PDF: Relationship between temporomandibular disorders and orthodontic treatment: a literature review

The problems associated with the diagnosis and management of temporomandibular disorders (TMD) have aroused interest to the orthodontist. 


The attention to signs and symptoms associated with TMD have modified the clinical management before and during orthodontic treatment.

According to the American Academy of Orofacial Pain, the term temporomandibular disorder refers to a set of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) and associated structures, or both, being identified as the leading cause of non-dental pain in the orofacial region and is considered a subclass of musculoskeletal disorders.

The signs and symptoms that indicate any abnormality of the TMJ are: Alteration of the mandibular movement, limitation of mouth opening, joint pain with mandibular function, constraint function, joint noises, asymptomatic radiographic changes of the TMJ and jaw locking with open mouth and closed mouth.

The most common symptom associated with TMD is pain, usually located in the masticatory muscles, preauricular area and / or temporomandibular joint (TMJ). The pain is often aggravated by chewing or other functional activities. Limitation of mouth opening and movement, and the presence of joint noises are other common complaints in patients with TMD.

There are several classification schemes that assist in the clinical diagnosis of TMD, e.g. schemes of the American Academy of Orofacial Pain. Almost all divide the TMD in subgroups: Muscular, articular and mixed. The role of malocclusion in the etiology of TMD has been reported as controversial in recent years. McNamara Jr., Seligman and Okeson5 published an extensive systematic review which concluded that there is a significant association between the presence of some occlusal factors (skeletal open bite, unilateral crossbite, absence of five or more teeth, deep overbite and severe overjet) and the presence of TMD signs and symptoms.

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