Generalized Anxiety

How can Generalized anxiety disorder (GAD) possibly be related to TMD / CCMD?

Temporo Mandibular Dysfunction (TMD) or more accurately, Cranio Cervical Mandibular Dysfunction (CCMD) refers to poor alignment of the lower jaw to the head and neck. The muscles and joints of the jaw and neck that have to compensate for this mis-alignment, can cause symptoms if a person's adaptive capacity is exceeded. This mis-alignment is best treated through Physiologic Neuro Muscular Dental (PNMD) correction of the structural deficit. There are many, many symptoms that result from CCMD that are far removed from the jaw or teeth. As such these symptoms are 'diagnosed' as many medical or psychiatric conditions.

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.

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).

The following is a Google review left by one of these patients:

I have to admit I was skeptical at first. I've had headaches and pain on the right side of my body for the last decade mixed with some anxiousness and irritability. And I've been to a lot of doctors with no permanent solutions.

However, when I did some background research, one dentist who has been in the practice for over 30 years said, "I don't know the specifics of Dr. Raman does now with TMD, but I know that he's an extremely smart man."

I also saw that Dr. Raman had a successful traditional dentistry prior to specializing in TMD. I also saw the held many esteemed positions throughout his years as a dentist, such as being the president of the KC dentist association.

So I concluded that he was well-respected by his peers as well.

And being in the sports coaching profession and having a little background in athletic development, his presentation on how jaw alignment can affect the rest of the body really hit home for me.

Throughout the entire process, Amy, Melissa, and Dr. Raman all have been awesome. They truly care about you. They're quick to respond. They will talk to you out of office hours. They will get you in ASAP to fix any little issue that you may have. I can't say enough about how great the team is.

It may sound kind of funny, but I forgot what pure joy felt like. After I had my orthotics put in, it was crazy. I just felt an overwhelming feeling of "calmness". I don't think I can describe it. If somebody could have had me experience this calmness and sense of peace prior to the procedure and said "This is going to be how you're going to feel after the procedure." I would have looked at them and said... "What the heck was that. Did you give me some drugs or something?" It felt great.

I had forgotten what it felt like to feel at such peace internally, because my muscles have been constantly overworked and my body has been in flight or fight mode for over the past decade.. possibly longer.

I was less irritable and anxious. And this resulted in better interactions with my family.

From a physical standpoint, I felt instant relief in my shoulders, neck, back, my hips, etc.

I didn't even realize how restricted my neck movement was. After the procedure, it felt so easy to see my blindspot when driving in the car.

Prior to the procedure, I developed an aching pain in my hip... now it's gone!

When playing with my kid, I couldn't throw a ball overhand. My shoulder would make all sorts of crunchy noises and it hurt. After the procedure, it felt great.

Also, listen to Dr. Raman's advice... we moved and I overworked myself... this caused a slight regression. He told me not do this from the start. I didn't listen as well as I should have. However, even with that slight regression, they are there to work with you to get things right again.

To say that I'm pleased and impressed is quite the understatement. Anybody that I hear complain about headaches, jaw pain, TMJ... I instantly refer Dr. Raman and his team.


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