--- title: "Ankylosing Spondylitis and Orthodontics UK 2026" url: https://virtualconsultant.online/guides/ankylosing-spondylitis-orthodontics-uk description: "AS causes enthesitis, TMJ involvement and bone changes that affect orthodontic treatment. UK 2026 guide for patients on TNF inhibitors." updated: 2026-08-25T00:00:00Z publisher: Virtual Consultant Online --- Ankylosing Spondylitis TMJ Biologics Axial SpA # Ankylosing Spondylitis and Orthodontics UK Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the spine and entheses — the sites where tendons and ligaments attach to bone. Approximately 10 to 35 per cent of AS patients experience temporomandibular joint (TMJ) involvement, and the medications used to manage AS have direct effects on bone remodelling and tooth movement. This guide covers everything UK patients with AS need to know before starting orthodontic treatment. [Start Photo Assessment](https://virtualconsultant.online/evaluations/quote) [Compare Costs](https://virtualconsultant.online/costs) ## What is ankylosing spondylitis and why it affects orthodontic treatment Ankylosing spondylitis (AS), also known as axial spondyloarthritis (axSpA), is a seronegative inflammatory arthritis primarily affecting the sacroiliac joints and spine, with a tendency to cause enthesitis — inflammation at the insertion points of tendons and ligaments into bone. In the context of orthodontic treatment, AS matters because: the temporomandibular joint (TMJ) is a synovial joint that can be affected by the same inflammatory process as other joints; the medications used to manage AS significantly alter bone metabolism; long-term inflammation can change alveolar bone density; and jaw stiffness from TMJ involvement can create practical difficulties during clinical procedures. Understanding these factors allows an orthodontist and rheumatologist to plan treatment that is both safe and effective. ## TMJ involvement in AS: how common and what it means Studies report TMJ involvement in approximately 10 to 35 per cent of AS patients, with a wide range reflecting differences in diagnostic criteria and study populations. TMJ involvement in AS presents as jaw pain, stiffness, restricted mouth opening, crepitus, and asymmetric jaw movement. In some patients, active TMJ inflammation causes condylar resorption — progressive loss of the condylar head similar to that seen in rheumatoid arthritis — which leads to progressive anterior open bite and bite instability. For orthodontic planning, the critical question is whether TMJ disease is active and progressive or inactive and stable. Active condylar resorption is a contraindication to starting orthodontic treatment aimed at correcting the bite, because any correction will be undermined by ongoing joint destruction. Stability should be confirmed on serial imaging — typically MRI or CBCT — over at least 12 months before committing to treatment. ## How TNF inhibitors affect bone remodelling during orthodontics Tumour necrosis factor inhibitors (TNFi) — including adalimumab, etanercept, infliximab, certolizumab pegol and golimumab — are the most widely used biological therapies for AS. TNF-alpha plays a central role in the inflammatory cascade that drives both osteoclastic bone resorption and, through RANKL/OPG signalling, osteoblastic bone deposition. Blocking TNF alters the balance of bone remodelling in complex ways. In periodontitis models, TNFi therapy has been shown to reduce periodontal bone loss. However, the effect on orthodontic tooth movement — which depends on a precisely calibrated cycle of osteoclastic resorption on the pressure side and osteoblastic deposition on the tension side — is not fully characterised. Clinically, some patients on TNFi appear to have slower or less predictable tooth movement than expected, while others respond normally. There is no consensus guidance for force levels in TNFi-treated patients. The prudent approach is to start with lighter forces than standard, extend appointment intervals, and monitor tooth movement objectively at each stage. ## NSAIDs, bone density and tooth movement Non-steroidal anti-inflammatory drugs (NSAIDs) — including ibuprofen, naproxen, diclofenac, and selective COX-2 inhibitors such as etoricoxib — are the first-line analgesic and anti-inflammatory treatment for AS. Long-term NSAID use has well-documented effects on bone biology. NSAIDs inhibit cyclooxygenase (COX) enzymes and thereby reduce prostaglandin synthesis. Prostaglandins are key mediators of the inflammatory response required for normal bone remodelling, including the resorption and deposition cycle that underlies orthodontic tooth movement. Animal studies have shown that NSAID administration significantly reduces the rate of orthodontic tooth movement. Clinical data in humans are more limited, but consistent long-term NSAID use — as is typical in AS management — is associated with slower tooth movement and potentially longer treatment timelines. Patients should inform their orthodontist of their NSAID regimen so that treatment expectations and wire sequencing can be adjusted accordingly. ## Jaw stiffness and limited mouth opening: practical management AS can affect the cervical spine and TMJ in ways that limit neck extension and jaw opening. Reduced maximum mouth opening — trismus or restricted temporomandibular movement — creates practical difficulties for orthodontic appointments. Impression-taking, bracket bonding, wire placement, and aligner scanning all require adequate mouth opening. Patients should inform the orthodontic team of any jaw stiffness, pain on opening, or restricted opening before appointments. Adjustments can include: using narrower impression trays or digital intraoral scanning (which requires less sustained opening than conventional impressions); positioning the patient semi-upright rather than fully reclined to reduce cervical spine discomfort; breaking longer appointments into shorter sessions; scheduling appointments during periods of lower disease activity (avoiding days of flare); and pre-medicating with pain relief as appropriate. Some patients benefit from physiotherapy or gentle TMJ mobilisation exercises before orthodontic appointments. ## Coordinating with your rheumatologist before treatment Before starting orthodontic treatment, patients with AS should request that their orthodontist and rheumatologist communicate directly. Key information the orthodontist needs includes: current medication regimen and any planned changes; disease activity score (BASDAI or ASDAS); whether the disease is currently in remission or active flare; whether there is any TMJ involvement and its current status; and whether there are any contraindications to dental procedures, including guidance on antibiotic prophylaxis if applicable. Many rheumatologists are unfamiliar with the specific orthodontic considerations for their patients and will welcome the opportunity to provide a structured summary. A letter from the orthodontist to the rheumatologist outlining the proposed treatment and asking specific questions is the most efficient approach. This liaison is not optional — it protects the patient and ensures both clinicians are working from the same information. ## NHS referral pathway for AS patients needing orthodontics Patients with AS who require orthodontic treatment follow the same NHS referral pathway as other adults, but with additional considerations. NHS orthodontics is not routinely available to adults in England — the NHS prioritises patients under 18 with a significant IOTN need. However, where AS-related TMJ involvement has caused malocclusion severe enough to require orthognathic (jaw) surgery in addition to orthodontics, there is a pathway through NHS hospital-based maxillofacial and orthodontic units. The GP should be the first point of contact, as they can refer to NHS oral and maxillofacial surgery for complex cases. Patients managing privately should ensure their orthodontist has experience with medically complex adults, as AS cases require modified protocols that not all practices routinely offer. ## Monitoring during orthodontic treatment with AS Patients with AS require more frequent monitoring during orthodontic treatment than otherwise healthy patients. The orthodontist should check at each appointment for signs of TMJ change — new asymmetry, changes in bite, or patient-reported increase in jaw symptoms. Any significant change in jaw alignment or bite during treatment warrants imaging and rheumatology review before adjustments continue. Periodontal health should be actively monitored, as AS and its treatments alter the immune response in ways that can affect gingival inflammation. Patients taking immunosuppressants should have their gum health assessed at every orthodontic appointment, not just at routine dental check-ups. If disease activity increases significantly during treatment, deferring orthodontic adjustments until the flare resolves is the safer approach. ## Useful related pages [Rheumatoid Arthritis and Orthodontics UK](https://virtualconsultant.online/guides/rheumatoid-arthritis-orthodontics-uk) [Autoimmune Disease and Orthodontics UK](https://virtualconsultant.online/guides/autoimmune-disease-orthodontics-uk) [Immunosuppressed Patients and Orthodontics](https://virtualconsultant.online/guides/immunosuppressed-orthodontics-uk) [Medication Effects on Orthodontic Treatment](https://virtualconsultant.online/guides/medication-effects-orthodontic-treatment-uk) [Orthodontics and Diabetes UK](https://virtualconsultant.online/guides/orthodontics-and-diabetes-uk) [Guides Hub](https://virtualconsultant.online/guides) This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist. ### Compare next steps [Orthodontist Near Me](https://virtualconsultant.online/locations/orthodontic-treatment-near-me) [Clear Aligners Near Me](https://virtualconsultant.online/treatments/clear-aligners-near-me) [Invisalign Near Me](https://virtualconsultant.online/locations/invisalign-provider-near-me) [Browse Locations](https://virtualconsultant.online/locations) ### Ready for a clearer starting point? Upload guided photos and receive an indication of likely treatment options and pricing before booking appointments. [Get an Online Quote](https://virtualconsultant.online/evaluations/quote) ### Frequently Asked Questions Can I have braces or aligners if I have ankylosing spondylitis? Yes, in most cases. AS does not automatically exclude orthodontic treatment. The key factors are whether your TMJ is stable (not actively resorbing), whether your disease is currently well controlled, and whether your rheumatologist is informed and supportive of treatment. Your orthodontist should be told about your AS diagnosis, all current medications including biologics and NSAIDs, and any jaw symptoms. Treatment may take longer than usual and require modified force protocols, but successful outcomes are achievable for well-selected patients. Does AS affect the jaw? Yes, in approximately 10 to 35 per cent of AS patients. The temporomandibular joint is a synovial joint and can be affected by the same inflammatory process that involves other joints. Symptoms include jaw pain, stiffness, restricted opening, clicking, and in some cases progressive condylar resorption leading to bite changes. If you have jaw symptoms alongside your AS diagnosis, ask your rheumatologist whether TMJ involvement has been assessed. An MRI of the TMJ is the most sensitive imaging method to detect active inflammation. Will TNF inhibitors slow down my orthodontic treatment? Possibly. TNF-alpha is involved in the inflammatory signalling that drives bone remodelling, and blocking it may alter the rate or predictability of tooth movement. Clinical evidence in orthodontic patients specifically is limited, but the biological mechanism suggests that lighter forces and longer treatment timelines may be appropriate. Your orthodontist should be aware of your biologic therapy and be prepared to adjust force levels and appointment intervals accordingly. Do NSAIDs affect how well my braces work? Long-term NSAID use is associated with reduced prostaglandin synthesis, which in animal studies significantly slows orthodontic tooth movement. In clinical practice this means patients taking regular NSAIDs for AS may move more slowly than expected, requiring extended treatment timelines. This does not mean NSAIDs should be stopped — AS management takes priority — but your orthodontist should factor this into treatment planning. Some patients work with their rheumatologist to time any NSAID dose adjustments around key stages of orthodontic treatment where possible. My jaw is stiff — will I cope with orthodontic appointments? Jaw stiffness from AS or TMJ involvement can make some aspects of orthodontic appointments uncomfortable, particularly impression-taking, bracket bonding and wire placement. Most experienced orthodontic practices can accommodate this with modifications: using digital scanning instead of impressions, positioning you semi-upright, breaking long appointments into shorter sessions, and scheduling during periods of lower disease activity. Tell your orthodontic team about your jaw stiffness before appointments start so they can plan around it. Should I see my rheumatologist before starting orthodontic treatment? Yes. Your orthodontist needs information from your rheumatologist about disease activity, current medications, TMJ status and any clinical contraindications before starting treatment. The most efficient approach is to ask your orthodontist to write to your rheumatologist with specific questions, and to bring a current medication list to your first orthodontic appointment. This coordination is not a formality — it directly affects treatment planning decisions, force selection, and how closely you need to be monitored during treatment. Is orthodontic treatment available on the NHS for AS patients? NHS orthodontics for adults is not routinely available in England regardless of diagnosis. If your AS has caused TMJ involvement severe enough to produce a significant malocclusion requiring jaw surgery as well as orthodontics, there is a pathway through NHS maxillofacial surgery units. Your GP can refer you for assessment. For straightforward orthodontic treatment — alignment, spacing or bite correction without the need for surgery — you will need to fund treatment privately. Costs typically range from £2,500 to £6,000 depending on the appliance type and case complexity. Can axial spondyloarthritis affect bone density around teeth? Chronic inflammation in AS is associated with systemic bone loss, and long-term corticosteroid use — sometimes used to manage AS flares — is known to reduce alveolar bone density. Reduced bone density around the teeth can slow tooth movement and, more importantly, can increase the risk of periodontal bone loss if gum disease is present during orthodontic treatment. A thorough periodontal assessment before treatment starts is essential. Any active periodontal disease must be treated and stabilised before orthodontic forces are applied. Explore your options Quick links Not sure where to start? 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Upload guided photos and get a tailored recommendation for your teeth and bite. [Start Photo Assessment](https://virtualconsultant.online/evaluations/quote) [Find an Orthodontist](https://virtualconsultant.online/locations) Citation details Title Ankylosing Spondylitis and Orthodontics UK 2026 Publisher Virtual Consultant Online Published 2026-06-14 Updated 2026-08-25 URL [https://staging.virtualconsultant.online/guides/ankylosing-spondylitis-orthodontics-uk](https://staging.virtualconsultant.online/guides/ankylosing-spondylitis-orthodontics-uk)