Temporomandibular disorders: no role for dental occlusion in the pathophysiology


Temporomandibular disorders (TMD) are a group of conditions affecting the temporomandibular joints (TMJ), the jaw muscles and/or related structures. They are relatively common affecting an estimated 12-65% of the population. The biopsychosocial model of TMD is now favoured by oro-facial pain experts and the relationship between dental occlusion and TMD is still a source of controversy

The aim of this review was to assess whether here any association between features of dental occlusion and temporomandibular disorders


Searches were conducted in the Medline, Scopus and Google Scholar databases for English language studies in adults assessing the association between temporomandibular disorders (e.g., signs, symptoms, specific diagnoses) and features of dental occlusion. Study selection was conducted independently by two reviewers with study quality being assessed based on the Newcastle-Ottawa Scale (NOS). No meta-analysis was conducted.


  • 25 studies (17  case-control, 8 comparative) were included.
  • Occlusal features and TMD diagnosis in studies showed high variability.
  • Findings were consistent with a lack of clinically relevant association between TMD and dental occlusion.
  • Only 2 studies were associated with TMD in the majority (≥50%) of single variable analyses in patient populations.
  • Only mediotrusive interferences are associated with TMD in the majority of multiple variable analyses.


The authors concluded: –

Based on findings, which support the absence of a disease-specific association, there is no ground to hypothesise a major role for dental occlusion in the pathophysiology of TMDs. Dental clinicians are thus encouraged to move forward and abandon the old-fashioned gnathological paradigm.


While 3 databases were searched for this review restricting the inclusion to English language article only may have resulted in missing some relevant studies. This review finds that with the exception of two studies no associations were associated with TMD.  The authors go on to point out that one would anticipate a much greater association between dental occlusal problems and TMD if it was of clinical importance. They also highlight in their discussion that the reported frequencies of occlusal disharmonies are present at the same frequencies in non-TMD patients.  As a result, their logical argument for a move away from the traditional gnathological approach to TMD management.


Primary paper

Manfredini D, Lombardo L, Siciliani G. Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era? J Oral Rehabil. 2017 Jun 10. doi: 10.1111/joor.12531. [Epub ahead of print] Review. PubMed PMID: 28600812.

 Other references

 Dental Elf – 14th May 2014

Study finds no evidence that replacing missing posterior teeth with removable dental prosthesis decreases risk of TMD pain in patients with shortened dental arches

Dental Elf – 2nd Dec 2013

Is there an association between head and neck posture and temporomandibular disorders?

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