Determining Risk Factors for the Development of Temporomandibular Disorders during Orthodontic Treatment

Abstract

Temporomandibular disorders (TMD) represent a complex disease with a multifactorial etiology. Despite several studies on the subject, a causal relationship between orthodontic treatment and different forms of TMD has not been established. The aim of this study was to analyze the effect of orthodontic treatment on two aspects of TMD: myofascial pain and disc displacement. This retrospective cohort study followed 224 orthodontic adult patients at three points in time: before treatment (T0), immediately after treatment (T1), and one year after treatment (T2). Disc displacement and myofascial pain were evaluated through a clinical assessment and with a semi-structured interview, along with headache, neck, and shoulder pain parameters and behavioral and somatic accompanying symptoms. Multivariate logistic regression was used to identify risk factors that could influence the development of TMD in these patients. There was a non-significant increase in disc displacement during orthodontic treatment, which mostly resolved after completion of treatment. Myofascial pain scores worsened during treatment, but improved when compared with the baseline once treatment was complete (T0 = 51.3%, T1 = 64.6%, T2 = 44.9%). Female gender (aOR = 1.9, CI 95%, 1.23–2.36), the presence of somatic symptoms (aOR = 3.6, CI 95%, 2.01–5.84), and symptoms of anxiety or depression (aOR = 2.2, CI 95%, 1.14–4.51) were significant risk factors associated with the development of TMD. There is a low and not significant risk of TMD development during orthodontic treatment. When TMD occurred, they resolved within 1 year of the end of treatment.

Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) from 2018 to 2022

“…In-depth analysis was performed on 19 papers, with the last 8 being excluded. Eventually, this literature review included 11 papers [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. The study selection process is shown in Figure 1 .…”

Risk factors of temporomandibular disorders: literature review

“…However, in some cases, it could persist. 14 Tecco et al showed the trigger points on masseter and temporal muscles, clicking sound, muscle, and joint pain significantly decreased after the orthodontic treatments. These findings fathomed the result of the maxillary expansion to align the teeth which allowed the mandible to move forward and settled in the natural decompressive position of the TMJs.…”

“…The authors suggested further studies were still needed to conclude the direct correlation between both. 14 Not much different for the hormonal factors, some studies that put gender variable into their work, concluded it did not significantly relate to TMD. 10,11 Meanwhile some other studies found females experienced TMD four times more often than males, so far they only suspected testosterone hormone played the role.…”

“…The findings were listed as 1) female patients had a 90% odds ratio higher than males to develop TMD after orthodontic treatments; 2) patients with depression or anxiety disorder had a 2.2 times higher risk to develop TMD after orthodontic treatments; 3) patients with somatic disturbance symptoms (phobia, tinnitus, back pain, headache, oral parafunctional, difficulties in chewing and swallowing, etc) had a 3.6 times higher risk to develop TMD after orthodontic treatments; 4) there were not enough evidence for malocclusion types and the length of orthodontics treatments to have a signifi-nificant correlation in developing TMD after the treatments. 14 Tecco et al did an observation regarding occlusal factors and TMD to 37 patients who had malocclusion and myofascial pain syndrome, they showed the trigger points on masseter and temporal muscles, clicking sound, muscle and joint pain significantly decreased after the orthodontic treatments. 15…”

“…16 Another study by Ugolini et al showed the patients with depression or anxiety disorder had a 2.2 times higher risk to develop TMD after orthodontic treatments. 14…”