Although I am not an orthodontist, I have been associated with academic orthodontic programs for over 30 years. During that time, I have heard many opinions similar to those expressed by Dr Antosz—but not always as vigorously presented. As the entire field of pain medicine (including TMD, orofacial pain, and chronic pain) has progressed during those years, I have been impressed by the willingness of most orthodontists to accept the changing paradigms in that field. At the same time, I have been distressed by the stubborn resistance of some dentists, in both the orthodontic specialty and the larger dental community.

It is especially troubling to hear a practicing orthodontist condemn the leaders of his specialty for their acceptance of evidence-based changes in concepts of etiology and treatment of TMDs. There is a name for that type of negative attitude about change: cognitive dissonance (translation: don’t tell me anything new that challenges my current beliefs). Based on his absurd statements about “evidence,” Dr Antosz advises graduating orthodontists to ignore what they have learned in their programs about TMD, occlusion, and the relationships between them. Instead, they should seek out the “real truth” by signing up for courses with various gurus and institutes (as he did some years ago).

However, the welfare of pain patients in general—and TMD patients in particular—depends entirely on our behaving as educated and caring professionals. Crossing the line from reversible medically based treatment to irreversible mechanistic treatments is the most important decision we have to make as doctors—and that decision MUST be based primarily on evidence. So, for dentists who persist in following the old beliefs and traditional practices for managing TMD patients, there’s not much more that can be said. But I would suggest that the whirling sound you hear is not your favorite guru spinning in his grave; instead, it is the engine of the “Good Ship Science” sailing slowly (but inexorably) into the future. For dentists who appreciate that fact, welcome aboard.