The relationship between dental occlusion and visual dysfunctions: A literature review.

Abstract

Theoretical and anatomical pathways suggest a connection between the stomatognathic and visual systems. However, the evidence for associations between dental occlusion, temporomandibular disorders (TMD), and visual function is fragmented and of uncertain quality. This study aimed to systematically review and critically appraise the evidence regarding associations between occlusal factors, TMD, and visual parameters. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE (via PubMed) from 1946 to March 2025 for English-language studies investigating occlusion/TMD and visual outcomes. Two reviewers independently screened records, extracted data, and assessed risk of bias using the Joanna Briggs Institute (JBI) critical appraisal tools. A narrative synthesis was performed due to clinical heterogeneity. Ten studies (*n* = 7 cross-sectional, *n* = 2 case reports, *n* = 1 experimental) met the inclusion criteria. Evidence suggested associations between Class II malocclusion and myopia, altered masticatory muscle activity in myopia, abnormal pupillary responses in TMD, and vergence disorders in TMD patients. However, the overall body of evidence was rated as very low certainty due to pervasive methodological limitations: All studies had a high risk of bias, small sample sizes (20--150), and a cross-sectional design. Most studies originated from a single research group. While some associations between occlusal factors, TMD, and visual function are reported, the current evidence is insufficient to establish causality or clinical significance. The high risk of bias, small sample sizes, and lack of independent replication preclude definitive conclusions. Future high-quality, prospective, and adequately powered studies are required.