Sadam (Algo-dysfunctional Mandicator System Syndrome) or Costen Syndrome is a very common but unrecognized condition in which dysfunction of the lower jaw joint is likely to cause pain and various symptoms, sometimes very disabling. The complex nature of this syndrome can be at the origin of a diagnostic error and often complicates the management.

Definition

Sadam (Algo-dysfunctional syndrome of the mandator apparatus), also called Costen’s syndrome, is a condition related to a dysfunction of the joint between the temporal cranial bone and the mandible, which forms the lower jaw. It results in variable manifestations, mainly localized or distant pain as well as mechanical problems of the jaw, but also other much less specific symptoms.

The anomalies involved can affect the various elements of the manducatory apparatus, which includes:

• the articular surfaces of the temporal bone as well as the rounded ends (condyles) of the lower jaw, covered with cartilage,
• the articular disc which covers the head of the condyle and prevents friction,
• masticatory muscles and tendons,
• dental occlusion surfaces (the term dental occlusion denotes the way in which the teeth are positioned with respect to each other when the mouth is closed).

Causes and risk factors

 Sadam is of multifactorial origin, with many possible causes that are often intertwined.

A dental occlusion disorder is often found: the teeth do not fit together correctly because they are misaligned, because some have been lost (edentulous), or because dental work has been poorly done.

Hypercontraction of the jaw muscles, conscious or not, is common. These tensions can result in bruxism, that is to say, grinding or clenching of the teeth, usually at night, sometimes associated with wear and tear of the teeth.

Trauma or fractures to the face, skull or neck can also cause joint damage. Sometimes a displacement of the articular disc is noted.

Stress and anxiety can play an important role in triggering symptoms, to the point that some specialists consider Sadam to be primarily a psychosomatic condition.

Among the other factors involved in the genesis of this syndrome, there are in particular:

• congenital anomalies,
• rheumatic pathologies,
• muscle or posture disorders,
• chronic nasal obstruction,
• hormonal factors,
• digestive disorders,
• sleep and vigilance disorders …

Diagnostic

Given the great variability of symptoms, diagnosis is often complicated. It is based primarily on a detailed medical examination as well as a clinical examination of the mouth opening, the masticatory muscles, the lower jaw joint and dental occlusion.

The panoramic dental x-ray makes it possible to check whether dental and jaw pathologies are not responsible for the pain symptoms. In some cases, a CT scan of the joint, open and closed mouth, or an MRI, which provides information in particular on the condition of the disc, will also be requested.

These examinations must in particular make it possible to rule out other possible causes of pain, such as fractures, tumors or neuralgia. Multidisciplinary medical advice is sometimes necessary.

The people concerned

Although little known, Sadam is extremely frequent: one in ten people is brought to consult because of the pain it causes, and up to one in two could be affected.

Anyone can be affected. However, it is found more often in young women (between 20 and 40-50 years).

By definition, a syndrome is characterized by a clinical set of symptoms. In the case of Costen’s syndrome, these can be quite variable. This is explained in particular by the location of the jaw joints in front of the ears, in an area with complex musculature, richly innervated and irrigated, the tensions of which can have repercussions on the relationship between the head and the spine. , with an impact on the entire muscle chain involved in the posture of the body.

Local symptoms

Symptoms very localized in the jaws and mouth are the most obvious.

pain

Often times, people suffering from Sadam will complain of pain or discomfort felt when closing or opening the mouth, but other types of pain may appear. It may be, for example, throbbing pain in the front of the ear, pain in the mouth, palate or gums, tooth sensitivity or even burning sensations in the mouth.

Neuralgia can occur in the jaw, face, neck or back of the skull.

Headaches and migraines are also common.

Joint problems

The mobility of the jaw may be reduced and its movements abnormal, which can make chewing difficult. Displacements of the disc cause a high risk of dislocation (dislocation).

Joint noises, such as clicking or “cracking” sensations when opening the mouth or when chewing, crackling or screeching are characteristic. Some people also have jaw blockages in the open or closed position.

Some people have osteoarthritis in the joint.

Sometimes the pain felt is done “at a distance”, that is to say in a place of the body more or less far from the jaw.

ENT problems

The manifestations of Sadam in the ENT sphere are also frequent. They can take the form of dizziness, tinnitus, a feeling of blocked ears, or even chronic sinusitis. These problems can be associated with eye problems.

Diverse

• Tooth wear or chipping
• Mouth ulcers
• Swallowing problems
• Hypersalivation…

Remote symptoms

pain

Not only can the pain radiate to the neck or cervical area, people suffering from Sadam can be prone to low back pain, pain in the hips or pelvis, sometimes even cramps in the feet.

Digestive problems

Digestive and transit problems can be the consequence of eating difficulties linked to poor chewing or salivation problems.

Diverse

• Lack of sleep
• Irritability
• Depression…

Sadam’s treatments must be as individualized as possible to adapt to the variability of symptoms.

Behavioral rehabilitation

When the discomfort is moderate and the pain is not very disabling, behavioral rehabilitation is preferred. Diet modifications (avoid difficult to chew foods, etc.), exercises to control the posture of the jaw or that of the body, as well as relaxation and stress management techniques may be recommended. Sometimes cognitive and behavioral therapies will also be beneficial.

Physical therapies

Some pains can be relieved in the short term by applying ice (sharp pain, inflammation), by applying a wet and warm washcloth (on sore muscles) or by massages.

Mandibular physiotherapy is helpful. Osteopathy also promotes the correction of dysfunctions.

Transcutaneous electrical nerve stimulation (TENS) is also useful for relieving muscle tension.

Drug treatments

In more severe cases analgesics, anti-inflammatory drugs or muscle relaxants may be necessary to improve quality of life. 

Dental orthosis (splint)

A dental appliance (orthosis, more commonly called a splint) can be prescribed by the dental surgeon or the stomatologist. Formerly regularly offered to people suffering from Sadam to correct dental occlusion abnormalities, reposition the mandible and relieve tension in the jaw, this type of device is instead prescribed today as a second line, when rehabilitation and physical therapy did not give any result.

Surgery and orthodontics

More invasive dental, orthodontic or surgical treatments are only considered on a case-by-case basis, to respond to very specific problems and after failure of other techniques.

Diverse

Other treatments like acupuncture, homeopathy or herbal medicine can be tried. Their effectiveness, however, has not been demonstrated.

Good hygiene and proper dental care can help prevent the onset of pain syndrome. It is also possible to prevent tightening of the jaw muscles by relaxation, but also by avoiding the abuse of chewing gum and hard food.