Anterior open bite and temporomandibular disorders: A scoping review

Anterior open bite and temporomandibular disorders: A scoping review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Anterior open bite and temporomandibular disorders: A scoping review Bryan Murchie, Giles McCracken, Heidi Bateman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6906775/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives To determine if there is evidence of an association between Anterior Open Bite (AOB) and Temporomandibular Disorders (TMDs), and evidence of any cause-and-effect relationship between these two factors. Methods Adhering to PRISMA-ScR guidelines, searches were conducted in MEDLINE-OVID, Scopus, Embase-OVID, and Web of Science. Inclusion criteria included studies investigating the association between AOB and TMDs, regardless of publication date. Data were presented through narrative exposition and tables. Results A total of 133 studies met the inclusion criteria, published between 1968 and 2024. Most studies were cohort designs, or case reports, involving the adult dentition only. 46% of included publications investigated a cause-and-effect relationship between AOB and TMDs. Of the relevant publications, 78% (n = 49) reported AOB occurring secondary to TMDs, which were almost exclusively attributed to degenerative joint diseases. 22% (n = 14) investigated AOB as the leading aetiological factor, where 93% of these studies observed that a pre-existing AOB significantly increased the risk of developing TMDs. Conclusions Individuals diagnosed with osteo- and rheumatoid arthritis, idiopathic condylar resorption, and juvenile idiopathic arthritis had a greater incidence of acquiring AOB. Analysis also suggests a potential link between those with a pre-existing skeletal AOB, and TMDs including disc displacement, arthralgia, and myofascial pain. At present, it is suggested that clinical treatment of concomitant AOB and TMD is guided by management of each condition in isolation, but evidence encourages clinicians to consider any potential interaction. Future research should consider case-matched longitudinal studies, over an extended period, to determine a strong association/causality between AOB and TMDs. Health sciences/Health care/Dentistry/Occlusion/Malocclusion Health sciences/Anatomy/Oral anatomy/Mandibular muscles Health sciences/Health care/Dentistry/Dental conditions/Malocclusion Health sciences/Health care/Dentistry/Preventive dentistry Health sciences/Health care/Dentistry/Dental treatments/Dental treatment planning Figures Figure 1 Key Points AOB may be a contributing factor of TMDs, in terms of disc displacement, arthralgia, and myofascial pain. Although there is currently limited evidence regarding causality. Individuals diagnosed with osteo and rheumatoid arthritis, idiopathic condylar resorption, and juvenile idiopathic arthritis of the TMJ, impacts occlusal stability and often lead to an acquired AOB. The current scoping review suggests the development of case matched cohort research, over extended periods, to address the cause-and-effect relationship between AOB and TMDs. Introduction Anterior open bite (AOB) is characterised as a condition where there is no contact between the mandibular and maxillary incisors. The incidence of AOB varies according to age ( 1 , 2 ). AOB is commonly characterised into three distinct types: dental AOB, including proclined and unerupted teeth, and finger/thumb sucking habits; skeletal AOB, describes excessive vertical growth of the dentoalveolar complex; and functional AOB, which is a combination of both skeletal and dental open bite ( 3 , 4 ). AOB has a reported prevalence ranging from 1.5–11% worldwide, where data suggests that rates may vary between different ethnicities ( 2 , 5 , 6 ), with an increased incidence in African and Afro-Caribbean populations. AOB is known to negatively impact the overall quality of life, which can affect speaking, eating, and impair oral hygiene ( 7 ). It is also recognised as one of the most complex and unpredictable dento-facial conditions to treat ( 4 , 8 ), where indications for treatment include aesthetic and functional management. Mild open bites may spontaneously resolve with early detection, advice, and observation, whereas more severe cases may justify orthodontic and/or surgical intervention. Regardless of the treatment strategy, there is a recognised high risk of relapse (11–43%) which may be attributed to soft tissue factors, habit resumption, and inappropriate surgical and orthodontic management ( 8 – 12 ). With consideration of the untreated patient cases, and post-treatment relapses, it can be assumed that a sizeable proportion of the population will experience AOB during their lifetime. There is a suggestion of a potential association between AOB and those experiencing signs and symptoms of temporomandibular disorders (TMDs) ( 13 – 15 ). TMD is an umbrella term, which the literature normally associates with the twelve most common myogenous and arthrogenous conditions, affecting the muscles of mastication and/or the temporomandibular joint (TMJ) complex ( 16 , 17 ). However, the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) also classifies less common TMD diagnoses that includes joint diseases, such as systemic arthritides and idiopathic condylar resorption ( 17 , 18 ). Importantly, TMDs represent the most common cause of non-dental orofacial pain ( 19 ), therefore, it is recognised as a major driver for patients seeking treatment and rising healthcare costs, while negatively impacting an individual’s quality of life ( 20 – 22 ). The aetiology of TMDs are considered multifactorial, which can be attributed to physical and psychosocial factors, where no single cause has been identified to-date ( 16 , 23 , 24 ). This could explain why any association between TMDs and AOB remains unclear in the literature and opens questions for clinicians on best practice/management when coexistent. It is not well-established if there is any cause-and-effect relationship between AOB and TMDs. There is an underlying logic that suggests individuals can acquire AOB secondary to TMDs, such as osteoarthritis, rheumatoid arthritis, and idiopathic condylar resorption ( 25 – 27 ). However, the current evidence-base is relatively unexplored regarding the role of a pre-existing AOB malocclusion (via a dental, skeletal or functional origin) increasing the risk of developing TMD signs and symptoms. The rationale for a scoping review is to present a broad overview of the evidence, helping to identify current gaps in knowledge and inform decision making for future research ( 28 ). It can also be used to identify a topic that is suitable for a systematic review. This current scoping review aims to identify publications that consider associations between TMDs and AOB. Furthermore, it aims to determine any cause-and-effect relationship between them. Methods Protocol and registration The protocol was registered with the Open Science Framework prior to searching the literature (DOI 10.17605/OSF.IO/B8E2N ). This scoping review was developed according to the “Preferred Reporting Items for Systematic review and Meta-Analysis extension for Scoping Reviews” (PRISMA-ScR) checklist. The review was guided by the PCC (Population, Concept, and Context) framework ( 29 , 30 ). Population (P): humans with Anterior Open Bite in the secondary dentition; Concept (C): identified as having a concurrent Temporomandibular Disorder(s); and Context (C): any healthcare setting in any country. The key research question is: What is the evidence that links AOB and TMDs? Inclusion criteria All publication types were included: case report, case series, clinical trial, RCT, cohort, and any other publications. Any healthcare setting in any country. Only those identified as having concurrent TMD and AOB were included. The inclusion criteria for TMDs was based on Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) ( 17 ). Publications reporting humans with AOB in the secondary or mixed dentitions were included. Only papers available in English were included. There was no limitation set on date of publication. Exclusion criteria Studies were excluded if only in the primary dentition, animal studies, or reported AOB or TMD in isolation. Studies reporting TMDs related to neoplasm, chondromatosis, and/or osteonecrosis were excluded. Patients who had previously undertaken treatment(s) for TMDs and/or AOB. Those with a history of craniofacial trauma. Information sources A comprehensive and systematic literature search was performed on 9th July 2024, using the electronic databases as follows: MEDLINE-Ovid ( https://www.ovid.com ); Embase-Ovid ( https://www.embase.com ); Web of Science ( https://www.webofscience.com ); and Scopus ( https://www.scopus.com ). The search strategy was developed, employing relevant Medical Subject Headings terms (MeSH). The chosen terms aimed to encompass a wide range of relevant studies. All publications up to 9th July 2024, that met the inclusion criteria, were retrieved Furthermore, a complementary search was performed in April 2025. This step was intended to update and enrich the search database with the most recent publications, ensuring the final manuscript included the latest articles. Search strategy To develop an effective search strategy, we initially performed a pilot search using an array of popular terms and common words within the field. It was decided that searches would not be filtered to show “English publications only”, as the provisional search results showed that English publications were being inexplicably excluded. All non-English studies were instead manually removed at the screening stage. No restrictions/limits were applied regarding the year of publication. The full search strategy can be found in Supplementary File Table 1 . Selection of sources of evidence The study selection process is shown in Fig. 1 . Search results were imported into EndNote (EndNote X9; Thomson Reuters, NY, USA). Covidence (Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia) was used to screen, reject and select publications. Independent title and abstract (TIAB) screening were conducted by two independent, blinded reviewers (B.D.M. and H.B.) to confirm that studies satisfied the inclusion criteria and duplicates were removed. Any conflicts were resolved by discussion with an independent third reviewer (G.M.). If based on TIAB screening eligibility could not be determined, the article was moved to full text screening. Full-text review was undertaken by two reviewers (B.D.M and H.B), and conflicts resolved by discussion with G.M. Data charting processes and data items Data extraction and charting were independently collected by the same two reviewers (B.D.M. and H.B.), with discrepancies resolved through consultation with G.M. All information was recorded in a pre-defined, customised data extraction table designed on Covidence. The standardized collation sheet included the following items: author(s), year of publication, type of study / report, dentition type (adult, mixed, or unclear), TMD diagnosis (all based on the DC/TMD classification), and the relationship between AOB and TMDs (AOB secondary to TMD, TMD secondary to AOB, or not defined). Data synthesis and presentation Data were summarized using descriptive statistics, and presented in tables and a narrative format. The qualitative synthesis was undertaken to provide an overview of the existing evidence, with a primary focus on the cause-and-effect relationship identifying AOB as the leading cause of TMDs. Quality assessment No quality assessment was performed in accordance with the PRISMA guidelines for scoping reviews. Results Study selection After searching the electronic databases, a total of 1751 studies were retrieved. 885 duplicates were removed. 866 studies were screened by TIAB, with 647 excluded as they did not meet the inclusion criteria. 219 studies were sought for retrieval for full-text screening. 1 study was unable to be retrieved, despite requests through inter-library loans. 218 studies were assessed at full text for eligibility, of these, 85 were excluded. The full-text articles were identified as not being written in the English language, although the relevant abstracts had been published in English which is why they were not initially excluded at the TIAB phase. Consequently, 133 studies were included in this scoping review (Fig. 1 .), where details of each study can be found in Supplementary File Table 2, ( 31 ), ( 32 ), ( 33 ), ( 34 ), ( 35 ), ( 36 ), ( 37 ), ( 38 ), ( 39 ), ( 40 ), ( 41 ), ( 42 ), ( 43 ), ( 44 ), ( 45 ), ( 46 ), ( 12 ), ( 47 ), ( 48 ), ( 49 ), ( 50 ), ( 51 ), ( 52 ), ( 53 ), ( 54 ), ( 55 ), ( 56 ), ( 57 ), ( 58 ), ( 59 ), ( 60 ), ( 61 ), ( 62 ), ( 63 ), ( 64 ), ( 65 ), ( 66 ), ( 67 ), ( 68 ), ( 69 ), ( 70 ), ( 71 ), ( 72 ), ( 73 ), ( 74 ), ( 75 ), ( 76 ), ( 77 ), ( 78 ), ( 79 ), ( 80 ), ( 81 ), ( 82 ), ( 83 ), ( 84 ), ( 85 ), ( 86 ), ( 87 ), ( 88 ), ( 89 ), ( 90 ), ( 13 ), ( 91 ), ( 92 ), ( 93 ), ( 94 ), ( 95 ), ( 15 ), ( 96 ), ( 97 ), ( 98 ), ( 99 ), ( 100 ), ( 101 ), ( 102 ), ( 103 ), ( 104 ), ( 105 ), ( 106 ), ( 107 ), ( 14 ), ( 108 ), ( 109 ), ( 110 ), ( 111 ), ( 112 ), ( 113 ), ( 114 ), ( 26 ), ( 25 ), ( 115 ), ( 27 ), ( 116 ), ( 117 ), ( 118 ), ( 119 ), ( 120 ), ( 121 ), ( 122 ), ( 123 ), ( 124 ), ( 125 ), ( 126 ), ( 127 ), ( 128 ), ( 129 ), ( 130 ), ( 131 ), ( 132 ), ( 133 ), ( 134 ), ( 135 ), ( 136 ), ( 137 ), ( 138 ), ( 139 ), ( 140 ), ( 141 ), ( 142 ), ( 143 ), ( 144 ), ( 145 ), ( 146 ), ( 147 ), ( 148 ), ( 149 ), ( 150 ), ( 151 ), ( 152 ), ( 153 ), ( 154 ), ( 155 ), ( 156 ). Study characteristics Type of report / study The studies identified were published between 1968 and 2024. The types of publications included: cohort studies (n = 58), where patients were investigated prospectively from three months up to 15 years ( 68 , 77 ); case reports (n = 44) were based on a single patient case, or a small number of patient cases; evidence synthesis / narrative review (n = 17); case series (n = 13) retrospectively reviewed patient cases; and a doctoral Thesis (n = 1). Dentition In each paper the reviewers recorded the dentition type, but only where directly stated by the author(s), or if it was clearly evident from the age group of participants when reviewing the text. 81 studies had participants with an adult dentition, who were aged between 14 and 60 years ( 110 , 124 ). 7 studies had participants with a mixed dentition aged between 7 years and 12 years ( 34 , 59 , 80 , 86 , 96 , 103 , 108 ). 26 studies had a combination of participants with either an adult or a mixed dentition. It was unclear what type of dentition the participants had in 18 studies ( 25 , 26 , 99 , 100 , 112 – 114 , 129 , 141 , 152 , 55 , 58 , 60 , 62 , 75 , 81 , 90 , 95 ). TMD diagnoses The type of TMDs included degenerative joint diseases (n = 85). RA, JIA and ICR were grouped under an umbrella category of “degenerative joint disease”, however it is recognised that these are all classed as separate conditions ( 17 ), so each were analysed and reported individually. 31 studies reported osteoarthritis (OA) ( 43 , 47 , 81 , 82 , 88 , 89 , 93 , 99 , 100 , 109 , 112 , 114 , 54 , 120 – 122 , 126 , 127 , 135 , 137 , 141 , 151 , 156 , 55 , 157 , 61 , 67 , 70 , 72 , 78 , 79 ), 22 cases were related to rheumatoid arthritis (RA) ( 67 , 98 , 134 , 136 , 137 , 142 – 145 , 148 – 150 , 99 , 157 , 112 , 113 , 115 , 117 , 128 , 131 , 133 ), 18 publications reported idiopathic condylar resorption (ICR) ( 25 , 32 , 125 , 132 , 139 , 152 , 154 , 155 , 157 , 53 , 65 , 66 , 75 , 114 , 116 , 118 , 124 ), and 14 publications of juvenile idiopathic arthritis (JIA) ( 26 , 27 , 146 , 147 , 152 , 153 , 59 , 60 , 90 , 97 , 115 , 129 , 138 , 140 ). Publications reported disc displacement with and without reduction (n = 84), arthralgia (n = 84), myogenous pain (n = 57). The majority of studies reported that more than one diagnosis occurred in varying combinations. One publication reported on Treacher Collins syndrome ( 101 ). Where the TMD diagnosis was not clearly identified we concluded that it was “unclear” (n = 4) ( 44 , 49 , 131 , 158 ). This excluded the risk of potential bias influencing our scoping review findings. Relationship of AOB and TMDs The majority of publications suggested an association between AOB and TMDs. In these publications, subjects with the conditions of interest were normally compared to a clinical control group, without any AOB/TMD conditions ( 15 , 62 , 95 , 138 , 139 , 67 , 74 , 75 , 79 , 80 , 82 , 86 , 92 ). 46% of studies investigated a cause-and-effect relationship between AOB and TMDs. Of these publications, 77% (n = 48) reported AOB occurred secondary to TMDs. 21% (n = 13) publications reported on the incidence of TMDs occurring secondary to AOB, and 2% (n = 1) reported that both AOB and TMD were leading aetiological factors. Where AOB occurred secondary to TMDs, 99% of publications reported that individuals were diagnosed with a type of joint disease: 18 for RA (38%), 12 were related to OA (25%), 12 for ICR (25%), and 10 for JIA (21%), where some publications reported on more than one condition. One case report reported AOB secondary to TMD, where the individual was diagnosed with posterior disc displacement (without reduction and limited opening) ( 119 ). In all cases, the TMJ diagnosis was confirmed by clinical examination, followed with CT and/or MRI imaging, and biochemistry/haematology where systemic conditions were present ( 127 , 132 , 139 ). 81% of publications were in relation to those with an adult dentition. Only children with a mixed dentition acquired an AOB secondary to JIA ( 27 , 59 , 138 , 140 , 146 , 147 , 153 ). AOB secondary to ICR was also reported to occur in children, but this was only where individuals had an adult dentition ( 124 ). The findings for AOB reported as the leading cause of TMDs have been summarised in Table 1 . The aetiology of AOB was primarily attributed to the skeletal growth pattern in five publications ( 14 , 105 , 107 , 108 , 111 ), but the aetiology was not clear from the remaining nine publications. Of the 14 publications, 13 (93%) suggested that a pre-existing AOB significantly increased the risk of developing TMD signs and symptoms. The majority of these reported a cohort design that considered causality via patient questionnaires and a clinical examination ( 14 , 102 , 103 , 105 , 106 , 108 ). Five publications reported statistically significant findings when reporting AOB as a leading cause of TMDs, which was normally compared with a control group ( 14 , 68 , 105 , 106 , 109 ). Two publications reported evidence of this link over a period of 5 to 8 years ( 103 , 107 ), and reported that females were disproportionately affected by myogenous pain, disc displacement, and arthralgia. One publication suggested a cause-and-effect relationship, which was based on TMD resolution following orthodontic AOB correction ( 111 ). Two evidence reviews report conflicted findings, but both were in agreement regarding the lack of well-designed investigations ( 99 , 100 ). Table 1 Characteristics of primary studies following cases of TMD secondary to AOB (evidence synthesis excluded). Author and year Type of report / study Dentition type TMD diagnosis Main findings Aghabeigi et al. 2001 ( 110 ) Case series Participant No = 83 Ages = 15 to 60 Disc displacements, and Degenerative joint disease Those with AOB had an increased risk of developing TMD, which increased further with age. Egermark-Eriksson et al. 1983 ( 102 ) Cohort Participant No = 402 Ages = 7 to 15 Disc displacements, Myogenous, and Arthralgia Those with AOB had an increased risk of developing TMD signs and symptoms compared to a control group. Egermark-Eriksson et al. 1990 ( 103 ) Cohort Participant No = 402 Ages = 7 to 15 Disc displacements, Myogenous, and Arthralgia Those with AOB had an increased risk of developing TMD signs and symptoms after the age of seven. Henrikson et al. 1997 ( 14 ) Cohort Participant No = 183 Ages = 11 to 15 Disc displacements, Myogenous, and Arthralgia Those with AOB had a significantly greater risk of developing TMD compared with a control group (p < 0.05). Huang et al. 2023 ( 111 ) Case report Participant No = 1 Age = 26 Disc displacements Orthodontic correction of AOB led to TMD resolution. This demonstrated a casual cause-and-effect relationship. Manfredini et al. 2014 ( 109 ) Cohort Participant No = 114 Ages = 20 to 54 Disc displacement, Myogenous, Degenerative joint disease, and Arthralgia Those with AOB were predisposed to TMD, where arthralgia was significantly greater in those with AOB compared to a control group (p < 0.05). Individuals also had an increased risk of myofascial pain and OA. Marangoni et al. 2014 ( 108 ) Cohort Participant No = 105 Ages = 7 to 12 Myogenous, and Arthralgia Children, and adolescents, with AOB were 1.2-fold more likely to develop TMD compared to a control group. Miyazaki et al. 1994 ( 104 ) Cohort Participant No = 532 Ages = 6 to 32 Disc displacements, and Arthralgia Demonstrated a significant relationship (p < 0.05) between AOB and TMD, when compared to a control group and other malocclusions. Pahkala et al. 2002 ( 107 ) Cohort Participant No = 287 Aged = 7 to 15 Disc displacements, Myogenous, and Arthralgia Children, and adolescents, with AOB were at an increased risk of developing TMD. Schmitter et al. 2007 ( 106 ) Cohort Participant No = 90 Ages = 18 to 65 Disc displacements, Myogenous, and Arthralgia Authors reported AOB significantly increased the risk of TMD (p < 0.05). Tanne et al. 1993 ( 105 ) Cohort Participant No = 305 Ages = 4 to 29 Disc displacements, Myogenous, and Arthralgia AOB significantly increased the risk of developing TMD (p < 0.05) compared to other malocclusions. Discussion The objective of this scoping review was to identify the current knowledge of associations between AOB and TMDs, and understand evidence that suggested any cause-and-effect relationship. In particular, the authors were interested in evidence that supported AOB as a leading causative factor of TMDs. At present, the general consensus is that targeted management of malocclusions, including AOB, has no role in the resolution of TMDs and is not recommended by current guidance ( 24 , 159 ). Furthermore, no clinical considerations are given for AOB management to assist TMD recovery/resolution. However, these recommendations are based on an overall lack of evidence from the current literature. The primary purpose of this scoping review was to provide an overview of the available evidence and identify current knowledge gaps, to establish a foundation for future primary research. This has the potential to inform future management strategies for TMD patients. Over 1/3 of all publications identified in this scoping review were patient case reports, which is acknowledged as a limited form of evidence to determine causality ( 160 ). Furthermore, a large proportion of all case reports did not attempt to investigate/report evidence of a cause-and-effect diagnosis ( 118 , 121 , 124 , 125 , 127 , 132 , 143 ). From this it is clear that case reports are not appropriate to answer the second objective of this scoping review, with regards to demonstrating a cause-and-effect relationship. Now considering publications that were not case reports. Those investigating individuals diagnosed with an acquired AOB, secondary to TMDs, normally had a diagnosis related to a type of joint resorption, including OA, RA, ICR, or JIA. These publications all strongly suggest that progressive joint disease significantly increases the risk of developing an acquired AOB ( 114 , 140 , 151 , 153 ), where the severity of the open bite is expected worsen with time. In each instance, the explanation given by authors for the acquired AOB were through destruction of the condylar morphology, resulting in a reduced ramus height and posterior retraction of the mandible ( 161 , 162 ). However, there were a distinct lack of publications in the literature that demonstrated a clear cause-and-effect relationship, which was a particular problem when attempting to interpretate and analyse the case-series study designs ( 152 – 156 ). In these publications, the exact onset of the TMD disease process, and AOB, was deduced predominantly through a brief patient history, without detailed clinical background information. These findings, therefore, have been interpretated with caution, as there was a tendency for an assumption of association as evidence of causality. There is a suggestion there is an inability of the TMJs to adapt to mechanical stresses and, therefore, could be a predisposing factor for OA and ICR conditions ( 162 – 165 ). One study identified in this scoping review supports this concept, where individuals with AOB had a nearly two-fold increase of OA compared with subjects allocated to a control group ( 109 ). It has been proposed that this link can be attributed to disproportionate occlusal force distribution, due to a loss of anterior/canine guidance and ICP instability ( 44 ). This was thought to result in overloading of the articular surfaces, which induced early TMJ resorption, leading to an acquired AOB. This is most relevant in individuals who experience a reduced adaptive capacity of the articulating surfaces ( 166 , 167 ). TMJ-OA progression is even thought to occur in those with a provisional diagnosis of anterior disc displacement ( 168 ). At present, however, the lack of evidence-base identified by this current scoping review suggests that this relationship is largely circumstantial, and the overall importance of naturally occurring AOB as an aetiological factor in joint disease remains unclear. There has also been suggestion within the literature that subjects with a pre-existing AOB had an increased risk of developing TMDs, including disc displacement (with and without reduction), arthralgia, myofascial pain, and headaches ( 14 , 68 , 102 , 103 , 105 , 106 , 169 ). In these studies, the AOB aetiology was mainly attributed to the patient’s skeletal pattern, with excessive vertical growth of the dento-alveolar complex, which led to a 1.2-fold greater chance of developing TMD symptoms ( 108 ). The initiating effect on these TMD symptoms is thought to occur as the AOB malocclusion can be unstable with functional overloading (as described above), which has a negative impact upon the muscles of mastication, TMJ, and other associated structures (166). However, only limited evidence has been found focusing primarily on AOB as the predisposing factor of TMDs, where most of these studies were published over 10 years previously. Currently, therefore, any cause-and-effect relationship between AOB and TMDs is considered weak. Of the publications reporting AOB as the leading factor in TMDs, nine were cohort designs (64%). Three of these studies recruited younger participants, from the age of 7, and had the advantage that individuals with AOB were identified before TMD symptoms became established ( 102 , 103 , 107 ). In addition to establishing causality, these longer-term follow-up periods (5–8 years) were also needed to highlight the importance of age related changes occurred only once above the ages of 7 or 10 ( 102 , 103 , 107 ). This trend was attributed to the continued growth and development of their TMJ apparatus. These cohort studies, therefore, support that AOB gave an increased risk of developing disc displacement, myofascial pain, and arthralgia. However, by comparison, the remaining cohort studies did not establish a clear cause-and-effect relationship. This was attributed to the restricted follow-up periods and limited details of the participants’ pre-existing occlusal and TMD history ( 14 , 102 , 104 – 106 , 108 , 109 ). Although, an important limitation associated with all the aforementioned cohort studies was that none undertook MRI imaging to support and confirm any disc displacement diagnosis and exclude/include other potential TMJ conditions ( 14 , 105 , 106 ). The overall strength of these findings must be questioned, as other confounding factors could have influenced the outcomes. Nine publications reported on patient cases, where complete resolution of disc displacement, and myofascial pain, occurred once the skeletal AOB had been orthodontically managed ( 36 , 37 , 39 , 41 – 43 , 46 , 51 , 111 ). These successful treatment outcomes might be interpretated as evidence of a negative impact of AOB on TMJ stability and health, especially as no other clinical factors were considered risks for TMDs. While this argument seems plausible, these findings were based on single patient case reports, which should not be viewed as conclusive evidence. Furthermore, the occurrence of TMD resolution post-treatment was solely noted by the authors of this scoping review, and directionality was not implied or mentioned directly by any of the orthodontic papers themselves. Comparisons with past research The findings from this current scoping review suggests that degenerative joint diseases impacts the occlusal scheme, and in some cases results in an acquired AOB ( 25 – 27 ). What is less clear is whether AOB predisposes to TMDs, which remains a controversial topic in the dental literature ( 170 ). From the available evidence, only two publications reviewed the relationship between AOB and non-degenerative TMDs ( 99 , 100 ), which reported conflicted findings. One favoured a weak association between both factors, however, this publication is over 30 years old with outcome measures that are not in place today ( 100 ). The review from 2018 concluded that there was no evidence to support a relationship between AOB and TMDs in either direction ( 99 ), however, this paper did not report to established evidence synthesis guidelines which suggest a potential increased risk of bias. A wider unstructured search of the literature suggests there is a lack of evidence from primarily investigations that support a strong association between different malocclusions and TMDs ( 25 , 168 , 171 , 172 ). This might support why there has been a paradigm shift with clinicians gradually moving away from historic gnathological concepts to more contemporary biopsychosocial models considering wider initiators and drivers of TMDs ( 173 ). A further key issue associated with gnathology model is the prescription of irreversible dental treatment to manage TMDs ( 159 , 174 ). This dynamic shift was reflected in our search results, where the number of investigations from a gnathological perspective decreased over time, which was particularly evident within the last 10 years. Limitations and future research This scoping review has several limitations. First, it included only studies written in English. Furthermore, the vast majority of studies did not clinically examine the extent of the open bite, or use a standardised grading/classification scale, when reporting the AOB diagnosis ( 105 , 106 , 108 , 109 ). It is, therefore, unknown whether different AOB severity levels have a significant impact on the TMJ apparatus. We were also unable to exclude the role of different malocclusions, such as posterior crossbites and open bites, as patients typically presented with a combination of more than one malocclusion, or the authors never explicitly shared the details of the occlusal status for each patient ( 14 , 102 , 103 , 106 , 107 , 111 ). This applies equally to occlusal interferences, that could potentially impact TMDs. These confounding occlusal factors may have overexaggerated the perceived effect caused by AOB. This review suggests that future research designs should have a renewed focus on establishing the directionality, primarily the pathogenesis associated with AOB. Detailed patient questionnaires, with evidence of past dental records ( 85 ), is vital to establish timelines and a reliable cause-and-effect relationship. A case matched cohort study could be an ideal research design, where participants are continually monitored over an extended period, avoiding ineffective shorter follow-up studies ( 148 ). The use of digital technologies (intraoral scanners) offers an alternative easily stored and transferred data source to permit researchers to accurately quantify the associated open bite changes ( 130 ). Use of robust and reliable clinical and patient centred outcome measures to clearly determine the initiation and progression of AOB and TMDs, and/or evidence of the pre-existing TMJ and occlusion issues are needed ( 85 ). This should also be seen in consideration of the current biopsychological model of TMDs with its initiators, drivers and strategies for management ( 18 , 24 , 159 ). Conclusions Within the limitations of this scoping review, it was possible to conclude that: 1. Evidence suggests that individuals diagnosed with osteo and rheumatoid arthritis, idiopathic condylar resorption, and juvenile idiopathic arthritis of the TMJ, impacts occlusal stability often leading to an acquired AOB. 2. AOB may be a contributing factor of TMDs, in terms of disc displacement, arthralgia, and myofascial pain. Although there is currently limited evidence regarding causality. 3. There is a lack of evidence defining the role of AOB as a predisposing factor for OA. To-date, there is no evidence available regarding the impact of AOB on other degenerative conditions, such as ICR. 4. There is a need for carefully designed and implemented long-term longitudinal research to address an understanding of any cause-and-effect relationship between AOB and TMDs. 5. Treatment of concomitant AOB and TMDs might be best guided by management of each condition in isolation, however, clinicians are encouraged to consider any potential interaction. Declarations Ethical approval : Not applicable. Informed consent : Not applicable. Consent to participate : Not applicable. Conflict of interest : The authors declare that they have no conflict of interest. Data availability statement: The data supporting this article can be made available by the corresponding author upon request. CRediT authorship contribution statement Bryan D. Murchie : Conceptualization, Validation, Visualization, Formal analysis, Investigation, Resources, Writing – original draft, Writing – review & editing. Giles I. McCracken : Conceptualization, Validation, Formal analysis, Supervision, Investigation, Resources, Writing – review & editing. Heidi L. Bateman : Validation, Visualization, Formal analysis, Investigation, Conceptualization, Resources, Writing – review & editing. 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Greene Charles S, Manfredini D. Overtreatment “Successes”—What Are the Negative Consequences for Patients, Dentists, and the Profession? J Oral Facial Pain Headache. 2023;37(2):81–90. Additional Declarations There is no duality of interest Supplementary Files PRISMAScRFillableChecklist.docx Scoping reivew checklist SupplementaryTable1.docx Supplementary table 1 SupplementaryTable2.docx Supplementary table 2 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6906775","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":498718196,"identity":"b78e720b-4dc5-4551-a148-07b3330dc7d6","order_by":0,"name":"Bryan Murchie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABIUlEQVRIie2RMUvDUBDHLwiJwxPXhGD6FS4EUoLiZ0kQOgXpVDIIFgSzBOcnFD+DUIijLzwwy3OPxEEQOkeyCCKaorZKn9jR4f2Wuxt+3P84AIXiH4LLlgCD5GsYfhRt/KciPnuGayqgna6h9G3htkPIo6v0tmBPF/cOlvyxbXAPtlOmW3RVCc5iz6ZQRxNxGBbn+cxDMfBNhgMwRahbl5JggqBNOoWaBPlWzqO8Ar8LxgEq0K0HqeK9LJTXCT/OK6NtGL5B73fFX27Rxjz0K4JdMAY4VyTBgkwf7RKsPUpiLLIb7l6LeGQKPCCuiE4Cyfl9sjGtSVLvUEN4zfMR71lpOW2SZN9xSl7cZasKwCb++M4CIv/KHENyoUKhUCi+8w6l/GwbrYEISgAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-1013-6791","institution":"Newcastle School of Dental Sciences","correspondingAuthor":true,"prefix":"","firstName":"Bryan","middleName":"","lastName":"Murchie","suffix":""},{"id":498718197,"identity":"845868c8-8955-4f27-b7ff-c55bac95fa41","order_by":1,"name":"Giles McCracken","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Giles","middleName":"","lastName":"McCracken","suffix":""},{"id":498718198,"identity":"a446e800-7558-40c4-aeae-58c5865f9300","order_by":2,"name":"Heidi Bateman","email":"","orcid":"https://orcid.org/0000-0002-6494-3273","institution":"School of Dental Sciences, Newcastle University","correspondingAuthor":false,"prefix":"","firstName":"Heidi","middleName":"","lastName":"Bateman","suffix":""}],"badges":[],"createdAt":"2025-06-16 15:06:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6906775/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6906775/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88959220,"identity":"4dcfeefe-f290-4099-b115-ac0a7ee95dff","added_by":"auto","created_at":"2025-08-13 07:44:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35562,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram summarizing the article selection process.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6906775/v1/58f620f3479d5ae14aaabba0.png"},{"id":96452942,"identity":"f5ebefde-5619-470c-83d6-932933f075bd","added_by":"auto","created_at":"2025-11-21 09:55:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":865223,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6906775/v1/a330c9b6-1185-489c-b9ec-7453f36957d2.pdf"},{"id":88957807,"identity":"136f46ee-4e32-489e-998d-d1444de28e8f","added_by":"auto","created_at":"2025-08-13 07:28:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":118797,"visible":true,"origin":"","legend":"\u003cp\u003eScoping reivew checklist\u003c/p\u003e","description":"","filename":"PRISMAScRFillableChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-6906775/v1/b109ed52384b4a2fc67b3426.docx"},{"id":88958255,"identity":"1fcc2d33-2dfa-406e-93c1-ca3af36f022c","added_by":"auto","created_at":"2025-08-13 07:36:45","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":15595,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary table 1\u003c/p\u003e","description":"","filename":"SupplementaryTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6906775/v1/ba343c46825a3f815aebef6f.docx"},{"id":88957809,"identity":"f118ff46-01bf-4b08-9a84-4dff02ff312e","added_by":"auto","created_at":"2025-08-13 07:28:45","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":40635,"visible":true,"origin":"","legend":"Supplementary table 2","description":"","filename":"SupplementaryTable2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6906775/v1/ee1fe597e6df6b6fe501abae.docx"}],"financialInterests":"There is no duality of interest","formattedTitle":"Anterior open bite and temporomandibular disorders: A scoping review","fulltext":[{"header":"Key Points","content":"\u003cul\u003e\n \u003cli\u003eAOB may be a contributing factor of TMDs, in terms of disc displacement, arthralgia, and myofascial pain. Although there is currently limited evidence regarding causality.\u003c/li\u003e\n \u003cli\u003eIndividuals diagnosed with osteo and rheumatoid arthritis, idiopathic condylar resorption, and juvenile idiopathic arthritis of the TMJ, impacts occlusal stability and often lead to an acquired AOB.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe current scoping review suggests the development of case matched cohort research, over extended periods, to address the cause-and-effect relationship between AOB and TMDs.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eAnterior open bite (AOB) is characterised as a condition where there is no contact between the mandibular and maxillary incisors. The incidence of AOB varies according to age (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). AOB is commonly characterised into three distinct types: dental AOB, including proclined and unerupted teeth, and finger/thumb sucking habits; skeletal AOB, describes excessive vertical growth of the dentoalveolar complex; and functional AOB, which is a combination of both skeletal and dental open bite (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAOB has a reported prevalence ranging from 1.5\u0026ndash;11% worldwide, where data suggests that rates may vary between different ethnicities (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), with an increased incidence in African and Afro-Caribbean populations. AOB is known to negatively impact the overall quality of life, which can affect speaking, eating, and impair oral hygiene (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). It is also recognised as one of the most complex and unpredictable dento-facial conditions to treat (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), where indications for treatment include aesthetic and functional management. Mild open bites may spontaneously resolve with early detection, advice, and observation, whereas more severe cases may justify orthodontic and/or surgical intervention.\u003c/p\u003e\u003cp\u003eRegardless of the treatment strategy, there is a recognised high risk of relapse (11\u0026ndash;43%) which may be attributed to soft tissue factors, habit resumption, and inappropriate surgical and orthodontic management (\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). With consideration of the untreated patient cases, and post-treatment relapses, it can be assumed that a sizeable proportion of the population will experience AOB during their lifetime. There is a suggestion of a potential association between AOB and those experiencing signs and symptoms of temporomandibular disorders (TMDs) (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTMD is an umbrella term, which the literature normally associates with the twelve most common myogenous and arthrogenous conditions, affecting the muscles of mastication and/or the temporomandibular joint (TMJ) complex (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). However, the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) also classifies less common TMD diagnoses that includes joint diseases, such as systemic arthritides and idiopathic condylar resorption (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eImportantly, TMDs represent the most common cause of non-dental orofacial pain (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), therefore, it is recognised as a major driver for patients seeking treatment and rising healthcare costs, while negatively impacting an individual\u0026rsquo;s quality of life (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The aetiology of TMDs are considered multifactorial, which can be attributed to physical and psychosocial factors, where no single cause has been identified to-date (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This could explain why any association between TMDs and AOB remains unclear in the literature and opens questions for clinicians on best practice/management when coexistent.\u003c/p\u003e\u003cp\u003eIt is not well-established if there is any cause-and-effect relationship between AOB and TMDs. There is an underlying logic that suggests individuals can acquire AOB secondary to TMDs, such as osteoarthritis, rheumatoid arthritis, and idiopathic condylar resorption (\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, the current evidence-base is relatively unexplored regarding the role of a pre-existing AOB malocclusion (via a dental, skeletal or functional origin) increasing the risk of developing TMD signs and symptoms.\u003c/p\u003e\u003cp\u003eThe rationale for a scoping review is to present a broad overview of the evidence, helping to identify current gaps in knowledge and inform decision making for future research (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). It can also be used to identify a topic that is suitable for a systematic review. This current scoping review aims to identify publications that consider associations between TMDs and AOB. Furthermore, it aims to determine any cause-and-effect relationship between them.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eProtocol and registration\u003c/p\u003e\u003cp\u003eThe protocol was registered with the Open Science Framework prior to searching the literature (DOI \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17605/OSF.IO/B8E2N\u003c/span\u003e\u003cspan address=\"10.17605/OSF.IO/B8E2N\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). This scoping review was developed according to the \u0026ldquo;Preferred Reporting Items for Systematic review and Meta-Analysis extension for Scoping Reviews\u0026rdquo; (PRISMA-ScR) checklist.\u003c/p\u003e\u003cp\u003eThe review was guided by the PCC (Population, Concept, and Context) framework (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Population (P): humans with Anterior Open Bite in the secondary dentition; Concept (C): identified as having a concurrent Temporomandibular Disorder(s); and Context (C): any healthcare setting in any country. The key research question is: What is the evidence that links AOB and TMDs?\u003c/p\u003e\u003cp\u003eInclusion criteria\u003c/p\u003e\u003cp\u003eAll publication types were included: case report, case series, clinical trial, RCT, cohort, and any other publications. Any healthcare setting in any country. Only those identified as having concurrent TMD and AOB were included. The inclusion criteria for TMDs was based on Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Publications reporting humans with AOB in the secondary or mixed dentitions were included. Only papers available in English were included. There was no limitation set on date of publication.\u003c/p\u003e\u003cp\u003eExclusion criteria\u003c/p\u003e\u003cp\u003eStudies were excluded if only in the primary dentition, animal studies, or reported AOB or TMD in isolation. Studies reporting TMDs related to neoplasm, chondromatosis, and/or osteonecrosis were excluded. Patients who had previously undertaken treatment(s) for TMDs and/or AOB. Those with a history of craniofacial trauma.\u003c/p\u003e\u003cp\u003eInformation sources\u003c/p\u003e\u003cp\u003eA comprehensive and systematic literature search was performed on 9th July 2024, using the electronic databases as follows: MEDLINE-Ovid (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ovid.com\u003c/span\u003e\u003cspan address=\"https://www.ovid.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e); Embase-Ovid (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.embase.com\u003c/span\u003e\u003cspan address=\"https://www.embase.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e); Web of Science (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.webofscience.com\u003c/span\u003e\u003cspan address=\"https://www.webofscience.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e); and Scopus (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.scopus.com\u003c/span\u003e\u003cspan address=\"https://www.scopus.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The search strategy was developed, employing relevant Medical Subject Headings terms (MeSH). The chosen terms aimed to encompass a wide range of relevant studies. All publications up to 9th July 2024, that met the inclusion criteria, were retrieved Furthermore, a complementary search was performed in April 2025. This step was intended to update and enrich the search database with the most recent publications, ensuring the final manuscript included the latest articles.\u003c/p\u003e\u003cp\u003eSearch strategy\u003c/p\u003e\u003cp\u003eTo develop an effective search strategy, we initially performed a pilot search using an array of popular terms and common words within the field. It was decided that searches would not be filtered to show \u0026ldquo;English publications only\u0026rdquo;, as the provisional search results showed that English publications were being inexplicably excluded. All non-English studies were instead manually removed at the screening stage. No restrictions/limits were applied regarding the year of publication. The full search strategy can be found in Supplementary File Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eSelection of sources of evidence\u003c/p\u003e\u003cp\u003eThe study selection process is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Search results were imported into EndNote (EndNote X9; Thomson Reuters, NY, USA). Covidence (Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia) was used to screen, reject and select publications. Independent title and abstract (TIAB) screening were conducted by two independent, blinded reviewers (B.D.M. and H.B.) to confirm that studies satisfied the inclusion criteria and duplicates were removed. Any conflicts were resolved by discussion with an independent third reviewer (G.M.).\u003c/p\u003e\u003cp\u003eIf based on TIAB screening eligibility could not be determined, the article was moved to full text screening. Full-text review was undertaken by two reviewers (B.D.M and H.B), and conflicts resolved by discussion with G.M.\u003c/p\u003e\u003cp\u003eData charting processes and data items\u003c/p\u003e\u003cp\u003e Data extraction and charting were independently collected by the same two reviewers (B.D.M. and H.B.), with discrepancies resolved through consultation with G.M. All information was recorded in a pre-defined, customised data extraction table designed on Covidence. The standardized collation sheet included the following items: author(s), year of publication, type of study / report, dentition type (adult, mixed, or unclear), TMD diagnosis (all based on the DC/TMD classification), and the relationship between AOB and TMDs (AOB secondary to TMD, TMD secondary to AOB, or not defined).\u003c/p\u003e\u003cp\u003eData synthesis and presentation\u003c/p\u003e\u003cp\u003eData were summarized using descriptive statistics, and presented in tables and a narrative format. The qualitative synthesis was undertaken to provide an overview of the existing evidence, with a primary focus on the cause-and-effect relationship identifying AOB as the leading cause of TMDs.\u003c/p\u003e\u003cp\u003eQuality assessment\u003c/p\u003e\u003cp\u003e No quality assessment was performed in accordance with the PRISMA guidelines for scoping reviews.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eStudy selection\u003c/p\u003e\u003cp\u003eAfter searching the electronic databases, a total of 1751 studies were retrieved. 885 duplicates were removed. 866 studies were screened by TIAB, with 647 excluded as they did not meet the inclusion criteria. 219 studies were sought for retrieval for full-text screening. 1 study was unable to be retrieved, despite requests through inter-library loans. 218 studies were assessed at full text for eligibility, of these, 85 were excluded. The full-text articles were identified as not being written in the English language, although the relevant abstracts had been published in English which is why they were not initially excluded at the TIAB phase. Consequently, 133 studies were included in this scoping review (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.), where details of each study can be found in Supplementary File Table\u0026nbsp;2, (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e), (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e), (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e), (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e), (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e), (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e), (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e), (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e), (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e), (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e), (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e), (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e), (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e), (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e), (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e), (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e), (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e), (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e), (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e), (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e), (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e), (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e), (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e), (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e), (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e), (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e), (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e), (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e), (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e), (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e), (\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e), (\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e), (\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e), (\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e), (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e), (\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e), (\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e), (\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e), (\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e), (\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e), (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e), (\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e), (\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e), (\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e), (\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e), (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), (\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e), (\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e), (\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e), (\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e), (\u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e), (\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e), (\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e), (\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e), (\u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e), (\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e), (\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e), (\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e), (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), (\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e), (\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e), (\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e), (\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e), (\u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e), (\u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e), (\u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e), (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), (\u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e), (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), (\u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e), (\u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e), (\u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e), (\u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e), (\u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e), (\u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e), (\u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e), (\u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e123\u003c/span\u003e), (\u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e), (\u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e), (\u003cspan citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e), (\u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e), (\u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e), (\u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e129\u003c/span\u003e), (\u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e), (\u003cspan citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e), (\u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e), (\u003cspan citationid=\"CR133\" class=\"CitationRef\"\u003e133\u003c/span\u003e), (\u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e), (\u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e135\u003c/span\u003e), (\u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e), (\u003cspan citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e), (\u003cspan citationid=\"CR138\" class=\"CitationRef\"\u003e138\u003c/span\u003e), (\u003cspan citationid=\"CR139\" class=\"CitationRef\"\u003e139\u003c/span\u003e), (\u003cspan citationid=\"CR140\" class=\"CitationRef\"\u003e140\u003c/span\u003e), (\u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e), (\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e), (\u003cspan citationid=\"CR143\" class=\"CitationRef\"\u003e143\u003c/span\u003e), (\u003cspan citationid=\"CR144\" class=\"CitationRef\"\u003e144\u003c/span\u003e), (\u003cspan citationid=\"CR145\" class=\"CitationRef\"\u003e145\u003c/span\u003e), (\u003cspan citationid=\"CR146\" class=\"CitationRef\"\u003e146\u003c/span\u003e), (\u003cspan citationid=\"CR147\" class=\"CitationRef\"\u003e147\u003c/span\u003e), (\u003cspan citationid=\"CR148\" class=\"CitationRef\"\u003e148\u003c/span\u003e), (\u003cspan citationid=\"CR149\" class=\"CitationRef\"\u003e149\u003c/span\u003e), (\u003cspan citationid=\"CR150\" class=\"CitationRef\"\u003e150\u003c/span\u003e), (\u003cspan citationid=\"CR151\" class=\"CitationRef\"\u003e151\u003c/span\u003e), (\u003cspan citationid=\"CR152\" class=\"CitationRef\"\u003e152\u003c/span\u003e), (\u003cspan citationid=\"CR153\" class=\"CitationRef\"\u003e153\u003c/span\u003e), (\u003cspan citationid=\"CR154\" class=\"CitationRef\"\u003e154\u003c/span\u003e), (\u003cspan citationid=\"CR155\" class=\"CitationRef\"\u003e155\u003c/span\u003e), (\u003cspan citationid=\"CR156\" class=\"CitationRef\"\u003e156\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eStudy characteristics\u003c/p\u003e\u003cp\u003eType of report / study\u003c/p\u003e\u003cp\u003eThe studies identified were published between 1968 and 2024. The types of publications included: cohort studies (n\u0026thinsp;=\u0026thinsp;58), where patients were investigated prospectively from three months up to 15 years (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e); case reports (n\u0026thinsp;=\u0026thinsp;44) were based on a single patient case, or a small number of patient cases; evidence synthesis / narrative review (n\u0026thinsp;=\u0026thinsp;17); case series (n\u0026thinsp;=\u0026thinsp;13) retrospectively reviewed patient cases; and a doctoral Thesis (n\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e\u003cp\u003eDentition\u003c/p\u003e\u003cp\u003eIn each paper the reviewers recorded the dentition type, but only where directly stated by the author(s), or if it was clearly evident from the age group of participants when reviewing the text. 81 studies had participants with an adult dentition, who were aged between 14 and 60 years (\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e). 7 studies had participants with a mixed dentition aged between 7 years and 12 years (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e). 26 studies had a combination of participants with either an adult or a mixed dentition. It was unclear what type of dentition the participants had in 18 studies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan additionalcitationids=\"CR113\" citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e, \u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e129\u003c/span\u003e, \u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e, \u003cspan citationid=\"CR152\" class=\"CitationRef\"\u003e152\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTMD diagnoses\u003c/p\u003e\u003cp\u003eThe type of TMDs included degenerative joint diseases (n\u0026thinsp;=\u0026thinsp;85). RA, JIA and ICR were grouped under an umbrella category of \u0026ldquo;degenerative joint disease\u0026rdquo;, however it is recognised that these are all classed as separate conditions (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), so each were analysed and reported individually. 31 studies reported osteoarthritis (OA) (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan additionalcitationids=\"CR121\" citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e, \u003cspan citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e, \u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e, \u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e135\u003c/span\u003e, \u003cspan citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e, \u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e, \u003cspan citationid=\"CR151\" class=\"CitationRef\"\u003e151\u003c/span\u003e, \u003cspan citationid=\"CR156\" class=\"CitationRef\"\u003e156\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR157\" class=\"CitationRef\"\u003e157\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e), 22 cases were related to rheumatoid arthritis (RA) (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e, \u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e, \u003cspan citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e, \u003cspan additionalcitationids=\"CR143 CR144\" citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR145\" class=\"CitationRef\"\u003e145\u003c/span\u003e, \u003cspan additionalcitationids=\"CR149\" citationid=\"CR148\" class=\"CitationRef\"\u003e148\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR150\" class=\"CitationRef\"\u003e150\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR157\" class=\"CitationRef\"\u003e157\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e, \u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e, \u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e, \u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e, \u003cspan citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e, \u003cspan citationid=\"CR133\" class=\"CitationRef\"\u003e133\u003c/span\u003e), 18 publications reported idiopathic condylar resorption (ICR) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e, \u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e, \u003cspan citationid=\"CR139\" class=\"CitationRef\"\u003e139\u003c/span\u003e, \u003cspan citationid=\"CR152\" class=\"CitationRef\"\u003e152\u003c/span\u003e, \u003cspan citationid=\"CR154\" class=\"CitationRef\"\u003e154\u003c/span\u003e, \u003cspan citationid=\"CR155\" class=\"CitationRef\"\u003e155\u003c/span\u003e, \u003cspan citationid=\"CR157\" class=\"CitationRef\"\u003e157\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e, \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e, \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e, \u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e), and 14 publications of juvenile idiopathic arthritis (JIA) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR146\" class=\"CitationRef\"\u003e146\u003c/span\u003e, \u003cspan citationid=\"CR147\" class=\"CitationRef\"\u003e147\u003c/span\u003e, \u003cspan citationid=\"CR152\" class=\"CitationRef\"\u003e152\u003c/span\u003e, \u003cspan citationid=\"CR153\" class=\"CitationRef\"\u003e153\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e, \u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e129\u003c/span\u003e, \u003cspan citationid=\"CR138\" class=\"CitationRef\"\u003e138\u003c/span\u003e, \u003cspan citationid=\"CR140\" class=\"CitationRef\"\u003e140\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePublications reported disc displacement with and without reduction (n\u0026thinsp;=\u0026thinsp;84), arthralgia (n\u0026thinsp;=\u0026thinsp;84), myogenous pain (n\u0026thinsp;=\u0026thinsp;57). The majority of studies reported that more than one diagnosis occurred in varying combinations. One publication reported on Treacher Collins syndrome (\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e). Where the TMD diagnosis was not clearly identified we concluded that it was \u0026ldquo;unclear\u0026rdquo; (n\u0026thinsp;=\u0026thinsp;4) (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e, \u003cspan citationid=\"CR158\" class=\"CitationRef\"\u003e158\u003c/span\u003e). This excluded the risk of potential bias influencing our scoping review findings.\u003c/p\u003e\u003cp\u003eRelationship of AOB and TMDs\u003c/p\u003e\u003cp\u003eThe majority of publications suggested an association between AOB and TMDs. In these publications, subjects with the conditions of interest were normally compared to a clinical control group, without any AOB/TMD conditions (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR138\" class=\"CitationRef\"\u003e138\u003c/span\u003e, \u003cspan citationid=\"CR139\" class=\"CitationRef\"\u003e139\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e). 46% of studies investigated a cause-and-effect relationship between AOB and TMDs. Of these publications, 77% (n\u0026thinsp;=\u0026thinsp;48) reported AOB occurred secondary to TMDs. 21% (n\u0026thinsp;=\u0026thinsp;13) publications reported on the incidence of TMDs occurring secondary to AOB, and 2% (n\u0026thinsp;=\u0026thinsp;1) reported that both AOB and TMD were leading aetiological factors.\u003c/p\u003e\u003cp\u003eWhere AOB occurred secondary to TMDs, 99% of publications reported that individuals were diagnosed with a type of joint disease: 18 for RA (38%), 12 were related to OA (25%), 12 for ICR (25%), and 10 for JIA (21%), where some publications reported on more than one condition. One case report reported AOB secondary to TMD, where the individual was diagnosed with posterior disc displacement (without reduction and limited opening) (\u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e). In all cases, the TMJ diagnosis was confirmed by clinical examination, followed with CT and/or MRI imaging, and biochemistry/haematology where systemic conditions were present (\u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e, \u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e, \u003cspan citationid=\"CR139\" class=\"CitationRef\"\u003e139\u003c/span\u003e). 81% of publications were in relation to those with an adult dentition. Only children with a mixed dentition acquired an AOB secondary to JIA (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR138\" class=\"CitationRef\"\u003e138\u003c/span\u003e, \u003cspan citationid=\"CR140\" class=\"CitationRef\"\u003e140\u003c/span\u003e, \u003cspan citationid=\"CR146\" class=\"CitationRef\"\u003e146\u003c/span\u003e, \u003cspan citationid=\"CR147\" class=\"CitationRef\"\u003e147\u003c/span\u003e, \u003cspan citationid=\"CR153\" class=\"CitationRef\"\u003e153\u003c/span\u003e). AOB secondary to ICR was also reported to occur in children, but this was only where individuals had an adult dentition (\u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe findings for AOB reported as the leading cause of TMDs have been summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The aetiology of AOB was primarily attributed to the skeletal growth pattern in five publications (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e), but the aetiology was not clear from the remaining nine publications. Of the 14 publications, 13 (93%) suggested that a pre-existing AOB significantly increased the risk of developing TMD signs and symptoms. The majority of these reported a cohort design that considered causality via patient questionnaires and a clinical examination (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e, \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e). Five publications reported statistically significant findings when reporting AOB as a leading cause of TMDs, which was normally compared with a control group (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e, \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e, \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e). Two publications reported evidence of this link over a period of 5 to 8 years (\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e), and reported that females were disproportionately affected by myogenous pain, disc displacement, and arthralgia. One publication suggested a cause-and-effect relationship, which was based on TMD resolution following orthodontic AOB correction (\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e). Two evidence reviews report conflicted findings, but both were in agreement regarding the lack of well-designed investigations (\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of primary studies following cases of TMD secondary to AOB (evidence synthesis excluded).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor and year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eType of report / study\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDentition type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTMD diagnosis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMain findings\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAghabeigi et al. 2001 (\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCase series\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;83\u003c/p\u003e\u003cp\u003eAges\u0026thinsp;=\u0026thinsp;15 to 60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisc displacements, and Degenerative joint disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThose with AOB had an increased risk of developing TMD, which increased further with age.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEgermark-Eriksson et al. 1983 (\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;402\u003c/p\u003e\u003cp\u003eAges\u0026thinsp;=\u0026thinsp;7 to 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisc displacements, Myogenous, and Arthralgia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThose with AOB had an increased risk of developing TMD signs and symptoms compared to a control group.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEgermark-Eriksson et al. 1990 (\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;402\u003c/p\u003e\u003cp\u003eAges\u0026thinsp;=\u0026thinsp;7 to 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisc displacements, Myogenous, and Arthralgia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThose with AOB had an increased risk of developing TMD signs and symptoms after the age of seven.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHenrikson et al. 1997 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;183\u003c/p\u003e\u003cp\u003eAges\u0026thinsp;=\u0026thinsp;11 to 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisc displacements, Myogenous, and Arthralgia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThose with AOB had a significantly greater risk of developing TMD compared with a control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHuang et al. 2023 (\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCase report\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003cp\u003eAge\u0026thinsp;=\u0026thinsp;26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisc displacements\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOrthodontic correction of AOB led to TMD resolution. This demonstrated a casual cause-and-effect relationship.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManfredini et al. 2014 (\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;114\u003c/p\u003e\u003cp\u003eAges\u0026thinsp;=\u0026thinsp;20 to 54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisc displacement, Myogenous, Degenerative joint disease, and Arthralgia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThose with AOB were predisposed to TMD, where arthralgia was significantly greater in those with AOB compared to a control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Individuals also had an increased risk of myofascial pain and OA.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarangoni et al. 2014 (\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;105\u003c/p\u003e\u003cp\u003eAges\u0026thinsp;=\u0026thinsp;7 to 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMyogenous, and Arthralgia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChildren, and adolescents, with AOB were 1.2-fold more likely to develop TMD compared to a control group.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiyazaki et al. 1994 (\u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;532\u003c/p\u003e\u003cp\u003eAges\u0026thinsp;=\u0026thinsp;6 to 32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisc displacements, and Arthralgia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDemonstrated a significant relationship (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between AOB and TMD, when compared to a control group and other malocclusions.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePahkala et al. 2002 (\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;287\u003c/p\u003e\u003cp\u003eAged\u0026thinsp;=\u0026thinsp;7 to 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisc displacements, Myogenous, and Arthralgia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChildren, and adolescents, with AOB were at an increased risk of developing TMD.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSchmitter et al. 2007 (\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;90\u003c/p\u003e\u003cp\u003eAges\u0026thinsp;=\u0026thinsp;18 to 65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisc displacements, Myogenous, and Arthralgia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAuthors reported AOB significantly increased the risk of TMD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTanne et al. 1993 (\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant No\u0026thinsp;=\u0026thinsp;305\u003c/p\u003e\u003cp\u003eAges\u0026thinsp;=\u0026thinsp;4 to 29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisc displacements, Myogenous, and Arthralgia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAOB significantly increased the risk of developing TMD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) compared to other malocclusions.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe objective of this scoping review was to identify the current knowledge of associations between AOB and TMDs, and understand evidence that suggested any cause-and-effect relationship. In particular, the authors were interested in evidence that supported AOB as a leading causative factor of TMDs. At present, the general consensus is that targeted management of malocclusions, including AOB, has no role in the resolution of TMDs and is not recommended by current guidance (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR159\" class=\"CitationRef\"\u003e159\u003c/span\u003e). Furthermore, no clinical considerations are given for AOB management to assist TMD recovery/resolution. However, these recommendations are based on an overall lack of evidence from the current literature. The primary purpose of this scoping review was to provide an overview of the available evidence and identify current knowledge gaps, to establish a foundation for future primary research. This has the potential to inform future management strategies for TMD patients.\u003c/p\u003e\u003cp\u003eOver 1/3 of all publications identified in this scoping review were patient case reports, which is acknowledged as a limited form of evidence to determine causality (\u003cspan citationid=\"CR160\" class=\"CitationRef\"\u003e160\u003c/span\u003e). Furthermore, a large proportion of all case reports did not attempt to investigate/report evidence of a cause-and-effect diagnosis (\u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e, \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e, \u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e, \u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e, \u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e, \u003cspan citationid=\"CR143\" class=\"CitationRef\"\u003e143\u003c/span\u003e). From this it is clear that case reports are not appropriate to answer the second objective of this scoping review, with regards to demonstrating a cause-and-effect relationship.\u003c/p\u003e\u003cp\u003eNow considering publications that were not case reports. Those investigating individuals diagnosed with an acquired AOB, secondary to TMDs, normally had a diagnosis related to a type of joint resorption, including OA, RA, ICR, or JIA. These publications all strongly suggest that progressive joint disease significantly increases the risk of developing an acquired AOB (\u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e, \u003cspan citationid=\"CR140\" class=\"CitationRef\"\u003e140\u003c/span\u003e, \u003cspan citationid=\"CR151\" class=\"CitationRef\"\u003e151\u003c/span\u003e, \u003cspan citationid=\"CR153\" class=\"CitationRef\"\u003e153\u003c/span\u003e), where the severity of the open bite is expected worsen with time.\u003c/p\u003e\u003cp\u003eIn each instance, the explanation given by authors for the acquired AOB were through destruction of the condylar morphology, resulting in a reduced ramus height and posterior retraction of the mandible (\u003cspan citationid=\"CR161\" class=\"CitationRef\"\u003e161\u003c/span\u003e, \u003cspan citationid=\"CR162\" class=\"CitationRef\"\u003e162\u003c/span\u003e). However, there were a distinct lack of publications in the literature that demonstrated a clear cause-and-effect relationship, which was a particular problem when attempting to interpretate and analyse the case-series study designs (\u003cspan additionalcitationids=\"CR153 CR154 CR155\" citationid=\"CR152\" class=\"CitationRef\"\u003e152\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR156\" class=\"CitationRef\"\u003e156\u003c/span\u003e). In these publications, the exact onset of the TMD disease process, and AOB, was deduced predominantly through a brief patient history, without detailed clinical background information. These findings, therefore, have been interpretated with caution, as there was a tendency for an assumption of association as evidence of causality.\u003c/p\u003e\u003cp\u003eThere is a suggestion there is an inability of the TMJs to adapt to mechanical stresses and, therefore, could be a predisposing factor for OA and ICR conditions (\u003cspan additionalcitationids=\"CR163 CR164\" citationid=\"CR162\" class=\"CitationRef\"\u003e162\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR165\" class=\"CitationRef\"\u003e165\u003c/span\u003e). One study identified in this scoping review supports this concept, where individuals with AOB had a nearly two-fold increase of OA compared with subjects allocated to a control group (\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e). It has been proposed that this link can be attributed to disproportionate occlusal force distribution, due to a loss of anterior/canine guidance and ICP instability (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). This was thought to result in overloading of the articular surfaces, which induced early TMJ resorption, leading to an acquired AOB. This is most relevant in individuals who experience a reduced adaptive capacity of the articulating surfaces (\u003cspan citationid=\"CR166\" class=\"CitationRef\"\u003e166\u003c/span\u003e, \u003cspan citationid=\"CR167\" class=\"CitationRef\"\u003e167\u003c/span\u003e). TMJ-OA progression is even thought to occur in those with a provisional diagnosis of anterior disc displacement (\u003cspan citationid=\"CR168\" class=\"CitationRef\"\u003e168\u003c/span\u003e). At present, however, the lack of evidence-base identified by this current scoping review suggests that this relationship is largely circumstantial, and the overall importance of naturally occurring AOB as an aetiological factor in joint disease remains unclear.\u003c/p\u003e\u003cp\u003eThere has also been suggestion within the literature that subjects with a pre-existing AOB had an increased risk of developing TMDs, including disc displacement (with and without reduction), arthralgia, myofascial pain, and headaches (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e, \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e, \u003cspan citationid=\"CR169\" class=\"CitationRef\"\u003e169\u003c/span\u003e). In these studies, the AOB aetiology was mainly attributed to the patient\u0026rsquo;s skeletal pattern, with excessive vertical growth of the dento-alveolar complex, which led to a 1.2-fold greater chance of developing TMD symptoms (\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e). The initiating effect on these TMD symptoms is thought to occur as the AOB malocclusion can be unstable with functional overloading (as described above), which has a negative impact upon the muscles of mastication, TMJ, and other associated structures (166). However, only limited evidence has been found focusing primarily on AOB as the predisposing factor of TMDs, where most of these studies were published over 10 years previously. Currently, therefore, any cause-and-effect relationship between AOB and TMDs is considered weak.\u003c/p\u003e\u003cp\u003eOf the publications reporting AOB as the leading factor in TMDs, nine were cohort designs (64%). Three of these studies recruited younger participants, from the age of 7, and had the advantage that individuals with AOB were identified before TMD symptoms became established (\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e). In addition to establishing causality, these longer-term follow-up periods (5\u0026ndash;8 years) were also needed to highlight the importance of age related changes occurred only once above the ages of 7 or 10 (\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e). This trend was attributed to the continued growth and development of their TMJ apparatus. These cohort studies, therefore, support that AOB gave an increased risk of developing disc displacement, myofascial pain, and arthralgia. However, by comparison, the remaining cohort studies did not establish a clear cause-and-effect relationship. This was attributed to the restricted follow-up periods and limited details of the participants\u0026rsquo; pre-existing occlusal and TMD history (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan additionalcitationids=\"CR105\" citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e, \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough, an important limitation associated with all the aforementioned cohort studies was that none undertook MRI imaging to support and confirm any disc displacement diagnosis and exclude/include other potential TMJ conditions (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e, \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e). The overall strength of these findings must be questioned, as other confounding factors could have influenced the outcomes.\u003c/p\u003e\u003cp\u003eNine publications reported on patient cases, where complete resolution of disc displacement, and myofascial pain, occurred once the skeletal AOB had been orthodontically managed (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e). These successful treatment outcomes might be interpretated as evidence of a negative impact of AOB on TMJ stability and health, especially as no other clinical factors were considered risks for TMDs. While this argument seems plausible, these findings were based on single patient case reports, which should not be viewed as conclusive evidence. Furthermore, the occurrence of TMD resolution post-treatment was solely noted by the authors of this scoping review, and directionality was not implied or mentioned directly by any of the orthodontic papers themselves.\u003c/p\u003e\u003cp\u003eComparisons with past research\u003c/p\u003e\u003cp\u003eThe findings from this current scoping review suggests that degenerative joint diseases impacts the occlusal scheme, and in some cases results in an acquired AOB (\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). What is less clear is whether AOB predisposes to TMDs, which remains a controversial topic in the dental literature (\u003cspan citationid=\"CR170\" class=\"CitationRef\"\u003e170\u003c/span\u003e). From the available evidence, only two publications reviewed the relationship between AOB and non-degenerative TMDs (\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e), which reported conflicted findings. One favoured a weak association between both factors, however, this publication is over 30 years old with outcome measures that are not in place today (\u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e). The review from 2018 concluded that there was no evidence to support a relationship between AOB and TMDs in either direction (\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e), however, this paper did not report to established evidence synthesis guidelines which suggest a potential increased risk of bias.\u003c/p\u003e\u003cp\u003eA wider unstructured search of the literature suggests there is a lack of evidence from primarily investigations that support a strong association between different malocclusions and TMDs (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR168\" class=\"CitationRef\"\u003e168\u003c/span\u003e, \u003cspan citationid=\"CR171\" class=\"CitationRef\"\u003e171\u003c/span\u003e, \u003cspan citationid=\"CR172\" class=\"CitationRef\"\u003e172\u003c/span\u003e). This might support why there has been a paradigm shift with clinicians gradually moving away from historic gnathological concepts to more contemporary biopsychosocial models considering wider initiators and drivers of TMDs (\u003cspan citationid=\"CR173\" class=\"CitationRef\"\u003e173\u003c/span\u003e). A further key issue associated with gnathology model is the prescription of irreversible dental treatment to manage TMDs (\u003cspan citationid=\"CR159\" class=\"CitationRef\"\u003e159\u003c/span\u003e, \u003cspan citationid=\"CR174\" class=\"CitationRef\"\u003e174\u003c/span\u003e). This dynamic shift was reflected in our search results, where the number of investigations from a gnathological perspective decreased over time, which was particularly evident within the last 10 years.\u003c/p\u003e\u003cp\u003eLimitations and future research\u003c/p\u003e\u003cp\u003e This scoping review has several limitations. First, it included only studies written in English. Furthermore, the vast majority of studies did not clinically examine the extent of the open bite, or use a standardised grading/classification scale, when reporting the AOB diagnosis (\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e, \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e, \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e). It is, therefore, unknown whether different AOB severity levels have a significant impact on the TMJ apparatus. We were also unable to exclude the role of different malocclusions, such as posterior crossbites and open bites, as patients typically presented with a combination of more than one malocclusion, or the authors never explicitly shared the details of the occlusal status for each patient (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e). This applies equally to occlusal interferences, that could potentially impact TMDs. These confounding occlusal factors may have overexaggerated the perceived effect caused by AOB.\u003c/p\u003e\u003cp\u003eThis review suggests that future research designs should have a renewed focus on establishing the directionality, primarily the pathogenesis associated with AOB. Detailed patient questionnaires, with evidence of past dental records (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e), is vital to establish timelines and a reliable cause-and-effect relationship. A case matched cohort study could be an ideal research design, where participants are continually monitored over an extended period, avoiding ineffective shorter follow-up studies (\u003cspan citationid=\"CR148\" class=\"CitationRef\"\u003e148\u003c/span\u003e). The use of digital technologies (intraoral scanners) offers an alternative easily stored and transferred data source to permit researchers to accurately quantify the associated open bite changes (\u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e). Use of robust and reliable clinical and patient centred outcome measures to clearly determine the initiation and progression of AOB and TMDs, and/or evidence of the pre-existing TMJ and occlusion issues are needed (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e). This should also be seen in consideration of the current biopsychological model of TMDs with its initiators, drivers and strategies for management (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR159\" class=\"CitationRef\"\u003e159\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWithin the limitations of this scoping review, it was possible to conclude that:\u003c/p\u003e\u003cp\u003e1. Evidence suggests that individuals diagnosed with osteo and rheumatoid arthritis, idiopathic condylar resorption, and juvenile idiopathic arthritis of the TMJ, impacts occlusal stability often leading to an acquired AOB.\u003c/p\u003e\u003cp\u003e2. AOB may be a contributing factor of TMDs, in terms of disc displacement, arthralgia, and myofascial pain. Although there is currently limited evidence regarding causality.\u003c/p\u003e\u003cp\u003e3. There is a lack of evidence defining the role of AOB as a predisposing factor for OA. To-date, there is no evidence available regarding the impact of AOB on other degenerative conditions, such as ICR.\u003c/p\u003e\u003cp\u003e4. There is a need for carefully designed and implemented long-term longitudinal research to address an understanding of any cause-and-effect relationship between AOB and TMDs.\u003c/p\u003e\u003cp\u003e5. Treatment of concomitant AOB and TMDs might be best guided by management of each condition in isolation, however, clinicians are encouraged to consider any potential interaction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cb\u003eEthical approval\u003c/b\u003e:\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cb\u003eInformed consent\u003c/b\u003e:\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cb\u003eConsent to participate\u003c/b\u003e:\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cb\u003eConflict of interest\u003c/b\u003e:\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eData availability statement:\u003c/h2\u003e\u003cp\u003eThe data supporting this article can be made available by the corresponding author upon request.\u003c/p\u003e\n\u003ch3\u003eCRediT authorship contribution statement\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eBryan D. Murchie\u003c/b\u003e: Conceptualization, Validation, Visualization, Formal analysis, Investigation, Resources, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing. \u003cb\u003eGiles I. McCracken\u003c/b\u003e: Conceptualization, Validation, Formal analysis, Supervision, Investigation, Resources, Writing \u0026ndash; review \u0026amp; editing. \u003cb\u003eHeidi L. Bateman\u003c/b\u003e: Validation, Visualization, Formal analysis, Investigation, Conceptualization, Resources, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding sources\u003c/strong\u003e\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHsu LF, Liu YJ, Wang SH, Chen YJ, Chen YJ, Yao CCJ. 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J Dent Rest. 2016;95(10):1084\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGreene Charles S, Manfredini D. Overtreatment \u0026ldquo;Successes\u0026rdquo;\u0026mdash;What Are the Negative Consequences for Patients, Dentists, and the Profession? J Oral Facial Pain Headache. 2023;37(2):81\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6906775/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6906775/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eTo determine if there is evidence of an association between Anterior Open Bite (AOB) and Temporomandibular Disorders (TMDs), and evidence of any cause-and-effect relationship between these two factors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e Adhering to PRISMA-ScR guidelines, searches were conducted in MEDLINE-OVID, Scopus, Embase-OVID, and Web of Science. Inclusion criteria included studies investigating the association between AOB and TMDs, regardless of publication date. Data were presented through narrative exposition and tables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 133 studies met the inclusion criteria, published between 1968 and 2024. Most studies were cohort designs, or case reports, involving the adult dentition only. 46% of included publications investigated a cause-and-effect relationship between AOB and TMDs. Of the relevant publications, 78% (n\u0026thinsp;=\u0026thinsp;49) reported AOB occurring secondary to TMDs, which were almost exclusively attributed to degenerative joint diseases. 22% (n\u0026thinsp;=\u0026thinsp;14) investigated AOB as the leading aetiological factor, where 93% of these studies observed that a pre-existing AOB significantly increased the risk of developing TMDs.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eIndividuals diagnosed with osteo- and rheumatoid arthritis, idiopathic condylar resorption, and juvenile idiopathic arthritis had a greater incidence of acquiring AOB. Analysis also suggests a potential link between those with a pre-existing skeletal AOB, and TMDs including disc displacement, arthralgia, and myofascial pain. At present, it is suggested that clinical treatment of concomitant AOB and TMD is guided by management of each condition in isolation, but evidence encourages clinicians to consider any potential interaction. Future research should consider case-matched longitudinal studies, over an extended period, to determine a strong association/causality between AOB and TMDs.\u003c/p\u003e","manuscriptTitle":"Anterior open bite and temporomandibular disorders: A scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-13 07:28:40","doi":"10.21203/rs.3.rs-6906775/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c7d548f-e63b-4562-89c6-fee9f83d84fb","owner":[],"postedDate":"August 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52967110,"name":"Health sciences/Health care/Dentistry/Occlusion/Malocclusion"},{"id":52967111,"name":"Health sciences/Anatomy/Oral anatomy/Mandibular muscles"},{"id":52967112,"name":"Health sciences/Health care/Dentistry/Dental conditions/Malocclusion"},{"id":52967113,"name":"Health sciences/Health care/Dentistry/Preventive dentistry"},{"id":52967114,"name":"Health sciences/Health care/Dentistry/Dental treatments/Dental treatment planning"}],"tags":[],"updatedAt":"2025-11-19T17:47:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-13 07:28:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6906775","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6906775","identity":"rs-6906775","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}