We thank Dr Roehm for his interest in our article. He provided a witty anecdote. Nonetheless, his comments are more theatrical than substantive. He furnished no research or evidence supporting his viewpoint, and his opinion typifies an experience-based (vs an evidence-based) view on the subject. Over the years, we have received numerous letters from orthodontists who have at one time subscribed to the tenets of gnathology but have since abandoned the philosophy, and they have the very opposite experience to Dr Roehm. That is, the gnathologic view makes little or no sense, does not hold up well to the demands of clinical practice, and is more or less a perfunctory exercise. If clinical decisions are to be based solely on experience (and not science and evidence), then whose experience should practitioners trust?
Regarding Dr Roehm’s analogy—he did make a valid point to the lessons from fixing automobiles: leave it to your mechanic! When it comes to treating patients, however, it is not as clear cut as the components that make up an inanimate object such as a car or an engine. There is no start or stop, no tear down, or clunkering or clankering. In treating patients, genetic, endocrine, social, sexual dimorphism, and psychological factors as well as growth, adaptation, and individual variation must be considered. A mechanistic approach to TMD, occlusion, condylar position, and orthodontics only serves to mislead our specialty and underestimate this complex subject. If we are doctors and not auto mechanics, then the topic of “occlusion/TMD” should be framed and referenced from an evidence-based perspective that considers the many factors that play a role in the diagnosis and management of TMD.
We hope that Dr Roehm is not advocating that TMD or orthodontic patients are best managed by gnathologically trained auto mechanics. Or maybe he is just not seeing the garage for the tools.