How can TMD / CCMD be related to GAD?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the American Psychiatric Association’s (APA) classification and diagnostic tool. Generalized anxiety disorder (GAD) is described on Page 222. In the United States the DSM serves as a universal authority for psychiatric diagnosis.

GAD is thought to be due to disruption of the function of amygdala where fear and anxiety are processed in the brain. As it is true with many other medical diagnoses, GAD is diagnosed, if certain symptoms persist for six months are more and other explanation for those symptoms are ‘excluded’. Diagnosis of exclusion is not uncommon in medicine. Treatment of GAD typically includes Buspirone or Selective Serotonin Reuptake Inhibitor (SSRI) medications.

According to National Institute of Mental Health, Generalized anxiety disorder symptoms include:

  • Restlessness or feeling wound-up or on edge
  • Being easily fatigued
  • Difficulty concentrating or having their minds go blank
  • Irritability
  • Muscle tension
  • Difficulty controlling the worry
  • Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)

Explanations linking each one of these above symptoms to TMD / CCMD as well as case histories of patients that had a GAD diagnosis that sought treatment for more typical TMD symptoms such as jaw pain, saw compete resolution of GAD symptoms once their TMD was treated through PNMD orthotic. This would support the idea that many patients being treated with medications to manage their GAD are really suffering from TMD / CCMD which can be resolved once and for all with PNMD.

The autonomic nervous system of our bodies work in one of two conditions at all times.

1. “Parasympathetic” mode when we “rest, repair and rejuvenate”. Secretions such as saliva are induced, the tone and contractility of smooth muscle are increased so the gut works and the heart rate is slowed all in preparation for rest, digestion and repair. This is the appropriate mode for rest after a nice meal.

2. “Sympathetic” mode where we are ready to ‘fight or flight’ is appropriate in certain situations. Adrenalin is pumped into our circulatory system. Our skeletal muscles are tight, gut is shut down, decrease secretions such as saliva, increase heart and breathing rates, blood vessels constrict and the blood pressure goes up. All of this prepares one for ‘action’. The responses to stimuli are often exaggerated which may be seen as “irritability”. If you are ready to receive a tennis serve or a police officer going into a dark building to investigate a burglar alarm, this is the mode to be most effective in responding instantly.

TMD / CCMD often adversely affects the entire posture of a person. As such the entire chain of muscles that support our posture would have to work over time to compensate for this postural instability. This keeps the body functioning in a sympathetic mode. If a diagnosed CCMD treatment position where the jaw and neck muscles are unstrained, is shown to also greatly improve the postural stability, it stands to reason that those muscles would actually be able rest.

The sagittal images in the following pages show patients standing erect. The ideal alignment connecting ear hole and ankle, is shown as a green line while the existing alignment in red. The further apart these two lines are, the worse the alignment is. In each of these cases, correcting the CCMD lessened the postural compensation which reduced the stress on the body also. The fact that the “anxiety” level also decreased and resolved should not be a surprise at all, when its connection to jaw / neck alignment is realized.

X-rays showing Obstructive Sleep Apnea

Other symptoms on the list earlier are also often related to CCMD. Muscles that are constantly hypertonic and over-worked is a cause of fatigue. One of the problems that is usually noted is inadequate or collapsed airway since narrow jaws or over closed jaw relation crowd out the tongue space. The following image shows the color coded cross section of the pharyngeal airway column. Ideally, it should be in the blue or white zone rather than the black or red zone as shown. This images is taken when the patient is upright and awake. During sleep, the tone of the throat muscles relaxes and the supine sleeping position further closes off the airway. This in turn leads to Sleep Breathing Disorders (SBD) including Obstructive Sleep Apnea (OSA).