Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, Naples, Italy.
Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, Naples, Italy; Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi (SA), Italy.
J World Fed Orthod. 2020 Oct;9(3S):S15-S18. doi: 10.1016/j.ejwf.2020.08.003. Epub 2020 Sep 30.
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.
咬合与颞下颌关节紊乱（TMD）之间的关系是科学文献中报道的主要争议之一。然而，来自大型基于人群的调查的可靠证据表明，两者之间的关联较弱且不一致，这表明咬合在 TMD 的病因学中不应被过分强调。此外，尽管矫治器类型不同，但传统的正畸治疗似乎对 TMD 的发病没有起到中性作用：具体来说，这种治疗方法并未被报道可以预防或增加 TMD 发病的风险。现在是时候将咬合的概念从基于牙齿与牙齿关系（外周输入）的纯机械解释转变为更广泛的观点，包括对中枢神经系统水平输入的解释。在这种情况下，临床医生必须考虑患者的个体适应性，以防止医源性的适应性不良行为。实际上，正畸医生和普通牙医应该了解 TMD 的多因素病因，并应了解在任何牙科或正畸干预之前、期间和之后管理患者的可用工具。
