We appreciate the initially encouraging words by Dr. Spahl about our "exposing the rift between clinical practice and academia" and the need for change. However, Dr. Spahl then accuses us of being contentious because we describe some of his theories about the etiology and treatment of temporomandibular disorders (TMDs) in a negative way. As a result, his letter ends up being a clear example of the problems within the TMD field today.
There are those who are determined to continue doing some version of what he proposes: "full-scale mandibular (condylar) relocation (advancement) and stabilization of the temporomandibular joints over the long term (often nine to 12 months), in concert with permanent alteration (correction) of the occlusion, by any means [emphasis added], to maintain that corrected structural relationship." And then there are those who follow a medical model to provide appropriate conservative and reversible therapies, without imposing such horrific somatic, psychological and financial burdens on people already suffering from their facial pain.
In Dr. Spahl’s letter, he implies that we have made specific negative comments about the importance of retruded condylar position, but, in fact, we never mention this particular concept. By introducing this topic, he can expand on his personal philosophy and belief system regarding this matter (without any evidence-based citations). We choose not to debate the details of these personal concepts about the management of TMD problems in this format; instead, we will leave it to the readers of The Journal to decide for themselves what is most appropriate in light of the current literature on this complex topic.
