Orthodontics for treating temporomandibular joint (TMJ) disorders

Luther F, Layton S, McDonald F

Published Online:

July 7, 2010

There is no evidence about the effects of different types of orthodontic braces for problems associated with the joint between the lower jaw and skull. When the joint between the lower jaw and the base of the skull is not working well (temporomandibular disorders (TMD)), it can lead to abnormal jaw movement or locking, noises (clicking or grating), muscle spasms, tenderness or pain. TMD is very common, and it is believed by some that it may be caused by the occlusion (the way the teeth bite), trauma or psychological stress. There is also a belief that the pain associated with TMD is similar, in that respect, to low back pain and may be related to variations of a person's individual pain perception. Changes in the way the teeth meet can be produced by the use of active orthodontic appliances. This review found that there is no evidence from trials to show that active orthodontic treatment can prevent or relieve temporomandibular disorders adding support to teeth not being part of its cause. It is suspected that we do not know the real cause of TMD at present.

Abstract (click to read)

Background:

Temporomandibular disorders (TMD) relate to discomfort of the temporomandibular joint (TMJ). The disorder is multifactorial with a degree of psychogenic influence varying throughout an individual's life with phases of symptoms affecting the quality of life. In an attempt to treat this complex group of disorders many treatment modalities have been identified some of which are also considered in other Cochrane reviews. The disorder also has a normal cycle of events appearing to spontaneously improve without treatment.

Objectives:

To establish the effectiveness of orthodontic intervention in reducing symptoms in patients with TMD (compared with any control group receiving no treatment, placebo treatment or reassurance) and to establish if active orthodontic intervention leads to TMD.

Search strategy:

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Handsearching of orthodontic journals and other related journals was undertaken in keeping with the Cochrane Collaboration handsearching programme. No language restrictions were applied.
Authors of any studies were identified, as were experts offering legal advice, and contacted to identify unpublished trials. Most recent search: 13th April 2010.

Selection criteria:

All randomised controlled trials (RCTs) including quasi-randomised trials assessing orthodontic treatment for TMD were included. Studies with adults aged equal to or above 18 years old with clinically diagnosed TMD were included. There were no age restrictions for prevention trials provided the follow-up period extended into adulthood. The inclusion criteria required reports to state their diagnostic criteria for TMD at the start of treatment and for participants to exhibit two or more of the signs and/or symptoms. The treatment group included treatment with appliances that could induce stable orthodontic tooth movement. Patients receiving splints for 8 to 12 weeks and studies involving surgical intervention (direct exploration/surgery of the joint and/or orthognathic surgery to correct an abnormality of the underlying skeletal pattern) were excluded. The outcomes were: how well were the symptoms reduced, adverse effects on oral health and quality of life.

Data collection and analysis:

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in triplicate and independently by three review authors. As no two studies compared the same treatment strategies (interventions) it was not possible to combine the results of any studies.

Main results:

The searches identified 284 records from all databases. Initial screening of the abstracts and titles by all review authors identified 55 articles which related to orthodontic treatment and TMD. The full articles were then retrieved and of these articles only four demonstrated any data that might be of value with respect to TMD and orthodontics. After further analysis of the full texts of the four studies identified, none of the retrieved studies met the inclusion criteria and all were excluded from this review.

Authors' conclusions:

There are insufficient research data on which to base our clinical practice on the relationship of active orthodontic intervention and TMD. There is an urgent need for high quality randomised controlled trials in this area of orthodontic practice.

When considering consent for patients it is essential to reflect the seemingly random development/alleviation of TMD signs and symptoms.

This record should be cited as:

Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint (TMJ) disorders. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD006541. DOI: 10.1002/14651858.CD006541.pub2

Assessed as up to date:

June 4, 2010

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Craniofacial anomalies > Orthodontic treatment

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Orthodontics for treating temporomandibular joint (TMJ) disorders

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