Symptoms and signs of temporomandibular disorders in children and adolescents, before and after orthodontic treatment.

The purpose of this doctoral thesis was to study longitudinally the frequency and evolution of temporomandibular disorders in 95 young patients with moderate to severe malocclusions. All the patients received orthodontic treatment and were examined before and after orthodontic treatment using a tissue specific diagnosis based on manual functional examination. One or more clinical signs of TMD were recorded in a high 54% of the subjects, being the most frequently recorded deflection of the mandible at mouth opening, muscle tenderness, pain on passive compressions on the right temporomandibular joint and laterotrusion to the right and protrusion limitation. The correlations between signs of TMD and different malocclusions or kind of treatment performed were mainly weak. According to patients’ evolution, most of the patients evaluated maintained their previous status in relation to recorded signs of TMD. A certain percentage from them though, showed either improvement or worsening of clinically registered signs after the treatment. A slight increase of the clicking, as well as an increased pain feeling during TJ passive compressions was registered after treatment. However, other TMD signs as muscular tenderness or mandible deflection clearly decreased after treatment. The findings have shown that individual fluctuations in relation to TMD are frequent. Therefore, a conservative treatment approach for these disorders is recommended. Furthermore, orthodontic treatment does not seem to increase the risk factor for TMD in subjects with previous moderate to severe malocclusions