Examination of temporomandibular disorders in the orthodontic patient: a clinical guide

Abstract

The possible association between orthodontic treatment and temporomandibular disorders (TMD) is a topic of great interest in the current literature. The true role of orthodontic therapy on the etiology of TMD, however, is still uncertain. From the clinical prospective, a thorough examination of the stomatognathic system is always necessary in order to detect possible TMD signs and symptoms prior to the beginning of the orthodontic therapy. Caution should be exercised when planning, performing and finalizing orthodontics, especially in patients who with history of signs and symptoms of TMD. The clinician must always eliminate patient’s pain and dysfunction before initiating any type of orthodontic mechanics. Muscle incoordination, unstable disc-condyle relationship and bone alterations are usual TMD conditions that can interfere with the presenting occlusal relationship. This article reviews these aspects and presents a detailed clinical guide for the examination of the orthodontic patient, considering aspects related to facial pain and dysfunction.

Evaluation of Symptoms of Temporomandibular Disorders in Orthodontic Appliance Users

“…These findings suggest that the orthodontic treatment with the use of fixed appliances is not an etiological factor related to TMD symptoms. The literature describes that TMD has multifactorial etiology and unpredictable nature, highlighting that malocclusion or use of orthodontic appliances does not configure triggering factors for these disorders (Greene et al, 1999;Conti et al, 2007;Machado et al, 2010).…”

“…Due to the etiological complexity and physiopathology of TMD their signs and symptoms can appear before, during or after orthodontic treatment (Conti et al, 2003;Henrikson & Nilner;Conti et al, 2007;Macfarlane et al;Bourzgui et al). In this sense, a complete articular diagnosis of patient prior to orthodontic treatment is advisable.…”

“…Its most common features are regional pain in the face, limitations in jaw movements and noises from the TMJs during jaw movements (Schiffman et al, 2014;Manfredini & Poggio, 2016;List & Jensen, 2017 ). It can also be manifested through articular noises, difficulties in chewing and cutting food, headaches and pain in the TMJ region, ear fullness, earache, tinnitus, dizziness and articular disc displacements (Conti et al, 2007;List & Jensen).…”

TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia: a cross-sectional study

“…The assessment of symmetry is important in comprehensive orthodontic treatment, as well as in malocclusions and dental evaluation; it is related to this aforementioned goal of orthodontic treatment, especially the functional and aesthetic evaluation of the craniofacial region 2, 3 . The asymmetries in human facial structures affect the skeleton, muscles and corresponding attached facial tissues.…”

“…The biopsychosocial model is hypothesized to be the most accepted theory for developmental asymmetry and complexity of TMD 5, 10 . Studies concerning TMD and the relevance of orthodontic treatment suggest that the achievement of a balance in the dynamic occlusion is necessarily related to the development of mandibular symmetry as a part of the successful management of TMD 2, 10– 13 . …”