Assessment and Management of Temporomandibular Disorders in Orthodontic Practice: Insights from a Survey of German Orthodontists

This study aimed to assess how temporomandibular disorder (TMD) diagnostics are integrated into routine orthodontic care and to explore how identified TMD symptoms influence treatment planning and therapy decisions. A survey was distributed to all officially registered orthodontists in Germany, collecting information on their professional experience, TMD-related specialization, and specific clinical practices. Responses were anonymized, organized, manually verified, and statistically analyzed. Fisher’s exact tests were used to evaluate differences in TMD-related procedures based on professional experience and specialization. Out of 2,359 questionnaires sent, 630 were completed and analyzed. Most respondents reported performing either a brief TMD screening or a comprehensive functional assessment. Only 21.1% rely solely on patient medical history for evaluation. A secondary full functional assessment was conducted by 33% during ongoing orthodontic treatment and by 56.6% only when initial findings indicated pathology. Non-painful temporomandibular joint (TMJ) clicking identified prior to therapy influenced treatment planning in 60.1% of respondents. Merely 4.3% reported taking no further action when TMD symptoms were present before treatment. While professional experience did not significantly affect diagnostic procedures, a specialization in TMDs did. The findings reveal a gap between research evidence and routine practice in German orthodontics, potentially leading to more extensive TMD evaluations, which, however, do not pose adverse health effects for patients.