TMJ problems plague a large proportion of the population at some point. There are many other descriptions such as myofascial pain and termporomandibular joint dysfunction. Middle aged females are most prone but it can affect anyone. There are strong opinions in the dental profession about the causes and treatment of TMJ problems but it is not simple to define and there are not one size fits all solutions. Some ardently believe that the bite (occlusion) is the primary source of TMJ problems and therein lies the solution. However, this position is not well supported by the scientific literature. Many people with what an orthodontist would consider a poor bite are totally unaffected by TMJ problems while others with excellent occlusions suffer from it. There are certain triggers from orthodontic issues that may induce TMJ pain. For example, a tooth in anterior crossbite may cause the lower jaw to be held forward in an attempt to find a comfortable position. This means that the lateral pterygoid muscles that position the mandible forward are chronically contracted and may then suffer spasm like any muscle overused.

A starting point for the treatment of TMJ problems is a thorough exam to rule out any other medical or dental issues that may be causing the pain. Orthodontic treatment may be initiated with TMJ problems but palliative care should be provided to make the patient comfortable first. Interestingly, patients will usually experience a decrease in symptoms as orthodontic treatment commences as habits such as bruxism are disrupted as teeth move into new positions. Some practitioners insist that the TMJ problems must be “cured” before orthodontic treatment can begin but this is an unreasonable expectation considering the complexity and chronicity of the malady. However, orthodontic treatment should not be initiated in the face of acute symptoms. Any treatment plan for TMJ patients should accept that this is a multifactorial, chronic problem with occlusion as only one factor. The post-orthodontic treatment plan should include plans for continuing care such as an occlusal splint if the bruxism or symptoms persist. The keys to successful TMJ treatment are listening and patience to find what works rather than a reliance on a silver bullet approach that is hoped to work for all.

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