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DOULEURS - Le SADAM, un mal encore méconnu

Posted on September 4, 2019 at 9:10 AM

Douleurs articulaires, manque de sommeil, dents qui grincent, fatigue visuelle… Et si c’était un SADAM ? Le point sur ce syndrome encore peu connu.



Le syndrome algodysfonctionnel de l’appareil manducateur (SADAM) est parfois aussi nommé le syndrome de Costen, du nom du médecin qui, en 1934, a décrit ce mal. On l’appelle syndrome parce qu’il ne s’agit pas, à proprement parler d’une maladie, mais d’un ensemble de symptômes correspondants à une pathologie.

Pour le dire simplement, le SADAM est un déséquilibre de la mandibule. Les mâchoires supérieures et inférieures permettent de parler et de mastiquer, grâce à une articulation située entre la mandibule et l’os temporal. Il s’agit d’un petit disque qui permet aux os de glisser. Si le disque ne se trouve plus dans la bonne position, cela crée un déséquilibre dont les causes sont incertaines, mais dont les conséquences peuvent se révéler très graves s’il est laissé sans soins. On parle du syndrome dès l’instant où ce déséquilibre devient la cause d’une réaction en chaîne et d’un nombre de symptômes élevés conduisant à une réelle entrave à la vie quotidienne, affectant la sphère physique autant que psychologique.


Un ensemble de symptômes

Parce que les symptômes du SADAM n’ont rien de spécifique, il est très facile de passer à côté. Pourtant, c’est la somme des symptômes qui doit vous mettre la puce à l’oreille, même si un patient peut ne pas les présenter tous de manière exhaustive.

Dans un premier temps, le patient se plaint de douleurs localisées dans la partie supérieure de son corps :

• Migraines

• Douleurs aux oreilles

• Acouphènes

• Torticolis

• Fatigue visuelle

• Vertiges

• Difficultés de mastication

• Douleurs aux articulations temporo mandibulaires

• Douleurs et inconfort au niveau de la mâchoire et de la face

Mais le déséquilibre ainsi créé va se répercuter dans la partie inférieure du corps :

• Asymétrie des hanches

• Douleurs du bassin

• Maux de dos

• Lombalgie

• Crampes dans les pieds

Il est important de noter que le bas du corps sera affecté de manière symétrique. On constate un déséquilibre du même côté que celui où on a constaté un défaut de l’appareil manducateur.

S’ensuit un important risque de luxation de la mâchoire. La mâchoire se déboîte, craque et devient de plus en plus douloureuse. Lorsque le patient parle, mange ou dort, on peut entendre un léger bruit au niveau de sa mâchoire ou des grincements de dents nocturnes. Progressivement, la partie supérieure et la partie inférieure se décalent, parfois on constate que la mâchoire inférieure s’est déplacée, impliquant une position en arrière, en avant ou décalée d’un côté ou de l’autre.


Quels sont les facteurs du SADAM ?

Le SADAM est une pathologie complexe en ce sens qu’elle ne possède pas une seule cause possible, mais un ensemble de facteurs potentiels. Parfois, on constate que l’une des conséquences du SADAM, l’un de ses symptômes, est en réalité le point de déclenchement de la pathologie. On dit que la pathologie est d’origine multifactorielle, parce qu’elle peut résulter d’un nombre important de facteurs sans qu’un seul ne puisse nécessairement permettre de l’anticiper. On distingue deux catégories de facteurs.

Les facteurs directs :

• Le stress agit souvent comme un hyper-contractant

• Le manque de sommeil favorise le stress

• Les anomalies congénitales peuvent comprendre un dysfonctionnement de l’appareil mandibulaire qui s’aggrave avec le temps

• Les troubles musculaires et de la posture vont venir créer une crispation de la mâchoire

• Les traumatismes ou fractures de la face

• Le trouble de l’occlusion dentaire, où les dents mal alignées impriment un déséquilibre à l’articulation temporo mandibulaire.

Les facteurs indirects :

• Les troubles digestifs

• L’obstruction nasale chronique

• Les rhumatismes

• Le déséquilibre hormonal

• La difficulté respiratoire

Les traitements proposés pour soigner le syndrome

Il est difficile d’obtenir un traitement dès le début dans la mesure où le diagnostic met souvent du temps à être posé. Le nombre de symptômes non spécifiques oriente souvent les médecins sur de mauvaises voies. Dans la majorité des cas, un patient atteint de SADAM va devoir rencontrer toute une batterie de spécialistes pour chaque symptôme pris isolément. Évidemment, ce parcours du combattant n’améliore pas la santé du patient qui arrive souvent dans une véritable détresse psychologique. Incompris, laissé pour compte, mal soigné, souvent désigné comme hypocondriaque, le malade augmente sa situation de stress à mesure que sa situation empire et que les médecins ne trouvent pas de solution. Il arrive souvent que le patient atteint du syndrome de Costen soit identifié comme dépressif. Un traitement par antidépresseurs ou anti spasmophiles ne l’aidera pas.

Une fois diagnostiqué, le patient est traité par plusieurs spécialistes, selon deux types de soins.

Les soins externes

• Un traitement kinésithérapie pour soulager les symptômes osseux et musculaires

• Un traitement médicamenteux pour supprimer la douleur et les tensions

• Une correction orthodontique avec pose d’une gouttière

• Un traitement des troubles du sommeil et de l’anxiété

Les soins chirurgicaux

• Repositionnement de la mandibule

• Implant dentaire

Lorsqu’un traitement commence, il faut que le diagnostic du SADAM ait été clairement posé par votre médecin, stomatologue ou chirurgien maxillo-facial. Cette identification permet alors au patient d’être pris en charge par la Sécurité sociale, plutôt que de consulter des spécialistes à ses frais. Lorsque le SADAM n’est pas identifié, les consultations multiples peuvent rapidement devenir une raison d’endettement sévère.

Pour ne pas passer à côté d’un diagnostic, restez à l’affût lorsque plusieurs maux surviennent en même temps. Il se peut qu’ils soient tous liés à un syndrome. Ne manquez pas de dresser une liste exhaustive à votre médecin et de lui parler de tous vos maux sans vous focaliser sur celui qui vous paraît le plus gênant.


(Sources : https://www.grands-meres.net, "Critères diagnostiques de Recherche des Désordres Temporomandibulaires“ (CDR/DTM) de Dworkin et LeResche - 1992, Jean-Paul Goulet, Sylvie Breton, Daniel Nachaat (trans.), « Critères Diagnostiques de recherche des Désordres Temporomandibulaires CDR/DTM » [archive], RDC-TMDinternational.org, novembre 2002 (consulté le 25 juillet 2012)


Categories: Santé et plantes, Ce que la science peine à expliquer, Questions / Réponses

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