While we feel that we made every effort to define the terms used in our article, Dr. Shulman is correct in that certain terms may have slightly different meanings to different practitioners.
To avoid confusion, the two terms most central to our discussion, "occlusal trauma" and "traumatogenic occlusion," were used according to definitions established by the American Academy of Periodontology.1 We also tried to point out that, while there are several possible physiologic responses to excessive occlusal contact, our article focused only on the effect of occlusion on the periodontium.
As for professional arguments about occlusion, they may be in part due to the fact that while we know how teeth "should" contact, in a large percentage of the population contacts do not follow a normal pattern. Surely, the vast amount of research that has been conducted in occlusion would have been unnecessary if malocclusion weren’t so commonplace.
Dr. Shulman’s point about normal occlusion versus parafunctional habits is well-taken. The best proof of a possible link between occlusion and periodontitis is in situations of an existing occlusal trauma lesion. While there are situations in patients with reduced alveolar bone support where even normal occlusal contact may be a traumatogenic force, we believe that forces created by most occlusal discrepancies, such as balancing (or non-working side) contacts, are usually not excessive.
We agree with Dr. Shulman that in situations in which parafunctional habits exist, the increased duration and degree of occlusal force are more likely to have an effect on the periodontium than in situations in which parafunctional habits are absent. The focus in most of the periodontal literature has been on eliminating traumatogenic occlusion by means of occlusal adjustment. It is possible that other, noninvasive means of occlusal therapy would have the same effects, but only as long as they were consistently applied.
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