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Craniomandibular problems and orofacial pain

 It is estimated that 15% to 20% of the population suffers from this problem.

Craniomandibular problems

The craniomandibular disorder is a very broad term that encompasses different processes affecting the temporomandibular joint and periarticular tissues, including the masticatory muscles. A very high percentage of joint disorders often lead to joint pain. In fact, almost 80% of patients, according to some epidemiological studies, have neck pain.

It is common for these patients to present localized pain in the orofacial region or referred to the head and neck, all of which may coexist with a greater or lesser loss of mouth opening or other masticatory difficulties.

The physiotherapist is key in the multidisciplinary team treating these patients, as he/she may be the one to provide the most complete treatment as long as he/she is an expert in the area and adopts a multimodal therapeutic approach.
The specific cause of a disorder of this type is unknown since it can appear in any person and at any time of life. However, there is scientific evidence that shows that they affect women more than men and that about 20% of the population suffers from them. The main causes that trigger them are parafunctional (such as bruxism) and stress. After the long development of the COVID-19 pandemic, the latter, emotional stress, seems to be a basic trigger that has increased this type of pathology in patients who were not suffering from disorders until now.

In addition to parafunction and stress, there are other related risk factors such as high-speed trauma or accidents involving mandibular fracture, micro and macro trauma, certain occlusal characteristics, prolonged mouth opening time (long dental treatments such as endodontics, for example), rheumatoid arthritis, and the fact of being a woman. There are other associated factors that may contribute to the worsening of temporomandibular disorder such as poor sleep quality, low levels of physical activity, the coexistence of headache, and the presence of anxiety and depression.
The most appropriate treatment for these disorders is conservative. For many years, surgical interventions were performed to correct disc positions or to improve the lubrication of the joint and clean it internally. These procedures have ceased to be performed routinely, among other things because scientific evidence has shown that conservative treatment is the best option.

Within the conservative options, there is the possibility of taking analgesics, anti-inflammatory drugs, or muscle relaxants, as prescribed by the physician.  The use of Botox for bruxism or masticatory muscle pain is also currently on the rise. However, this expert in the area assures that there is not enough scientific evidence to justify the use of Botox for analgesic purposes in these patients. For this reason, she always recommends, instead, treatment by means of manual therapy on the craniomandibular structures and the prescription of therapeutic exercise. All this, together with the appropriate recommendations and a systematic therapeutic education process make it possible for patients to recover in most cases. If properly performed, very few will have to undergo surgery.
It is very important to manually treat and precisely prescribe the exercises in these cases; with some patients, the participation of a maxillofacial surgeon will be required to assess whether the case may require surgery.

On the other hand, it is important to point out that a high percentage of patients with long-standing craniomandibular disorders end up developing psychological disorders. For this reason, he believes that the interdisciplinary treatment team should always include a psychologist since some patients need cognitive-behavioral therapy focused on reducing pain, self-management of daily stress, or treatment of certain maladaptive behaviors that the patient may present.

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