TMD & Bruxism

Braces and TMJ problems: Are they related?

The relationship between TMJ problems and braces has also been a topic of debate. There is a considerable body of evidence on this topic, since it is vitally important for dentists, orthodontists, and the public to be aware of any connection between braces and TMJ problems.

TMJ is the abbreviation for Temporomandibular Joint. The joint is the connection between the lower “U” shaped jaw (mandible) to the skull. The joint is highly complex since it allows rotation, for opening and closing the mouth, and sliding side to side as well as front to back. In addition to the complexity of the joint, it is constantly used throughout the day for talking, chewing, and in some patients, grinding.

Many people have heard of conditions of the TMJ – more appropriately described as TMD (Temporomandibular Disorder). Problems with the joint range from clicking or popping sounds when opening and closing, to significant pain or locking of the jaw. The extent to which these symptoms are present in a particular patient will dictate what type of treatment may be recommended. The dentist or orthodontist may recommend treatment or a referral to a dentist with additional training for TMD patients.

The cause of TMD frequently cannot be isolated to one particular cause. It is therefore regarded as multifactorial, since behavior, emotions, bite, and other physical factors may contribute to the disorder. The role that the bite plays in the disorder is controversial, however (J Orofacial Pain 1995;9:73-90) (J Craniomandib Disord Facial Oral Pain 1991;5:96-106). This needs to be emphasized because some patients choose to pursue braces to help with their TMJ problems. The changes that occur with braces in the alignment of the teeth and bite may not in fact “cure” TMD.

The role of braces causing TMJ problems has also been studied extensively. There is overwhelming evidence that braces generally do not increase the risk of developing TMJ problems later (Am J Orthod Orthop 1992;101:79-83). The study cited here was a comprehensive review of many studies done previously. Results of approximately 1300 patients from around the world were represented, and were treated with different plans (i.e. extraction, non-extraction, and various appliances).

The complexity of the TMJ and the circumstances surrounding the potential causes of TMJ problems may not be entirely clear. That said, numerous studies support the fact that TMJ problems have many causative factors, and the changes occurring during braces are gradual, which generally allows the TMJ to adapt without difficulty.