CRANIO-MANDIBULAR DYSFUNCTION – “CMD”

The good news is that some patients with movement disorders such as Parkinson’s can see a reduction in symptoms if there is a TMJ component to the symptoms.

I met with Jo Rosen at the American Academy of Craniofacial Pain (AACP) 28th Annual Convention in July of last year. During our conversation, she mentioned the concept of not referring to Temporomandibular Dysfunction (TMD) as such, and that she thought that it was better described as Cranio Mandibular Disorder (CMD).

This is a very important concept since the symptoms often involve more than the TMJ (Temporomandibular Joint), this is especially true in treatment of our TMD/Parkinson’s patients. As a dentist, I am limited by my license to treating disorders which affect the head and neck, but as a seasoned practitioner, I realize how everything is connected. This is the reason I work closely with other practitioners such as chiropractors, osteopaths, physical therapists, and massage therapists. “The head bone is connected to the neck bone…” and on it goes. The other connection which has become apparent is the relationship between CMD and Sleep Disordered Breathing (SDB). When seeking treatment, there are some guidelines which you should follow, and perhaps questions to ask.

1. What is the level of the practitioner’s experience? I say this because we are talking about life/death and life changing therapies. Seek a dentist who is highly experienced and may even dedicate their practice to treating people with CMD.
2. Do I snore or stop breathing at night? Do I gasp for breath? Do I wake with a headache? Do I fall asleep easily? Stay asleep all night? Do I wake rested? These are all questions you should ask yourself.
3. Is this therapy effective? How does the dentist determine that it will help you?
4. Is this therapy invasive?
5. Are there non- invasive alternatives?
6. Any treatment for Obstructive Sleep Apnea (OSA) must be conducted in conjunction with your physician. A dentist is not authorized to “diagnose” OSA (they may be competent to do so, but it is not allowed legally in most states). The dentist may form a strong suspicion and refer to a sleep physician for diagnosis.
7. CMD is solely the area of the dentist’s expertise and is independent of a medical doctor.
8.  How will the CMD treatment affect my airway? OR How will the OSA treatment affect my TMJ/CMD?

The good news is that some patients with movement disorders such as Parkinson’s can see a reduction in symptoms if there is a TMJ component to the symptoms. Also, if OSA is preset, quality of life can improve significantly when it is addressed with Oral Appliance Therapy. A word of caution! Please do not think this is something you can treat yourself! A study at the University of Montreal showed that 40% of the oral appliances (including over-the-counter) actually make the airway 50% worse. Even Doctor made appliances can do this if the person creating the appliances is not aware of / does not specifically address the airway issue. Find Doctor Lipskis in the Parkinson's Resource Organization Wellness Village.