Temporomandibular joint disorders
Temporomandibular joint disorders (commonly referred to as TMD), have gained an unfortunate association with orthodontic treatment. Patients who suffer from TMD want to know whether their orthodontic treatment (even treatment they had in the past) could have caused their TMJ maladies. Orthodontists believe that the link between TMD and orthodontic treatment might be the biggest case of “fake news” ever to gain traction. The mechanics of TMD are still being studied, but here’s a brief history of TMD and the how the dispute arose over orthodontic treatment.
Temporomandibular joint disorders were first identified in 1934. Initially, doctors believed that tooth loss could cause TMD. As time progressed, orthodontic researchers expanded their ideas about the probable origins of TMD. Tooth loss was dismissed as both a cause and a contributor to TMD in the mid 1940’s. By the 1960’s, malocclusion – a misalignment of the top and bottom jaws – and other factors emerged as prime TMJ suspects. (Today, malocclusion is mostly off the hook, too.)
Brimm v Malloy: the TMD case heard ’round the world
The notion that orthodontic treatment causes TMJ problems arose in a court case from Michigan (Brimm v. Malloy) in 1987. A patient claimed that she began to experience pain in her temporomandibular joints following the commencement of orthodontic treatment. Experts agreed that the orthodontist’s treatment plan reflected standard orthodontic treatments of the time. The orthodontist removed the orthodontic appliances used to treat her condition and made a retainer. According to the patient, the retainer made the pain worse. The orthodontist referred the patient to an oral surgeon to extract the patient’s wisdom teeth.
Following the surgery, she complained that her situation was even worse. She now experienced clicking and locking of her joints, in addition to severe, unrelenting pain. Her attorney filed suit against the oral surgeon, claiming that the extraction used such force that it traumatized the patient’s temporomandibular joints. He also claimed that the orthodontist’s treatment had set the stage for a TMJ disorder, where none had existed before. The jury sided with the patient, and awarded her $850,000 in compensation for pain and suffering.
The decision literally rocked the orthodontic world. Few orthodontists (if any) believed that standard orthodontic treatment could possibly have caused a TMJ disorder. They especially disagreed with the plaintiff’s theory at trial of how such a thing could happen. The jury’s adverse findings triggered decades of research into the origins of temporomandibular joint disorders. Could orthodontic treatment possibly create a TMJ disorder?
The state of TMD research today
Today, thanks to the research that followed Brimm v. Malloy, we know there is no one specific cause of TMD. Many factors can combine to cause TMD. Additionally, the cause of some TMDs may lie beyond the jawline.
TMD patients have a higher incidence of other “systemic” conditions, including chronic fatigue syndrome, chronic headache, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, low back pain, sleep disorders, and vulvodynia. TMD patients experience these conditions much more frequently than the average person does. That leads researchers to believe that TMDs might be part of a broader condition, or perhaps even an autoimmune disorder.
Research shows that TMDs are much more complex than initially believed. The condition may be less about a patient’s anatomy and more about his or her genetics, environment, gender and behavior. For example, about 12% of the US population experiences some form of TMD. The majority of TMD patients are women. As the severity of symptoms increase, the ratio of affected women to men increases. Of those patients most severely affected by TMD, 90% are women. Further, the peak age of incidence of TMD is between 20 and 40 years of age. This means that most affected women are of childbearing age. These connections lead some researchers to believe that estrogens may play an important role in TMD.
