Temporomandibular disorders (TMDs) have a multifactorial etiology, and a report in General Dentistry highlights clear aligner therapy (CAT) as a probable cofactor of TMD in a patient who developed masticatory pain during CAT. Dentists should be aware that CAT may exacerbate existing factors in some patients, leading to TMD symptoms.

Case Report
A 56-year-old woman whose chief concern was maxillary and mandibular crowding also had missing teeth, end-on molar occlusion, excess overjet, and generalized tooth wear. The patient reported a history of clenching but no prior history of TMD symptoms. Although a comprehensive treatment plan was offered, the patient chose CAT with a limited goal of improved esthetics. After a few weeks of wearing the aligner trays full time, the patient developed acute pain in the masseter and preauricular areas. When the symptoms did not resolve with routine home care methods such as mandibular relaxation exercises, a softer diet, and anti-inflammatory pain medication, basic behavioral education was introduced, and the course of orthodontic treatment was altered. The patient was instructed to discontinue wearing the aligners for 1 week while she learned to reduce the tension in her jaw muscles. The patient then resumed CAT with only nighttime use, and a new series of aligners was designed to compensate for the lack of daytime wear. The patient followed the new CAT protocol without experiencing TMD symptoms and was satisfied with the outcome of treatment.

Summary
Severe, acute orofacial pain may arise even during orthodontic treatment that has limited goals. In this context, CAT differs from fixed appliance therapy in having occlusal coverage that may initiate unpredictable responses in patients who adapt poorly to occlusal changes. In this case, the treatment plan was changed to address the patient’s TMD symptoms, allowing satisfactory completion of orthodontic treatment.

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