I read with interest Dr. Gordon Christensen’s comments concerning a possible connection between occlusion and periodontal destruction in April JADA ("The Major Part of Dentistry You May Be Neglecting"). Dr. Christensen encouraged "additional long-term investigations on the relationship of occlusion to periodontal health."
Dr. Martha Nunn and I published a series of four articles between 2001 and 2004 in the Journal of Periodontology that we feel answers many of Dr. Christensen’s questions.1–4
These articles were based on a long-term retrospective study of patients with periodontal disease. We found that there was a highly statistically significant relationship between the presence of occlusal discrepancies and the long-term progression of periodontal disease. Furthermore, the treatment of occlusal discrepancies by occlusal adjustment significantly slowed the progression of periodontal disease. The statistical analysis was strong enough that we felt comfortable in stating that occlusal discrepancies are a major risk factor for the progression of periodontal disease in patients with existing periodontal disease.
This concept was explored further in several articles published in the journal Periodontology 2000.5–6 Our data were retrospective in nature and, therefore, did not rise to the "gold standard" of a controlled clinical trial. However, a controlled clinical trial on occlusion and periodontal disease would necessitate following untreated patients with diagnosed periodontal disease over an extended period. This is clearly ethically unacceptable, and should never be performed in an ethical society.
Because of this, we feel that our retrospective data may represent the best approach for answering the long-standing question of the relationship between occlusion and periodontal disease. We believe our data strongly support the need for the treatment of occlusal discrepancies in patients with periodontal disease.
It should be stated clearly that our data did not indicate that occlusion was a causative agent of periodontal disease. We believe that bacterial plaque and its products are the initiating factor for periodontal disease. Occlusal discrepancies appear to function as risk factors, like smoking, for the progression of the periodontal disease process.
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