EOS Congress 2025: Sheldon Friel Lecture – Orthodontics and Temporomandibular Disorders: my long journey

The relationship between orthodontics and temporomandibular disorders (TMD) represents one of the major controversies reported in the scientific literature. 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, 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.

Orthodontists 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 orthodontic intervention. A routine TMD-related examination before the commencement of orthodontic therapy appears to be crucial. It is mandatory to start by taking a thorough history and a comprehensive TMD examination to assess pain intensity, interference in function due to pain, and distress. As a general rule, it is not recommended to initiate an orthodontic treatment until the pain is managed. Furthermore, whenever TMD signs and symptoms appear during an orthodontic treatment it is generally suggested to stop the active treatment and to manage the pain with full available methods. Orthodontic treatment can be continued as previously planned or, if necessary, modified according to the patient’s conditions, when the patient is pain-free.