Association between OrthodonticTreatment and TemporomandibularDisorders among Adult Patients inSaudi Arabia: A Cross-Sectional Study
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Abstract
Introduction: Patients receiving orthodontic treatment frequently have temporomandibular disorders (TMDs).
However, because it depends on the symptoms of patients, the relationship between TMDs and orthodontic
therapy is still up for debate. Objectives: The objective of the study was to evaluate whether orthodontic treatment
in adult patients is associated with TMD symptoms in Saudi Arabia. Materials and Methods: A cross-sectional
study was conducted between July 2025 and January 2026 across various regions of Saudi Arabia. Data were
collected from 384 participants aged 18 years old and above who undergo orthodontic treatment or finished from
the treatment within <1 year using Fonseca Anamnestic Index questionnaire. The severity of TMD was assessed
and divided into mild, moderate, and severe. Results: Among 285 eligible respondents, 67.4% were female, and
68.1% had a bachelor’s degree. The mean Fonseca Anamnestic Index (FAI) score was 29.4 ± 19.2 (median 30;
range 15–45). No participant reported prior TMJ disease, major jaw trauma, rheumatoid arthritis, or recent muscle
relaxant use, limiting confounding. Overall, 67.0% screened positive for TMD symptoms: 37.2% mild, 29.5%
moderate, and 0.4% severe; 29.8% met criteria for moderate/severe TMD. Commonly endorsed symptoms/
behaviors were headaches (54.7% yes/sometimes), chewing-related muscle pain (52.3%), TMJ clicking (40.7%),
clenching/grinding (59.0%), and self-reported tension (59.2%). TMD severity differed significantly by education
level (P = 0.0001) and region of residence (P = 0.025), but not by gender (P = 0.244). Orthodontic variables were
also associated with severity: moderate/severe TMD was higher among participants currently under treatment
(41.4%) or within <1 year of completion (45.2%) than those 1–3 years post-treatment (21.0%) (P = 0.0001).
By treatment duration, moderate/severe TMD was highest with <1 year of treatment (46.5%), intermediate
with >2 years (35.9%), and lowest with 1–2 years (22.6%) (P = 0.0001).
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