It is interesting that you would choose to print the letter to the editor called "Chronic TMD" by Dr. Ronald A. Gilligan (March JADA), since his anecdotal accounts of successful treatment are so contrary to established fact and to the consensus publications of both the ADA and the National Institutes of Health. I feel that you owe to your readers a contrary view challenging his assertion that temporomandibular disorders are caused by occlusal problems.
He starts with the premise that treatment should be aimed at eliminating causes rather than treating effects. Then he states that he can "eliminate the symptoms of TMD" solely by addressing occlusal causes. Addressing Dr. Gilligan’s criticisms in their response, the authors (Dr. Jake Epker and colleagues, "A Model for Predicting Chronic TMD: Practical Applications in Clinical Settings," October JADA) point out that 80 percent of patients would improve regardless of the treatment rendered.
Unfortunately the authors did not continue that there are a multitude of epidemiologic and controlled laboratory studies published in refereed journals showing that occlusion plays little if any role in the variable complex of physical and psychological causes, and that invasive nonreversible modalities should be considered only after more conservative measures have been exhaustively explored by patient and experienced therapists.
I am readying for publication 1,200 patient histories attesting to over 92 percent success in symptom control achieved only by teaching the patient to stop nonfunctional jaw activities which have exceeded the temporomandibular system’s ability to adapt.
There was occlusal intervention only in those infrequent cases where the patient had become fixated on a prematurity, thereby triggering bruxing habits. In the latter cases, occlusal adjustment was the only invasive modality and was confined to removing the irritating prematurities.
If The Journal is to include any anecdotal references to occlusion as a cause of TMD, then don’t you think that it would be a service to at least mention the existence of the prevalent contrary view based on published studies? Readers could well interpret The Journal’s lack of refutation as tacit approval.
If you only have a hammer, then everything looks like a nail.
