The impact of malocclusion on the prevalence of pain-related temporomandibular disorders in children and adolescents: A systematic review

Liliana Szyszka-Sommerfeld ^1* Magdalena Sycińska-Dziarnowska ¹ Karolina Gerreth ² Gianrico Spagnuolo ^3,4 Krzysztof Woźniak ¹ Agata Czajka-Jakubowska ²

• ¹ Pomeranian Medical University, Szczecin, Poland
• ² Poznan University of Medical Sciences, Poznań, Greater Poland, Poland
• ³ University of Naples Federico II, Naples, Campania, Italy
• ⁴ Kaohsiung Medical University, Kaohsiung, Taiwan

Background: The relationship between occlusion and temporomandibular disorders (TMD) is still being debated and it appears that no consensus has been reached in the literature. Pain-related TMD are the most common types of TMD. They comprise myalgia, arthralgia, and headaches attributed to TMD. This systematic review aims to synthesise the current scientific evidence regarding impact of malocclusion on the prevalence of pain-related TMD in children and adolescents.Methods: The search strategy included the PubMed, Scopus, Embase, and Web of Science databases. The inclusion criteria were studies examining the association between malocclusion and pain-related TMD in individuals under 18 years. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). The certainty of evidence was evaluated using the Grading Recommendations Assessment, Development and Evaluation (GRADE) approach. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram was created to provide a visual presentation of the subsequent screening and inclusion processes. The data from primary studies were narratively synthesized. Results: The initial search strategy identified 868 potential articles. Thirteen studies met the inclusion criteria. Most of the studies were evaluated as having a moderate quality according to the NOS assessment. The certainty of evidence was rated as low, according to the GRADE approach. Most of the studies showed that malocclusion may be associated with TMD-pain signs/symptoms in children and adolescents. The most frequent relationship was found between the prevalence of pain-related TMD and posterior crossbite, Class II malocclusion, Class III malocclusion, and anterior open bite. Conclusion: Certain types of malocclusion may have an impact on the prevalence of some TMD-pain signs and symptoms in subjects under 18 years of age. However, taking into account the low quality of evidence in the literature and the variance between studies, further long-term well designed studies are needed. Trial registration: PROSPERO database (CRD42024570950).