Occlusion, orthodontics, and temporomandibular disorders: Cutting edge of the current evidence

The relationship between occlusion and temporomandibular disorders (TMD) represents one of the major controversies reported in the scientific literature. Nevertheless, sound evidence from large population-based surveys point toward weak and inconsistent associations, supporting that the role of the occlusion in the etiology of TMD should not be overstated. Also, despite the type of device, traditional orthodontic treatment seems to play a neutral role with regard to the onset of TMD: in particular, this therapeutic approach has been reported not to prevent or to increase the risk of TMD development. It is time to shift the concept of occlusion from a purely mechanical interpretation, based on the teeth-to-teeth relationship (peripheral input), to a broader view that includes the interpretation of the input at the level of the central nervous system. In this context, patients' individual adaptability must be considered by clinicians to prevent iatrogenic maladaptive behaviors. Indeed, orthodontists and general dentists should be aware about the multifactorial etiology of TMD and should be instructed regarding the available tools to manage patients before, during, and after any dental or orthodontic intervention.