As faculty members of an oral medicine and orofacial pain department, and as practicing clinicians, we have a considerable interest in topics such as bruxism and temporomandibular disorders (TMDs). We were pleased to see that April JADA featured a group of excellent scientifically supported articles on orofacial pain, as well as an outstanding editorial on that subject by an eminent Israeli professor.1–4
However, in contrast, it was a surprise to see in this same JADA issue an anecdotally based opinion by Dr. Gordon Christensen, "The Major Part of Dentistry You May Be Neglecting." In these "Observations," he states, "Occlusal equilibration is one of the major treatments for occlusally oriented diseases, [but] this procedure is not accomplished frequently by many practitioners."
He goes on to list a number of clinical problems in dentistry that, according to him, require occlusal equilibration as at least a part of appropriate therapy. These include various restorative, orthodontic, esthetic and periodontal situations, but, unfortunately, he also has included bruxism and TMDs in his list of "occlusally oriented diseases." At the end of his commentary, he laments the fact that, "treatment of occlusal conditions sadly [is] neglected in the profession."
Space does not permit a full discussion of this matter, but it must be said that Dr. Christensen’s viewpoint about treating bruxism and TMDs with occlusal equilibration is not supported by years of literature. Presenting an opinion as "fact" is a disservice to dentists and patients alike. While his observations may have been reasonable 30 to 40 years ago, and would have been arguable 10 to 20 years ago, they are indefensible in the face of enormous amounts of research on these topics.
Today, nocturnal bruxism is classified as a sleep-related phenomenon that is centrally mediated; as such, it has little to do with specific occlusal variables, and is only secondarily affected by life stressors. Therefore, when he says that "most practitioners agree that the [occlusal adjustment] procedure reduces patients’ tendency to aggressively continue their destructive habit," he is only encouraging dentists to further mutilate the dentition beyond what the bruxism itself has done. This is a classical example of misuse of an irreversible procedure with no evidence of its therapeutic value.
The situation is even worse with respect to treating TMDs. Despite hundreds of research articles during the past 25 years showing only minimal relationships between occlusal variables and these disorders, many dentists continue to utilize equilibration, orthodontics, prosthodontics and even orthognathic surgery as primary modalities of TMD treatment. We cannot expect any one article in JADA to resolve this problem. However, since JADA is one of the most widely read journals in our profession, we hope that the editor will monitor the non–peer-reviewed opinions in future issues of The Journal. By doing so, JADA can elevate the scientific foundations of practice and can avoid misinforming its professional readers, while protecting the public from unnecessary therapies.
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