Download Addendum I - Orthodontics and TMD

Addendum I
January 11, 2014
Orthodontics and TMD
Orthodontic treatment is often considered in the situation when major occlusal alterations
are thought to be dentally advantageous. Fixed, removable, functional, and extraoral orthodontic
appliances are all capable of improving occlusal and mandibular stability. 1 However,
orthodontics employed for the treatment of TMD is a different issue. Many retrospective clinical
studies have examined the relationship between orthodontic treatment and TMD and have found
no significant correlation on a population basis. 2-12 Furthermore, recent reviews of the literature
concluded that, based on the available evidence, orthodontic treatment “neither causes nor cures”
TMD. 13-16
After being involved in a motor vehicle accident (MVA), some individuals complain that
their “bite feels different”. The dental practitioner may even observe this reported
“malocclusion”. Hence, treatment involving orthodontics may be a consideration in restoring the
original maxillomandibular relationship resulting in occlusal harmony and stability. However, a
situation that must be accounted for is that during an MVA the masticatory and/or cervical
muscles may become traumatized with associated pain and/or pain referral. Therefore, alterations
to the maxillomandibular relationship and subsequent occlusal scheme may be a result of pain
from the musculature. This can be diagnosed with a thorough history and comprehensive
examination (as previously discussed). If treatment is directed at restoring proper muscle
function (relief of pain) then the maxillomandibular relationship and occlusal scheme will
naturally return to its original position. If orthodontics would have been instituted then one must
question the biologic advantage to be gained from this invasive treatment associated with
additional expense. 17, 18
References
1.
Perry HT. Occlusal therapy: Repositioning. In: Laskin DM, Greenfield W, Gale E (eds).
The President’s Conference on the Examination, Diagnosis and Management of
Temporomandibular Disorders. Chicago: American Dental Association, 1983:155–160.
2.
Lieberman MA, Gazit E, Fuchs C, Lilos P. Mandibular dysfunction in 10-18 year old
school children as related to morphological malocclusion. J Oral Rehabil 1985;12(3):20914.
3.
Sadowsky C, BeGole EA. Long-term status of temporomandibular joint function and
functional occlusion after orthodontic treatment. Am J Orthod 1980;78(2):201-12.
4.
Sadowsky C, Polson AM. Temporomandibular disorders and functional occlusion after
orthodontic treatment: results of two long-term studies. Am J Orthod 1984;86(5):386-90.
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Janson M, Hasund A. Functional problems in orthodontic patients out of retention. Eur J
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Reynders RM. Orthodontics and temporomandibular disorders: a review of the literature
(1966-1988). Am J Orthod Dentofacial Orthop 1990;97(6):463-71.
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Dibbets JM, van der Weele LT. Extraction, orthodontic treatment, and craniomandibular
dysfunction. Am J Orthod Dentofacial Orthop 1991;99(3):210-9.
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Sadowsky C, Theisen TA, Sakols EI. Orthodontic treatment and temporomandibular joint
sounds--a longitudinal study. Am J Orthod Dentofacial Orthop 1991;99(5):441-7.
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Kremenak CR, Kinser DD, Melcher TJ, Wright GR, Harrison SD, Ziaja RR, et al.
Orthodontics as a risk factor for temporomandibular disorders (TMD). II. Am J Orthod
Dentofacial Orthop 1992;101(1):21-7.
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Hirata RH, Heft MW, Hernandez B, King GJ. Longitudinal study of signs of
temporomandibular disorders (TMD) in orthodontically treated and nontreated groups.
Am J Orthod Dentofacial Orthop 1992;101(1):35-40.
12.
Rendell JK, Norton LA, Gay T. Orthodontic treatment and temporomandibular joint
disorders. Am J Orthod Dentofacial Orthop 1992;101(1):84-7.
13.
Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint
(TMJ) disorders. Cochrane Database Syst Rev 2010(7):CD006541.
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Luther F. TMD and occlusion part I. Damned if we do? Occlusion: the interface of
dentistry and orthodontics. Br Dent J 2007;202(1):E2; discussion 38-9.
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Michelotti A, Iodice G. The role of orthodontics in temporomandibular disorders. J Oral
Rehabil 2010;37(6):411-29.
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Leite RA, Rodrigues JF, Sakima MT, Sakima T. Relationship between
temporomandibular disorders and orthodontic treatment: a literature review. Dental Press
J Orthod 2013;18(1):150-7.
17.
Obrez A, Turp JC. The effect of musculoskeletal facial pain on registration of
maxillomandibular relationships and treatment planning: a synthesis of the literature. J
Prosthet Dent 1998;79(4):439-45.
18.
Obrez A, Stohler CS. Jaw muscle pain and its effect on gothic arch tracings. J Prosthet
Dent 1996;75(4):393-8.