Etiology Of Temporomandibular Disorders Research Articles

The etiology of temporomandibular disorders: Are we missing something?

The etiology of temporomandibular disorders: Are we missing something?

Relationship Between Occlusal Factors and Temporomandibular Disorders: A Systematic Literature Review.

Temporomandibular disorders (TMD) originate from various components within the temporomandibular joint (TMJ), causing an impact on the masticatory muscles, the joint itself, and associated structures. They are a widely prevalent issue across the world. According to epidemiological research, up to 50% of adults in the population have TMD-related symptoms. The objective of this work was to analyze the existing scientific literature regarding the association between malocclusion classes, bruxism, and tooth loss in relation to the etiology of TMD. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 analysis protocol. For the development of the question focus, the population, intervention, control, and outcomes (PICO) study design protocol was used. The question in focus according to the PICO format was: "Do malocclusion, tooth loss, and bruxism contribute to temporomandibular disorders?". The review was performed with articles from PubMed, Web of Science, and Google Scholar databases according to the specified inclusion and exclusion criteria. The included articles were not older than five years. The risk of bias was assessed in the included studies by using the Cochrane Risk-of-bias 2 (RoB-2) tool. Out of a total of 32 results received, 21 articles were chosen according to the established criteria after conducting a review and analysis of their full texts. The article search sequence was presented in the PRISMA 2020 flow diagram, and the outcomes of the chosen articles were presented. The literature results revealed a relationship between occlusion and the development of TMD. The influence of occlusal factors on the TMJ was explained by an examination of joint anatomy and symptoms related to TMD. This study revealed variations in TMJ factors across different malocclusion classes. Additionally, it was observed that the occurrence and attributes of TMD are influenced by the number of tooth loss quadrants and the frequency of missing teeth. Furthermore, a correlation was found between bruxism and the symptoms of TMD, including myofascial pain, disc displacement, arthralgia, and muscle disorders. This literature review provides comprehensive information on the relationship between malocclusion classes, bruxism, tooth loss, and TMDs. This prompts healthcare professionals to prioritize patients' occlusal assessment and TMJ condition.

Clinical Study to Evaluate the Prevalence of TMD Before and After Delivery of Complete Denture

Temporomandibular disorder (TMD) is a broad term that encompasses number of clinical problems including the temporomandibular joints, the masticatory musculature and related structures, or both. The etiology of TMD is ambiguous since the signs and symptoms which exist in patients with natural teeth may also being observed in edentulous patients. Thus, TMD is a multifactorial problem with varying symptoms combinations and rates. Relationship between removable complete dentures and tempromandibular joint disorder in different gender and age groups. A total of 30 patients (15 female and 15 male) who submitted to Prosthodontics Department, College of Dentistry, Al-Mustansiriyah University to make a new complete denture. The age of participants ranges from (40-80) years with the mean age (65.9) years. Two clinical examiners conducted the patient’s examination; the first examiner takes on a questionnaire to identify the TMD symptoms signs and. Clinical examination of the patients was assessed through part I, II of research diagnostic criteria pre and post one and two months of applying the prosthesis. The clinical evaluation of prosthesis done by the second clinical examiner related to (retention, stability, fitness, occlusion and centric relation) was evaluated twice at predetermined intervals of 1 and 2 months after construction and delivery of denture. Evaluation performed by using Dawson's bimanual technique and recorded within clinical case sheet for complete denture records. The present study shows that the highest frequency of TMD obtained in age group of 70-80 years old followed by age group of 60-69 years old at all intervals, internal derangement (ID frequency) significantly higher in females than male patients (p=0.02). There is significant statistical difference regarding the Myofacial pain dysfunction (MPD) frequency according to the time of using the dentures, those patients with Diabetes Mellitus (DM) formed the highest percentage (39.1%) of those whom presented with MPD followed by those with Hypertension (HT) (32%) and those with history of HT and DM represent (17.4%) only The results also illustrated that prosthesis properties (retention, stability, fitness, occlusion and centric relation) show significant relation with TMDs improvement post one and two months. Most patients with complete denture perceived improvement in the sign and symptoms of TMDs.

Hubungan antara kebiasaan parafungsional dan gangguan temporomandibula pada anak usia remaja (Kajian terbatas di Jakarta)

Background: Temporomandibular disorders (TMD) are musculoskeletal disorders involving the temporomandibular joints, masticatory muscles, and associated structures. The etiology of temporomandibular disorders is complex and multifactorial. Parafunctional activities are considered main factors that are associated with TMD. Objective: To examine the association between parafunctional habits and temporomandibular disorders in adolescence. Methods: An analytical observational study with a cross-sectional design was carried out on 443 children (236 men and 207 women) aged 12-13 years. The data obtained consisted of univariate and bivariate data on parafunctional habits and temporomandibular disorders based on the results of the adolescent’s questionnaire V.2. The data were analyzed by Chi-square test. Result: Bivariate analysis showed a significant association (p <0.05) between sleep clenching and awake clenching with temporomandibular pain (p = 0.047 and p = 0.001). A significant association was found between sleep grinding and biting the lips / cheeks habits with joint sounds (click / pop) (p = 0.045 and p = 0.020). Analysis of the association between sleep grinding and sleep clenching with limited jaw motion also showed a significant association (p = 0.014 and p = 0.004). Conclusion: There are associations between clenching and temporomandibular pain; sleep grinding and biting the lips / cheeks with joint sounds (click / pop); and between sleep bruxism and limited jaw motion.

The psychological aspects of dental students with temporomandibular disorders at Hue University of Medicine and Pharmacy

Background: Psychological factors such as anxiety and depression have been recognized as the etiology of temporomandibular disorders. Objectives: The study aimed to evaluate the prevalence of temporomandibular disorders in dental students and describe the state of depression and anxiety and related factors in the students with the disorders. Materials and methods: 323 students at the Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, were examined to detect temporomandibular disorders, using the DC/TMD axis I. Then GAD-7 and PHQ-9 questionnaires were used to screen for anxiety and depression in the group with the disorders. Results: The proportion of students with temporomandibular disorders was 38.1%, intra-articular disorders accounted for the highest rate (80.5%). The percentages of depression and anxiety among students with the disorder were 28.4% and 55.3%, respectively. 41.5% of TMD students had mild anxiety and the same proportion of students had risk of depression. Risk factors associated with depression and anxiety were economic status and excercise, respectively (p < 0.05). Conclusions: The percentage of students with temporomandibular disorders is relatively high. The majority of students with the disorders are at risk for depression and low level of anxiety. There is a link between the economic status and depression, between exercise and anxiety. Key words: anxiety, depression, temporomandibular disorders.

TME disk deplasmanında synovial sıvı pro-inflamatuar sitokinlerin ve klinik bulguların değerlendirilmesi

Aims: Temporomandibular disorders (TMD) are common musculoskeletal disease that affects the soft tissues and bone structures of the temporomandibular joint (TMJ). Inflammatory mediators play a critical role in the etiology of TMD by affecting various molecular mechanisms. This study aims to investigate the effect of pro-inflammatory cytokines on TMJ internal derangements and evaluate the relationship between clinical features.
 Methods: Patients who underwent arthrocentesis because of TMD were included in this study. Patients were divided into 2 groups according to anterior disc displacement with reduction (Group 1) and without reduction ( Group 2). Clinical findings before and after the arthrocentesis were evaluated retrospectively. Synovial fluid TNF-α, IL-1β, and IL-6 levels were analyzed with the ELISA method. 
 Results: A total of 28 patients were included, with 15 patients in Group 1 and 13 patients in Group 2. All patients were female with an average age of 30.75±14.9. The average pre-operative pain score was 6.6±1.95 in all patients. After the arthrocentesis, the average pain score was 2.0 ( 1.0 - 2.5) and the difference was significant (p

The Role of Supraerupted and Distoverted Maxillary Third Molars in the Treatment of Temporomandibular Disorder: A Randomised Controlled Trial.

Objective Temporomandibular disorder (TMD) is a multifactorial disease that is classified into muscular and joint disorders. The etiology of TMD is unknown but it is related to various factors such as bruxism, uncorrected high dental restorations, and occlusal prematurities. This study aims to provide treatment modalities for TMD patients with supraerupted and/or distoverted maxillary third molars that have premature contact with the opposing arch. Methods A total of 430 subjects diagnosed with TMD were included in the study and randomized into study and control groups based on their treatment needs. A detailed case history was taken, and findings of intra and extra oral examination were recorded along with other investigations such as study model analysis, orthopantomogram (OPG), cone-beam computed tomography (CBCT), and MRI. The multiphase treatment included counseling in phase I, extraction in phase II (only for the study group), and oral appliance in the third phase. The final phase involved the restoration of edentulous areas or reduced vertical dimension. Results Extraction of supraerupted and/or distoverted maxillary third molars in the study group during phase II showed a 96% reduction in TMD when compared to the control group who did not undergo extraction. Conclusion TMD is a repetitive motion disorder, and the success of treatment relies on the elimination of causative factors, the type of appliance used, and the establishment of ideal occlusion. This study suggests that the extraction of supraerupted and/or distoverted maxillary third molars is a prerequisite for treating TMD patients.

Temporomandibular Joint Dysfunctions: A Systematic Review of Treatment Approaches.

Temporomandibular disorders (TMDs) encompass a diverse array of conditions affecting both the structure and function of the jaw. The aetiology of TMDs is multifactorial and may arise from muscular and joint disorders, degenerative processes, or a combination of various symptoms. The objective of this review was to analyse the physiotherapy treatment techniques used for the management of temporomandibular disorders. This review also aimed to compare the effectiveness of the differenttreatment methods used and identify the dysfunctions for which physiotherapy interventions are applied as the main treatment. A systematic literature review was conducted using the PubMed, ScienceDirect, Dialnet, and PEDro databases. After applying the inclusion criteria, 15 out of 656 articles were included. The application of different physiotherapy techniques, both alone and in combination, is effective in controlling the primary symptoms of TMD in patients. These symptoms include pain, functionality, and quality of life. The use of physiotherapy as a conservative intervention method for TMDs is supported by sufficient scientific evidence. The combination of different therapies within physiotherapy achieves the best results in treatment. Therapeutic exercise protocols, in combination with manual therapy techniques, are the most commonly utilized method for addressing TMDs and thus provide the best results according to the analysed studies.

A brief comment about terminology and diagnostic standards in temporomandibular disorders

Temporomandibular disorder (TMD) is a common musculoskeletal condition. Changes in diagnostic criteria followed the relevant changes in the understanding of the etiology of TMD. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is a suite of validated instruments and guidelines for the most accurate and reliable diagnosis of various TMD-associated pathologies. This text reviews the leading DC/TMD questionnaire options, in either symptom checklists or psychosocial/functional sections.

Stress Experience, Depression and Neck Disability in Patients with Temporomandibular Disorder—Myofascial Pain with Referral

The etiology of temporomandibular disorders (TMDs) is firmly anchored in the biopsychosocial model in which a special role is attributed to the stress, depression, somatic symptoms, and anxiety. The aim of the study was to assess the level of stress, depression and neck disability in patients with temporomandibular disorder-myofascial pain with referral. The study group enrolled 50 people (37 women and 13 men) with complete natural dentition. All the patients underwent a clinical examination according to the Diagnostic Criteria for Temporomandibular Disorders and were diagnosed as individuals with myofascial pain with referral. The questionnaires were associated with stress, depression, and neck disability; Perceived Stress Scale (PSS-10), Beck Depression Inventory(BDI), and Neck Disability Index (NDI) were evaluated. Of the individuals evaluated, 78% showed elevated levels of stress, and the average value of the PSS-10 in the study group was 18 points (Me = 17). Furthermore, 30% of the subjects presented depressive symptoms, with the average value of BDI was 8.94 points (Me = 8), and 82% of the subjects showed neck disability. The multiple linear regression model revealed that BDI and NDI allowed explanations for the 53% differentiation of PSS-10. In conclusion, stress, depression, and neck disability coexist with temporomandibular disorder-myofascial pain with referral.

A brief comment about terminology and diagnostic standards in temporomandibular disorders

Temporomandibular disorder (TMD) is a common musculoskeletal condition. Changes in diagnostic criteria followed the relevant changes in understanding of the etiology of TMD. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is a suite of validated instruments and guidelines for the most accurate and reliable diagnosis of various TMD-associated pathologies. This text review the leading DC/TMD questionnaire options, in either symptom checklists or psychosocial/functional sections.

Main considerations of the temporomandibular joint, its disorders, and treatments: a systematic review

Introduction: The temporomandibular joint (TMJ) can be affected by end-stage pathologies such as arthritic disease, trauma, and ankylosis. The main debilitating symptoms result in limited mouth opening and pain. The TMJ prosthesis is indicated for diseases that result in anatomical changes and aims to restore joint function with pain relief. Prosthetic replacement for terminal TMJ disease is gradually becoming a common procedure due to good functional results and low morbidity. Objective: A concise systematic review was carried out to present the main considerations about the temporomandibular joint, as well as the main clinical results of the treatment of temporomandibular disorders (TMD). Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from October to December 2022 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2013 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 240 articles were found, 65 articles were evaluated in full and 26 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 45 studies with a high risk of bias and 94 studies that did not meet GRADE. It was concluded that the etiology of temporomandibular disorder is multifactorial, with muscle disorders, joint disorders, and muscle disorders affecting mastication muscles. As a treatment, each CAD/CAM component is manufactured using the patient's data. This system is designed for the specific patient situation and should provide a perfect fit. However, the communication of the fossa and condyle articular surfaces of the implant are standardized, as in the stock system. The treatment of TMD is diverse and depends on the type of disease, as well as the duration and subjective level of pain. Alloplastic reconstruction can be advantageous in obtaining a rapid improvement in symptoms and rapid rehabilitation of masticatory function.

Оклюзія і скронево-нижньощелепні розлади

Summary. Clinicians and researchers have considered occlusion as one of the main direct and/or indirect etiological factor that cause temporomandibular disorders (TMD) for many years. The relationship between occlusion and TMD (temporomandibular disorders) has been based on the observation of an anatomical relationship between tooth position and jaw function for a long time, as well as on the higher prevalence of TMD in people with malocclusion compared to the general population. A significant number of studies have examined factors associated with occlusion and malocclusion as a potential mechanism for the development of signs or symptoms of TMD. At the same time, there are other concepts for the development of TMJ pathology. Aim of the research: to analyze modern views on the etiological factors of temporomandibular disorders according to the latest sources of scientific and medical information. Recent scientific trends have shifted the focus of TMD etiology from biomedical to a more complex multi-factor biopsychosocial model that includes biological, psychological, and social factors. Therefore, a proper understanding of the relationship between «occlusion» and SNA seems extremely important, since a paradigm shift requires a more comprehensive interpretation of the concepts of occlusion and maxillary relationships. The role of malocclusion in the etiology of temporomandibular disorders should be considered limited, unless a causal relationship is proven. Instead, clinicians should pay serious attention to patients «occlusal awareness» and concerns during general and dental consultations, as some patient groups may develop iatrogenic maladaptive behavior. Key words: temporomandibular joint, temporomandibular disorders, occlusion, malocclusion, splint therapy, prosthetic and orthodontic treatment.

Temporomandibular Disorders as a Risk Factor for Suicidal Behavior: A Systematic Review.

Temporomandibular disorders (TMD) are a group of common musculoskeletal dysfunctions that affect the temporomandibular joint or masticatory muscles and related structures or are expressed as a clinical combination of these two factors. The etiology of TMD is multifactorial and features related to anxiety, depression and mental disorders can contribute to the predisposition, onset and progression of TMD. The ability to adapt and develop coping attitudes was reduced in patients presenting with chronic pain, while suicidal behavior (suicidal ideation, suicide attempts, and suicide completion) was increased. The objective of this review was therefore to investigate suicidal behavior in relation to TMD. The review was performed according to the PRISMA 2020 guidelines. Six databases (PubMed, MEDLINE, EMBASE, Scopus, Ovid, and Google Scholar) were consulted through the use of keywords related to the review topic. The study is registered on PROSPERO (CRD42022320828). The preliminary systematic search of the literature yielded 267 records. Excluding duplicates, 15 were considered potentially relevant and kept for title and abstract analysis. Only six articles were considered admissible reporting a single exposure factor, TMD and a single outcome, suicidal behavior, although these were evaluated through different assessment tools. We found a low association of TMD with suicidal behavior in observational studies, with estimates partly provided [prevalence ratio (PR) from 1.26 to 1.35, 95% confidence intervals (CI) from 1.15 to 1.19 (lower) and from 1.37 to 1.54 (higher); and odds ratios (OR) from 1.54 to 2.56, 95% CI from 1.014 to 1.157 (lower) and 2.051 to 6.484 (higher)], a relevant sample size (n = 44,645), but a few studies included (n = 6). The results of the included studies showed that the prevalence data of suicidal behavior were more present in young adults with TMD, with a controversial association with gender. Suicidal behavior was also correlated and aggravated by the intensity of pain.

Association between Sleep Disorders and Sleep Quality in Patients with Temporomandibular Joint Osteoarthritis: A Systematic Review.

Background: Osteoarthritis (OA) is a leading cause of disability, the most common form of chronic disease in the temporomandibular joint (TMJ), and the most severe disease type of temporomandibular disorders (TMD). The etiology of TMD is multifactorial, considering parafunctional habits, sleep bruxism, or sleep disturbance as common factors. Insomnia and apnea are the two most frequent forms of sleep disorders in TMD patients. Due to this, the objective of this systematic review was to highlight whether there is currently scientific evidence in the literature describing that patients with temporomandibular joint osteoarthritis (TMJ-OA) are associated with increased sleep disorders or impaired sleep quality. Methods: This systematic review was completed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement and was registered with PROSPERO prior to completion of the main search. Original observational studies that analyze the association of sleep disorders and sleep quality in patients with TMJ-OA were included in the present review. Results: 770 studies were screened by abstract and title according to inclusion and exclusion criteria, and finally, 7 articles were included in the qualitative synthesis and a total of 772 patients diagnosed with TMJ-OA. Conclusions: There is insufficient evidence to indicate that patients with TMJ OA are associated with increased sleep disorders or poorer sleep quality.

Variasi Posisi Kondilus Mandibula Pada Pasien Maloklusi Kelas I Angle Dilihat Dari Radiografi Panoramik

Introduction : Mandibular condyle is the temporomandibular joint component that is most active and mainly receives loads when the mandible is functioning. The load received by the condyle can cause Temporomandibular Disorder (TMD). One of the etiology of TMD is the non-harmonious occlusion, as can be seen in Class I Angle Malocclusion which can affect the change in the condyle position from the center of the mandibular fossa. Panoramic radiographs examination can aid in the diagnosis of the condyle and measure the position in the condylar space. The purpose of this study was to determine the symmetries and the variations in positions of the mandibular condyles in Malocclusion Class I Angle patients and to determine their causes. Methods : This type of research is a quantitative, observational descriptive method, with a purposive sampling method. Samples were taken using the purposive sampling method from secondary data from patients with malocclusion who visit independent practice orthodontists from August 2017 - March 2020. Results : In the patient with Class I Angle Malocclusion, there were 14 (70%) with an asymmetric mandibular condyle position, 16 patients (80%) with right condyles anterior to the central fossa, and 15 patient (75%) with left condyles anterior to central fossa. Conclusion : Pathological occlusion in Class I malocclusion could also affect the mandibular condyle.

Temporomandibular Disorders. Part 1: Anatomy, Aetiology, Diagnosis and Classification

Temporomandibular disorders (TMD) are the most common causes of chronic pain in the orofacial region. The aetiology of TMD is complex owing to its multifactorial biopsychosocial nature. TMD shares many commonalities, and can be associated with, other chronic pain conditions. The physical and psychological impact of chronic pain on the individual can be far-reaching and should not be underestimated. This article, the first of a six-part series, aims to provide the reader with a background to TMDs as well as an overview of the clinical examination and diagnostic process for patients presenting with TMD-related pain. CPD/Clinical Relevance: Clinicians should be aware of the signs and symptoms of TMD with which their patients might present and understand the complex nature of chronic pain conditions.

Knowledge and Attitude Toward Temporomandibular Disorders: A Survey in İstanbul.

The aim of this study was to identify the strategies used for the diagnosis and treatment of patients with temporomandibular disorders (TMDs) by general dental practitioners (GDPs) in the city of Istanbul. A total of 154 GDPs were assessed by a single examiner in this questionnaire-based study. Descriptive statistics were calculated for all variables, and the results were analyzed at a 95% CI and statistical power of 80% with the significance level set at P < .05. The most frequently employed strategies for obtaining a diagnosis were patients' medical history (33.1%), physical examination (37.7%), and a combination of diagnostic methods (29.2%). The most commonly referred specialties were prosthodontics (62.2%) and maxillofacial surgery (36.9%). All GDPs treated their TMD patients with occlusal splints, and the majority of the occlusal splints were hard occlusal splints (62.8%). Half of the GDPs considered the etiology of TMD to involve stress, whereas 49.4% believed that TMD is of a multifactorial etiology. The GDPs clarified that TMD patients were mostly treated with occlusal splints and this datum is consistent with the suggestions of previous consensus papers.

A comparative study of condyle position in temporomandibular disorder patients with chewing side preference using cone-beam computed tomography.

Chewing side preference (CSP) could cause structural and morphological changes of temporomandibular joint (TMJ) and has been suggested as one aetiology of temporomandibular disorders (TMDs), but the condylar position in TMD patients with CSP is unknown. To compare the condylar position in the TMD patients with and without CSP. Ninety TMD patients with unilateral symptom (69 with CSP and 21 without CSP) and 20 asymptomatic participants received cone-beam computed tomography. The condylar position was determined based on the measurements of sagittal joint spaces. Intergroup and intra-group comparisons of the condylar position were performed. The condyles in asymptomatic participants located nearly randomly in anterior, centric and posterior positions. Patients without CSP had significantly more posterior condyles than asymptomatic participants (57.1% vs 30.0%, p<0.05). In patients with CSP, 50.7% of the condyles on the preferred chewing side and 42.0% on the unpreferred side located posteriorly, reaching no significant level compared with the asymptomatic participants and patients without CSP (p>0.05). The symptomatic joints and asymptomatic joints in patients with CSP and without CSP showed no significant differences in condylar position. While patients without CSP had significantly more posterior condyles in symptomatic joints than asymptomatic participants (p<0.05), patients with CSP showed a trend towards more posterior condyles in symptomatic joints compared with the asymptomatic participants (53.6% vs 30.0%, p=0.054). Condylar position is not a strong indicator to differentiate CSP-related TMDs from non-CSP-related TMDs. Posterior condyle could not be viewed as one indicator of TMD.

The relationship between orthodontic treatment and temporomandibular disorders: A dental specialists' perspective.

ABSTRACTIntroduction: The relationship between temporomandibular disorders (TMDs) and orthodontic treatment/malocclusion has changed from a cause-and-effect association to an idea without sufficient evidence. Objective: This survey was designed to assess the beliefs of different disciplines - orthodontists, oral surgeons, and oral medicine specialists - on the relationship between TMDs and orthodontic treatment, with regard to treatment, prevention and etiology of TMDs. Method: A survey in the form of questionnaire was designed and distributed to 180 orthodontists, 193 oral surgeons and 125 oral medicine specialists actively involved in treating TMDs. The questionnaire aimed to collect basic information about each participant and their beliefs, and clinical management of patients with TMDs. Results: Halve of the responding orthodontists and most of the oral surgeons (69.9%) were male participants, whereas the majority of oral medicine specialists (83.3%) were female respondents. The participants’ age ranged from 29 to 58 years. The majority of orthodontists believes that there is no relationship between orthodontic treatment and TMDs, and that orthodontic treatment does not provoke TMDs or prevent the onset of the disorder. However, oral surgeons and oral medicine specialists have different and conflicting opinions. Most surgeons tended to treat those patients, while most of the other two disciplines tended to seek an interdisciplinary approach. Chi-square test was done to find an association between the referral status and specialists’ experience, and to compare between the different disciplines’ belief. Conclusions: Orthodontist’s beliefs were in accordance with the scientific evidence, whereas most oral surgeons and oral medicine specialist believed that orthodontic treatment may provoke TMDs. Therefore, continuing program series development is important to embrace the concept of the multidisciplinary team approach and improve the health care and quality of life for those patients.