Does Orthodontic Treatment (Braces) Cause TMJ?

TMJ problems can be a real burden for many patients, that leads to pain, limitations on eating and embarrassing jaw joint noises. I often get asked, “Can braces cause TMJ?” Although there’s no easy answer, I’ll do my best to explain.

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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.

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There are many environmental and physiological 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), this could be due to stress and lifestyle. 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. Therefore, although it is good idea to eliminate certain bite conditions such as cross bite and underbite to aid in better dental health, there is no direct correlation between TMJ and Bad Bite.