DentaltownUK February 2018 - 36

What You Should Know About
Temporomandibular Joint Dysfunctions
If You're Carrying Out Orthodontics
by Dr. Mohammed Almuzian
Dr. Mohammed
Almuzian (Mo)/Specialist
Orthodontist/ GDC. No:
260485. BDS (Hons.),
MFDS RCPS (Glasg.), MFDS
RCS (Edin.), MJDF RCS
(Eng.), MFD RSC (Ireland),
MSc. Orthodontics.
(Distinction), MSc. HCA
(Atlanta), DClin.Dent.
Orthodontics (Glasgow), PG.Cert.Sys.Rev.Health
(Portsmouth), MOrth RCS (Edin.), IMOrth RCPS
(Glasg./ Eng.), IADFE (USA), MARCDS. Orth. (Sydney).
Email: dr_muzian@hotmail.com

Abstract
The correlation between orthodontic
treatment and temporomandibular joint
dysfunction (TMD) is vague. Previous studies
in this field tend to be either opinion or case
reports, and most had conflicting conclusions. The aim of this article is to review the
current evidence regarding the correlation
of TMD, malocclusion and orthodontic
treatment and lastly the orthodontic roles
in the management of TMD.

Introduction
The possibility of a link between TMD
and orthodontics was provoked in 1987
after the court ruling on the case of Brimm
vs. Malloy. In this case, the jury awarded
almost $1 million U.S. to a patient who
had developed symptoms of TMD after
orthodontic treatment.1 The reasoning behind
this judgment was that the patient had not
received appropriate management when TMD
symptoms first began during orthodontic
treatment and that there had been inadequate
pretreatment documentation of the patient's
TMD status. Moreover, there was a lack of
evidence around the orthodontics and TMD
correlation.2 Consequently, the orthodontist
was blamed for causing the patient's TMD.

Evidence about the relationships
among TMD and orthodontic
treatment, occlusal interferences
and malocclusion
Correlation among occlusal interference, malocclusion and TMD: There is some
evidence regarding the association between
TMD and anterior open bite (AOB), excess

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overjet, posterior crossbite and deep overbite.3-5
Magnusson and Enbom found that the
signs and symptoms of TMD are twice as
high in a group of subjects with artificially
induced nonworking side interferences
compared with controls. 6 On the other
hand, Sadowsky and BeGole concluded that
nonworking side contacts are common and
not related to the development of TMD.7
Moreover, Proffit8 found that 5-30 percent
of individuals had TMD, yet 50-75 percent
had at least a moderate malocclusion. Luther9
showed a weak association among TMD,
AOB, Class III malocclusion, crossbite and
nonworking-side contacts.
Orthodontic treatment as a treatment
option for TMD: A few studies suggest that
orthodontic treatment causes the periodontal
ligament to become temporarily painful, which
might reduce bruxism habits and TMD
symptoms.8,10, 11 On the other hand, Egermark
et al. in their 20-year follow-up studies found
that orthodontic treatment in childhood does
not reduce the risk of developing TMD in
adulthood.12, 13
Orthodontic treatment as a causative
factor for TMD: Roth14 thought that condylar
position could be altered with the aid of some
orthodontic mechanics such as the use of
heavy intermaxillary elastics, headgear or
chin cap treatments, which might lead to
TMDs. Luecke and Johnston15 investigated
Roth's claims and found that orthodontic
treatment does not force the condyle distally;
in fact, it moves temporarily forwards by
0.7mm (in 70 percent). Similarly, Kircos et
al.16 found that there was no evidence that
the TMJ disc position can be altered by
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