Does Orthodontic Treatment (Braces) Cause TMJ?
Every May our office sees an increase in the number of phone calls from parents of high-school-aged children concerned because they have suddenly developed “TMJ” (or more appropriately TMD or temporomandibular disorders). They want to come and see me (an orthodontist) assuming the joint symptoms are directly related to their bite. What is the real relationship between the temporomandibular disorders and orthodontics? Following a landmark lawsuit in 1987 where a Michigan patient received a legal judgment against her orthodontist for giving her "TMJ," hundreds of studies and millions of dollars have been spent by the scientific community to find if there really is a relationship between orthodontic treatment and the health of the temporomandibular joints (TMJ). Obviously this would be an important finding for doctors and patients alike. These studies have examined the different types of bad bite as well as the various approaches to treatment to see if there are any cause and effect relationships.
Time and time again scientific studies have found that orthodontics neither causes nor cures TMJ disorders. Except for two exceptions, malocclusion in general cannot be linked to a higher prevalence of joint problems. The two exceptions are a posterior cross bite that causes the jaw to shift to one side upon closure, and an anterior open bite where all the biting force is on the back teeth only and the front teeth do not touch at all. Neither overbite, underbites, crowding, or alignment issues have been shown to cause any problems at all. As for treatment modalities, these studies have been unable to find any links between the use of headgear, extractions, rubber bands, oral surgery, or any other orthodontic treatment and TMJ problems.
There are many conditions that can cause pain in the area of the TMJ that are not related to the teeth at all. Some are serious like degenerative arthritis and cancer. Others are related to functional habits (like clenching and grinding). While cross bites and open bites may be linked to joint problems, not all bad bites result in TMJ pain. Many orthodontic patients have "bad bites," and yet very few report TMJ pain. On the other hand, many patients who report severe TMJ pain often have ideal bites. This simple observation supports the scientific studies that have separated the fields of TMJ and orthodontics. If all bad bites had TMJ symptoms and all great bites never had any pain, a direct relationship would be defensible.
For the latest on the relationship between orthodontics and TMJ, check out this lecture by the most respected expert on occlusion in the world, Dr. Jeffrey Okeson. He is not an orthodontist and has no motivation to protect orthodontists. he just reports the facts.
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.