TMD and Your Bite: What the Evidence Actually Says

“Irreversible bite treatments, like crowns or orthodontics, have not consistently shown improvement in pain or function for TMD patients”

One of the most common misconceptions about temporomandibular disorders (TMD) is that they are caused by a “bad bite” or malocclusion. While that belief was once widespread, today’s leading professional organizations—including the American Dental Association (ADA), the American Academy of Orofacial Pain (AAOP), and the National Institute of Dental and Craniofacial Research (NIDCR)—do not support irreversible bite-changing procedures as evidence-based treatment for TMD [1,2].

In fact, a growing body of research has shown that occlusion plays a limited role in most TMD cases. The AAOP’s position statement explicitly states that “altering the occlusion through orthodontics, full mouth reconstruction, or equilibration is not recommended as initial therapy for TMD” [2]. Similarly, the ADA emphasizes conservative, reversible treatment approaches such as splint therapy, physical therapy, and behavioral strategies, rather than irreversible dental work [1].

There’s good reason for this caution. Irreversible bite treatments, like crowns or orthodontics, have not consistently shown improvement in pain or function for TMD patients—and in some cases, may even worsen symptoms [3]. Today’s gold standard for care prioritizes accurate diagnosis using DC/TMD criteria and a personalized, multidisciplinary treatment approach grounded in the biopsychosocial model of pain using reversible treatment modalities.

Between my training and Penn and academic and private practices, I rarely have ever advocated bite adjustments and changes to address your TMD. We focus on identifying muscle versus joint-related causes of jaw pain and only recommend bite interventions in rare instances as secondary treatmen and not as a default treatment for TMD. If you or your patients have been told their TMD pain is simply due to a bad bite, it may be time for a second opinion based on current best practices.

References

[1] American Dental Association. (2023). Temporomandibular Disorders (TMD): Clinical Guidelines. https://www.ada.org

[2] American Academy of Orofacial Pain. (2020). Guidelines for Assessment, Diagnosis, and Management of Orofacial Pain. 6th ed.

[3] Greene CS. (2010). Managing the care of patients with temporomandibular disorders: A new guideline for care. J Am Dent Assoc, 141(9), 1086–1088.