The role of orthodontics in temporomandibular disorders

Abstract

Temporomandibular Disorder (TMD) is the main cause of pain of non-dental origin in the oro-facial region including head, face and related structures. The aetiology and the pathophysiology of TMD is poorly understood. It is generally accepted that the aetiology is multifactorial, involving a large number of direct and indirect causal factors. Among such factors, occlusion is frequently cited as one of the major aetiological factors causing TMD. It is well known from epidemiologic studies that TMD-related signs and symptoms, particularly temporomandibular joint (TMJ) sounds, are frequently found in children and adolescents and show increased prevalence among subjects between 15 and 45 years old. Aesthetic awareness, the development of new aesthetic orthodontic techniques and the possibility of improving prosthetic rehabilitation has increased the number of adults seeking orthodontic treatment. The shift in patient age also has increased the likelihood of patients presenting with signs and symptoms of TMD. Because orthodontic treatment lasts around 2 years, orthodontic patients may complain about TMD during or after treatment and orthodontists may be blamed for causing TMD by unsatisfied patients. This hypothesis of causality has led to legal problems for dentists and orthodontists. For these reasons, the interest in the relationship between occlusal factors, orthodontic treatment and TMD has grown and many studies have been conducted. Indeed, claims that orthodontic treatment may cause or cure TMD should be supported by good evidence. Hence, the aim of this article is to critically review evidence for a possible association between malocclusion, orthodontic treatment and TMD.

Anxiety/depression and orofacial myofacial disorders as factors associated with TMD in children

“…19 A new scenario for the risk of developing TMD arises when considering gene-environment interactions. 25,26 Shortcomings in the current study must be considered. First, the study was based on a convenient sample of limited size.…”

Orthodontics is temporomandibular disorder–neutral

“…Such an approach is actually not supported, and systematic reviews of the literature provide evidence-based recommendations that there is a lack of causal relationship between TMD and occlusion; they also offer evidence that irreversible occlusal treatments are not more useful than conservative treatment alone to either manage or prevent TMD. [11][12][13][14] The literature [15][16][17] on the effects of orthodontic treatment supports the neutral effects on the temporomandibular joint (TMJ). In particular, a recent systematic review 16 concludes that there are insufficient research data on the relationship between active orthodontic intervention and TMD on which to base our clinical practice.…”

Knowledge and Beliefs Regarding TMD: Has Anything Changed After 20 Years?

“…On the current survey 93.9% of the respondents disagreed with the statement "Orthodontic treatment can prevent the onset of TMD", against 77% of the respondents in the original survey. This topic has been extensively investigated, and despite the fact most of the publications support that Orthodontic treatment is not able to prevent TMD (23)(24)(25)(26)(27), some papers support the opposite (28,29). Most of the papers that stated that orthodontic treatment does not prevent TMD were published after 1990, and this might explain why the current survey shows a higher percentage of respondents who disagreed with the above-mentioned statement.…”