Orthodontic treatment and temporomandibular disorders

The relationship between orthodontic treatment and temporomandibular disorders (TMDs) has long been of interest to the practicing orthodontist, but only during the past decade have a significant number of clinical studies been conducted that have investigated this association. This interest in orthodontics and TMD in part was prompted in the late 1980s after litigation that alleged that orthodontic treatment was the proximal cause of TMD in orthodontic patients. This litigious climate resulted in an increased understanding of the need for risk management as well as for methodologically sound clinical studies. The findings of current research investigating the relation of orthodontic treatment and TMD can be summarized as follows: (1) signs and symptoms of TMD may occur in healthy persons; (2) signs and symptoms of TMD increase with age, particularly during adolescence, until menopause, and therefore TMDs that originate during orthodontic treatment may not be related to the treatment; (3) in general, orthodontic treatment performed during adolescence does not increase or decrease the chances of development of TMD later in life; (4) the extraction of teeth as part of an orthodontic treatment plan does not increase the risk of TMD; (5) there is no increased risk of TMD associated with any particular type of orthodontic mechanics; (6) although a stable occlusion is a reasonable orthodontic treatment goal, not achieving a specific gnathologic ideal occlusion does not result in signs and symptoms of TMD; and (7) thus far, there is little evidence that orthodontic treatment prevents TMD, although the role of unilateral posterior crossbite correction in children may warrant further investigation.