Contributing Factors in TMD Causation

“The complexity of TMD makes developing a “cook book” impossible,
even though that is precisely what everyone would like.”

Jeffery P. Okeson, DMD



Below is a discussion of several of the most common TMD contributing factors:



It is useful to categorize the Contributing Factors to TMDs as:

Predisposing — Precipitating — Perpetuating

Predisposing (or risk) factors for TMDs can be:

  • • Systemic (affecting the entire body or a particular body system)
  • • Psychosocial (interaction of psychological and social variables)
  • • Physiologic (cellular and metabolic processes, neuromuscular)
  • • Structural (dental occlusion, musculoskeletal, articular, developmental anomalies)


Precipitating (or initiating) factors often involve trauma or overuse. Repetitive activities that maintain the jaw in a sustained or abnormal posture or under abnormal load, such as when playing a wind instrument or violin, can have a precipitating role. Sleep posture can trigger a painful TMD episode.


Perpetuating (or sustaining) factors often include parafunction, overuse, systemic disease, occlusal factors, or psychological distress. These are factors which, in spite of treatment that has reduced the symptoms, may cause the problem to resurface. When possible it is desirable to identify potential perpetuating factors and to reduce or eliminate them. This is the means of minimizing the likelihood that the problem will re-emerge in the future.