Orthodontics and temporomandibular disorders: a comprehensive review

Temporomandibular disorders (TMDs) present a diverse group of musculoskeletal conditions affecting the temporomandibular joint, with symptoms ranging from pain to limited mandibular function. With growing interest in how orthodontic practices might influence or intersect these disorders, this review evaluates TMD from an orthodontic perspective. The paper outlines the multifactorial aetiology of TMD, incorporating biological, psychological, and biomechanical elements. Clinical evaluation and diagnosis are explored with emphasis on evidence-based assessment tools and imaging modalities. The review also considers the debated relationship between malocclusion, occlusal interferences, and TMD, revealing weak associations but no conclusive causal links. Orthodontic treatments, including extractions, orthognathic surgery, and appliance therapy, are critically examined, along with controversial concepts such as reverse orthodontics. Despite anecdotal claims, most current evidence indicates that well-executed orthodontics neither causes nor cures TMD. Management should prioritise reversible, conservative strategies, including patient education, behavioural modifications, splint therapy, and physical therapy. Surgery remains a last resort for non-responsive cases. The review advocates for a cautious, individualised approach to TMD in orthodontic patients, highlighting the need for more robust longitudinal data to inform future practice.