CMD treatment: 15 questions, answered honestly

What are the symptoms of CMD?

In shortRarely just jaw problems. Typical is a combination of several symptoms for which no finding is made individually.

Because the jaw system is connected to the head, ear, neck and spine via muscles and nerves, CMD usually shows up in several places, and rarely where the cause lies. Common are:

• Jaw and teeth: clicking or grating in the jaw joint, restricted or painful mouth opening, pain in the jaw muscles, grinding or clenching, sensitive teeth, the feeling that your bite does not fit properly
• Head: headaches, often in the morning, pressure at the temples, migraine-like attacks
• Ear: ear pressure, ringing in the ears (tinnitus), dizziness
• Neck and back: tension in the neck and shoulders that returns after massage or physiotherapy
• Sleep and energy: unrefreshing sleep, exhaustion

There are solid foundations for the connection with the head, face and neck. For ear symptoms, an association is documented, not a cause. Whether your symptoms fit a typical pattern can be shown by a first self-test.

What triggers CMD?

In shortRarely a single cause. CMD is considered multifactorial: several strains come together until the body can no longer compensate for them.

The purely occlusal explanation, i.e. “the bite is to blame”, is considered outdated. Common triggers and amplifiers are:

• teeth grinding and clenching, at night or unconsciously during the day
• stress and inner tension
• poor or too little sleep
• accidents with injuries to the neck or head
• changes to the bite, for example from crowns, dentures or braces
• posture, long hours at a screen
• keeping the mouth wide open for a long time, for example during dental treatment

The fact that dental or orthodontic treatment was involved does not mean it is the cause. A causal link between orthodontics and CMD is not supported by the evidence.

What happens if CMD is not treated?

In shortThat varies greatly. Acute symptoms often subside again. If they last longer, the pain can take on a life of its own.

CMD is not a progressive disease in the sense of organ damage. But it can become chronic. Chronic CMD is now classified as nociplastic pain with central sensitisation: the nervous system then processes pain more sensitively, even far beyond the original region.

Possible consequences over the years are teeth worn down by grinding, persistently poor sleep and psychological strain, because constant pain wears you down and nobody finds anything.

Which doctor is responsible for CMD?

In shortFor assessing the jaw system, a dentist specialising in functional diagnostics. Other causes are ruled out beforehand by your GP and specialists.

The sensible order is:

• First rule out other causes: GP, neurology, ENT or orthopaedics, depending on the symptom. Warning signs always go there first.
• Then examine the jaw system: by a dentist who measures function, not just checks teeth.
• Alongside: physiotherapy for jaw and neck, psychological support when under heavy strain.

The CMD-Klinik specialises in this one field. We see ourselves as a complement to your doctors, not a replacement. How we work.

Can any dentist treat CMD?

In shortIn principle, any dentist may treat CMD. But functional diagnostics is a field of its own that not every practice offers in depth.

Many practices offer a splint. But not all splints are the same: a night guard or protective splint protects the teeth, a bite or relaxation splint eases acute muscle symptoms. A splint intended to change the bite position in a targeted way requires that bite position to have been measured beforehand.

Questions that help you choose:

• Is function measured, such as bite position, muscle activity and movement, or only looked at?
• Is head posture taken into account when registering the bite?
• Is there collaboration with physiotherapy?
• Do the first steps remain removable, without grinding down healthy teeth?

Can an orthopaedist help with CMD?

In shortYes, with neck, shoulder and back problems. But orthopaedics does not treat the cause in the jaw system, and conversely, body posture can hardly be changed via the bite.

Orthopaedics rules out structural causes and treats the musculoskeletal system. That remains important. If neck and shoulder problems keep recurring and there are also jaw signs, such as clicking, grinding or pressure in front of the ear, it is worth examining the jaw system as well.

What is proven: bite position and head posture are measurably connected. What is not proven: that the pelvis, lumbar spine or knees can be changed via the bite. In a study with a splint, forward head posture and shoulder rounding changed, the rest of the posture did not.

How long does it take for CMD to heal?

In shortThat cannot seriously be said in advance. With us, the entire regulation process usually takes 12 to 18 months.

In the vast majority of cases, CMD is readily treatable. But how quickly symptoms change varies from person to person. Acute muscle symptoms often ease within a few weeks. If pain has become entrenched over years, it takes longer.

That is why we speak not of repair but of regulation: a system that has fallen out of step is brought back in small, controlled steps, and every step is measured.

What should you avoid with CMD?

In shortAbove all, nothing irreversible before your function has been measured. In everyday life, a few simple rules help.

• Do not press your teeth together: at rest, your teeth belong apart. Lips closed, teeth apart.
• Go easy during acute phases: no chewing gum, no very hard or tough food, do not yawn wide without restraint.
• Do not rest your chin on your hand, do not sleep with your jaw on your arm.
• No permanent changes to the bite such as grinding down healthy teeth without prior functional diagnostics.
• Do not see splints from the chemist as the solution: they protect the teeth but do not treat the cause.
• Do not stop or change medication on your own.
• Do not wait out warning signs: have sudden hearing loss, acute vertigo or new neurological signs checked immediately.

Can I treat CMD myself?

In shortPartly. Self-help can relieve the muscles and is part of first-line treatment. But it does not reach the control behind them.

What you can do yourself:

• consciously keep your teeth apart during the day
• gentle exercises for jaw and neck, slowly and without pain
• warmth on jaw muscles and neck
• breaks from the screen and an upright posture
• reduce stress and make sure you get enough sleep

If symptoms still remain or return, that is not a failure of your discipline. Exercises reach the muscles but not the control behind them. Then functional diagnostics is worthwhile. You will find instructions in the article Relieving CMD yourself.

Which medications can relax the jaw muscles?

In shortIn the short term, medication prescribed by a doctor can ease pain and tension. It does not reach the cause.

Depending on the situation, options include anti-inflammatory painkillers for a short time, muscle relaxants also only short-term as they can cause drowsiness, and, for chronic pain in pain medicine, certain medications at a low dose. Your doctor decides which one is right.

Painkillers dampen pain. If the jaw muscles are permanently overloaded, for example by grinding at night, the source remains. That is why medication for CMD is for relief, not the solution.

Who prescribes physiotherapy for CMD?

In shortIn Switzerland, doctors of all specialties, including dentists. With a prescription, basic insurance covers the costs, less the deductible and co-payment.

The prescription states the diagnosis and the instructions for physiotherapy. For CMD, targeted treatment of jaw and neck makes sense; treating the neck as well is the professional standard for CMD.

Physiotherapy works and is a first choice. It works best when coordinated with the other steps, for example with splint therapy.

How long does CMD treatment with a physiotherapist take?

In shortIn Switzerland, a prescription covers up to nine sessions. How many courses are needed depends on progress.

The first session must take place within five weeks of the prescription being issued. After each course, it is assessed whether and how to continue; each time this requires a new prescription.

If symptoms keep coming back after several courses, it is worth asking whether something further up is constantly working against it. Then the jaw system should be assessed as well.

Who gets a long-term prescription for physiotherapy?

In shortA “long-term prescription” in the German sense does not exist in Switzerland. After 36 sessions, continuing requires a justification to the health insurer’s medical adviser.

The prescribing doctor can freely prescribe the first four courses of nine sessions each. If physiotherapy is to continue at the expense of basic insurance after that, the treating doctor submits a report with a justified proposal. The medical adviser decides whether, to what extent and for how long it will continue to be covered. Long-term therapy is mainly considered for severe conditions, such as neurological diseases.

If you are insured in Germany: different rules apply there for long-term therapy needs. Your health insurer can tell you more.

How much does CMD treatment cost?

In shortThat depends on the findings and therefore cannot be given as a flat figure. You receive a description of services with the costs before each step.

The CMD-Klinik is a private clinic for self-paying patients. So that you do not pay for anything that does not help, the process is divided into steps:

• Phone consultation: we assess your symptoms together. This costs nothing and commits you to nothing.
• CMD Systems Check: measurement takes place in two stages with an interim evaluation. If it becomes clear after the first stage that further measurements will not help, we stop there.
• CMD Systems Therapy: scope and costs follow from the findings, not from a fixed scheme.

You decide after each step whether to continue.

What does health insurance cover for CMD?

In shortBasic insurance only covers dental treatment for certain serious diseases exhaustively listed by law. A typical functional CMD does not usually fall under this. Physiotherapy prescribed by a doctor is covered.

The list of these diseases is in the Swiss Health Care Benefits Ordinance (KLV, Art. 17–19). Whether an exception applies is decided by the health insurer on a case-by-case basis.

• Basic insurance: physiotherapy prescribed by a doctor, less deductible and co-payment; dental treatment only in the exceptional cases mentioned
• Supplementary insurance: many supplementary dental insurance policies contribute, depending on the contract. Ask before treatment begins.
• Accident: if the cause is an accident, accident insurance may be responsible.

With our description of services, you can ask your insurer in advance whether and to what extent it will contribute.

Sources

• Swiss Health Care Benefits Ordinance (KLV), Art. 5 (physiotherapy) and Art. 17–19 (dental services)
• Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)
• Reviews on aetiology, chronification and posture, as cited on our pages for professionals

This article is for general information and does not replace a medical or dental assessment. Insurance benefits may change; your insurer’s information is what counts.