I appreciate Dr Greven’s positive comments about our recent Point/Counterpoint articles, and I agree that the editor deserves a lot of credit for initiating this type of exchange in the AJO-DO . I’m not sure why Dr Greven feels that the field of TMD, bruxism, and occlusion has been long neglected, because it seems that the opposite has been true for at least 20 or 30 years. Much has been written and discussed about these topics during that time, and significant progress has been made in understanding how they might or might not relate to each other. This is especially true for bruxism, which is the major focus of Dr Greven’s comments. It is now clear that both original concepts of bruxism etiology (occlusal factors and psychic stress) were seriously flawed, and they have been replaced by the current model of sleep disorder phenomenology, which is accepted worldwide.
Thus, I was surprised when Dr Greven said that I was describing sleep bruxism as a “social-psychologic disease,” while at the same time I was completely denying the “contribution of occlusal causal factors.” I have followed the evolution of this field carefully over the years, and, as the sleep laboratory studies by excellent researchers have emerged and been validated, I have accepted that new paradigm completely. In our Point/Counterpoint, Professor Slavicek said “Grinding and clenching are expressions of psychic stress assimilation and are mainly controlled by the neuromuscular system and occlusion,” whereas I wrote that “significant nocturnal orofacial parafunctions (sleep bruxism) are part of a disordered sleep cycle, and they are now labeled as parasomnias.” For those reasons, I described some of Professor Slavicek’s references on the bruxism topic as largely outdated literature. For the same reason, I cannot accept Dr Greven’s statement that “Most of the older cited literature [on bruxism] is still state of the art.”
Finally, I am glad that Dr Greven agreed with me that we need to understand basic biologic concepts and apply them to each patient with care. I’m a little concerned when he talked about orthodontists detecting “upcoming problems” and deciding when to take a therapeutic initiative. Since orthodontic treatment is neither preventive nor therapeutic for either bruxism or TMDs, I encourage orthodontists to focus mainly on their primary mission—to provide excellent evidence-based treatment for their malocclusion patients.