When the pain has long become independent – and still has a way in
You see these people late. After years, after many previous practitioners, with a pain that has detached itself from its cause. That is precisely why the question about the jaw system is neither naive nor too late here.
You know these patients
Chronic head and facial pain without a tangible correlate. Widespread tenderness far beyond the original region. Poor sleep, a strong tendency to catastrophise, a long path through the specialties – and a history in which “the jaw” was mentioned at some point, without anyone having examined it.
What has been measured
Chronic CMD is a nociplastic pain condition
Chronic craniomandibular dysfunction is now classified as nociplastic pain with central sensitisation. It therefore sits in the same category you already work in – and not in the dental pigeonhole of a “mechanical problem in the joint”.
The predictors of chronification are the same
Pain catastrophising and depressive symptoms are the most consistent predictors of pain persistence in CMD. The reference standard DC/TMD therefore includes a second axis: psychosocial distress, grading via the GCPS, jaw function via the JFLS. A CMD finding without Axis II is half a finding.
Psychological procedures work as well here as standard treatment
In painful CMD, psychological treatments reduce pain intensity to a similar extent as standard dental treatment. That is no argument against the functional assessment – it is the argument for running both side by side rather than one after the other.
Where the evidence ends
The aetiology of CMD is considered multifactorial and biopsychosocial; the purely occlusal explanation is outdated. We do not claim that the bite is the cause of a chronified pain condition. We claim that it can be an accessible, measurable and modifiable component of it – and that this can be established rather than assumed.
When a referral is useful
Useful
- head and facial pain with jaw signs – clicking, bruxism, restricted mouth opening, tenderness of the jaw musculature
- persistence over three months despite guideline-based first-line treatment
- a high GCPS grade with an unclear peripheral component
- before escalating drug therapy – to clarify whether a functional component has remained untreated
Not useful
- as a substitute for pain-medicine care – we do not take it over
- with unresolved red flags; the specialist work-up comes first
- with the expectation of resolving central sensitisation with a splint
Division of roles: the patient remains under your care. We take over the functional part, measure it, report back – and refer back. Any treatment beyond this only at your express request.
Three routes – you choose
I want to know more
DC/TMD Axis II instruments, our measurement protocols and the sources in full text.
I have a question about a case
A call back from the CMD specialist, not from reception.