd1d3e74b7daff4eea4b75b27\" id=\"h-traumatisch-chirurgische-storfaktoren\">Traumatic surgical disruptive factors<\/h3>\n\n<p>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.<\/p>\n\n<h3 class=\"wp-block-heading has-dir-blue-color has-text-color has-link-color wp-elements-a4e3567e299c659de78870618e95b912\" id=\"h-orthopadische-storfaktoren\">Orthopaedic disruptive factors<\/h3>\n\n<p>The orthopaedic disruptive factors are located in the specialist fields of orthopaedics, manual medicine, pediatrics, speech therapy, dentistry and oral and maxillofacial surgery.\nThey 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. <\/p>\n\n<h3 class=\"wp-block-heading has-dir-blue-color has-text-color has-link-color wp-elements-d9f26d9b0a69d370a13954012ea7ff57\" id=\"h-psychosoziale-storfaktoren\">Psychosocial disruptive factors<\/h3>\n\n<p>Psychosocial disruptive factors are naturally assigned to the fields of psychiatry and psychology.  <\/p>\n\n<p>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.\nHowever, there is current data on the increasing dominance of psychosocial disruptive factors over the last few decades.\nThe mechanisms by which psychosocial stress (as a synonym for disruptive factors) can contribute to the development of CMD were described by Gameiro et al.\nin a review.\nAccording to this, stress can profoundly modulate the processes of pain conduction and perception in the sense of a psychosomatic projection (somatization or somatoform disorder).\nFurthermore, 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.\nThe non-physiological increase in teeth grinding and clenching can be convincingly explained by Lazarus and Laurier&#8217;s transactional stress model, according to which each person has individual stress coping skills (active and passive coping).\nIn active coping according to the frustration-aggression theory, the aggressive reaction occurs on a somatic-muscular level as an archaic fight response.\nIn the passive coping strategy, frustration triggers resignation and subsequently depression.        <\/p>\n\n<h3 class=\"wp-block-heading has-dir-blue-color has-text-color has-link-color wp-elements-7a692c17f7d6762dd172e270b4ecf033\" id=\"h-parafunktionen\">Parafunctions<\/h3>\n\n<p>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.\nThese are then the cause of secondary consequential damage to the temporomandibular joints, periodontium, teeth, adjacent soft tissues, neck muscles and cervical spine joints. <\/p>\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[125,138,140,139],"class_list":["post-3897","post","type-post","status-publish","format-standard","hentry","category-unkategorisiert","tag-cmd-en","tag-functional-analysis","tag-jaw-dysfunction","tag-masticatory-muscles"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.1 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CMD: A complex clinical picture - DIR System<\/title>\n<meta name=\"description\" content=\"The clinical picture of CMD describes the pathological condition of a functional disorder or a mechanical misload of the masticatory muscles.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dir-system.de\/en\/cmd-a-complex-clinical-picture\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMD: A complex clinical picture\" \/>\n<meta property=\"og:description\" content=\"The clinical picture of CMD describes the pathological condition of a functional disorder or a mechanical misload of the masticatory muscles.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/dir-system.de\/en\/cmd-a-complex-clinical-picture\/\" \/>\n<meta property=\"og:site_name\" content=\"DIR System\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/dirsystem\" \/>\n<meta property=\"article:published_time\" content=\"2024-06-05T09:36:28+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-11-07T07:45:49+00:00\" \/>\n<meta name=\"author\" content=\"Ute Unger\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@funktion_dir_konzept\" \/>\n<meta name=\"twitter:site\" content=\"@funktion_dir_konzept\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Ute Unger\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/dir-system.de\/en\/cmd-a-complex-clinical-picture\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/dir-system.de\/en\/cmd-a-complex-clinical-picture\/\"},\"author\":{\"name\":\"Ute Unger\",\"@id\":\"https:\/\/dir-system.de\/en\/#\/schema\/person\/701e2b9b46cae6a2ea1be15bf6306a27\"},\"headline\":\"CMD: A complex clinical picture\",\"datePublished\":\"2024-06-05T09:36:28+00:00\",\"dateModified\":\"2024-11-07T07:45:49+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/dir-system.de\/en\/cmd-a-complex-clinical-picture\/\"},\"wordCount\":1050,\"publisher\":{\"@id\":\"https:\/\/dir-system.de\/en\/#organization\"},\"keywords\":[\"CMD\",\"Functional analysis\",\"Jaw dysfunction\",\"Masticatory muscles\"],\"articleSection\":[\"Unkategorisiert\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/dir-system.de\/en\/cmd-a-complex-clinical-picture\/\",\"url\":\"https:\/\/dir-system.de\/en\/cmd-a-complex-clinical-picture\/\",\"name\":\"CMD: A complex clinical picture - 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