Balanced Jaw and Orthodontic Harmony

Unlock Your Perfect Bite: A Comprehensive Guide to Craniomandibular Disorders and Orthodontic Treatment Options

Reese Marlowe in Health & Wellness June 2025 • 5 min read.

"Navigate the complexities of CMD and discover how the right mandibular reference position can transform your orthodontic journey for a healthier, more comfortable smile."

Craniomandibular disorders (CMDs) and their relevance to orthodontics is a highly debated topic. CMDs relate to discomfort of the temporomandibular joint (TMJ). The disorder, characterized by different symptoms, has psychogenic influence, affecting the quality of life of individuals. Many psychological explanations have been advanced; none was able to clearly establish a direct causal link with CMD.

There is no agreement on the definition of CMD in the literature. Many different definitions of CMD dysfunction have come into existence and, consequently, even in a single individual the diagnosis of TMJ dysfunction depends on the definition used. CMDs refer to a variety of symptoms, signs, and combinations that are assigned to the TMJ and its related structures. "Craniomandibular disorders" are used to refer to disorders affecting either the cephalic region or the TMJ, or both. These conditions impact the quality of life of patients as well as their social functioning.

Traditionally, it was believed that these disorders could be treated through a gnathological occlusal approach. However, both the gnathological and the neuromuscular approaches show marked differences; this is true with patients who manifest numerous symptoms that compromise their craniomandibular function. Therefore, a new approach, “the biopsychosocial model", has been suggested; it has gained wide recognition among the dental scientific community since its explanations are heavily based on a “medico-cognitive approach".

Decoding Craniomandibular Disorders (CMD): What You Need to Know

The literature on craniomandibular disorders shows that 75% of the population manifests at least one symptom of CMD, and about 33% demonstrate at least one symptom (i.e. facial pain, joint pain, etc.). 85 to 95% of the population would exhibit at least one or more symptoms of CMD during their life. Interestingly, about 5 to 6% of the population has been reported to have clinically significant CMD-related jaw pain. CMDs affect all age groups (i.e., children, adolescents, and adults).

Studies have shown that CMDs manifest themselves in 16–25% of children, 30% of adolescents, and 60% of adults. Other studies found these abnormalities in children of varying ages. An increase in CMD prevalence with increasing age has been found in children. A difference in CMD prevalence between boys and girls during adolescence has also been reported, where CMD prevalence is higher and the severity of signs and symptoms more pronounced in girls compared with boys. General health problems are also more frequently reported in adolescents with CMD compared with a control group.

Predisposing Factors: Increase CMD risk, including occlusal patterns, tissue quality, systemic diseases, age, facial typology, and bruxism.
Trigger Factors: Macrotrauma or microtrauma, bruxism, and exceeding articular tolerance ability.
Perpetuating Factors: Behavioral, social, and emotional status, which often dominate the condition.

Behavioral factors often outweigh the severity of physical symptoms. Studies show a strong association between pain-related disability and depression and somatization. Neurobiological mechanisms, such as interference with endogenous pain regulators, genetic factors, and disruption of adrenergic function in the autonomic nervous system, are also reported as contributing factors to CMD. In addition, the stomatognathic system is complex, and patients adapt to their existing vertical dimension of occlusion.

Choosing the Right Treatment Path for CMD

In summary, navigating CMD requires a multifaceted approach. Orthodontists should be able to handle clinical situations based on scientific evidence, considering the multifactorial aspect of the trouble, and distinguish patients with and without CMD risk. The goal is to opt for criteria that favor occlusal stability while maintaining its functions. Orthodontic treatment, when approached as an occlusal therapy, should be done with careful consideration of the mandibular reference position to ensure effective occlusion reconstruction and overall balance in the stomatognathic system.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5772/60061, Alternate LINK

Title: Craniomandibular Disorders And The Choice Of Mandibular Reference Position In Orthodontic Treatment

Journal: Issues in Contemporary Orthodontics

Publisher: InTech

Authors: Farid Bourzgui, Hakima Aghoutan, Samir Diouny

Published: 2015-09-03

Everything You Need To Know

What exactly are Craniomandibular Disorders (CMDs) and how do they relate to my oral health?

Craniomandibular Disorders (CMDs) encompass a variety of symptoms, signs, and conditions affecting the temporomandibular joint (TMJ) and related structures, as well as the cephalic region. They can significantly impact your quality of life and social functioning. While traditionally treated with gnathological occlusal approaches, the biopsychosocial model, based on a medico-cognitive approach, has gained recognition due to the complex interplay of factors involved. The biopsychosocial model suggests a more holistic approach, considering psychological and social factors in addition to the physical aspects of CMD.

How common are Craniomandibular Disorders (CMDs) and am I likely to experience them?

Research indicates that Craniomandibular Disorders (CMDs) are quite prevalent. Approximately 75% of the population experiences at least one symptom of CMD, with about 33% exhibiting at least one specific symptom like facial or joint pain. Over a lifetime, 85% to 95% of people will likely experience some CMD symptoms. Clinically significant jaw pain related to CMD has been reported in about 5% to 6% of the population. Prevalence varies across age groups with children showing 16-25%, adolescents 30%, and adults 60% exhibiting symptoms. CMD prevalence and symptom severity tend to be higher in adolescent girls compared to boys, and general health problems are more frequently reported in adolescents with CMD.

What factors contribute to the development of Craniomandibular Disorders (CMDs)?

Several factors can contribute to Craniomandibular Disorders (CMDs). These are generally grouped into predisposing, trigger, and perpetuating factors. Predisposing factors increase the risk of CMD and include occlusal patterns, tissue quality, systemic diseases, age, facial typology, and bruxism. Trigger factors can initiate CMD, such as macrotrauma or microtrauma, bruxism, and exceeding the articular tolerance ability. Perpetuating factors maintain or worsen the condition, and these often involve behavioral, social, and emotional status. It’s important to note that behavioral factors often outweigh the severity of physical symptoms, and there is a strong association between pain-related disability and conditions like depression and somatization. Neurobiological mechanisms, such as interference with endogenous pain regulators, genetic factors, and disruption of adrenergic function in the autonomic nervous system, are also contributing factors.

How can orthodontics help with Craniomandibular Disorders (CMDs), and what is the importance of mandibular reference position?

Orthodontics can play a role in managing Craniomandibular Disorders (CMDs) by addressing occlusal stability and overall balance within the stomatognathic system. The key lies in carefully considering the mandibular reference position during occlusal reconstruction. Orthodontic treatment, when approached as an occlusal therapy, should be based on scientific evidence and tailored to the individual's specific condition. Orthodontists need to distinguish patients with and without CMD risk, favoring criteria that support occlusal stability. This approach emphasizes the importance of establishing an effective occlusion that is in harmony with the overall function of the jaw and related structures.

With conflicting definitions of Craniomandibular Disorders (CMDs) and TMJ dysfunction, how can I ensure an accurate diagnosis and effective treatment?

The lack of a universally agreed-upon definition for Craniomandibular Disorders (CMDs) and TMJ dysfunction means that diagnosis can vary depending on the criteria used. Given this complexity, it is crucial to consult with a practitioner experienced in CMDs and orthodontics who adopts a comprehensive diagnostic approach. This approach should consider the multifactorial aspect of CMD, including physical, psychological, and social factors. Opting for criteria that favor occlusal stability while maintaining functions and ensuring effective occlusion reconstruction based on the mandibular reference position are vital. A multidisciplinary approach involving specialists in orthodontics, pain management, and psychology might be necessary to address all aspects of CMD.