The range of our scoping review literature search was 2004 through May 2017; over 1 year later, the peer review process was complete, and the article was published. So it is no surprise that more articles have been published since we completed our search, and we are glad to learn of the 2 mentioned by Dr Hudson. We wonder, however, whether Dr. Hudson has correctly interpreted the meaning of those articles. To clarify this matter, we contacted Dr Manfredini, whose works are extensively cited to support Dr Hudson’s arguments. Manfredini’s reaction was that those works were being misinterpreted due to a narrow focus on certain findings, while other larger points were being ignored. For example, in regard to his reference 5, Manfredini told us, “The presence of a CR-MI slide had an odds ratio for TMDs higher than 2 only in one out of nine studies,” so “discarding the other eight with negative findings seems to be a very poor strategy to support the importance of dental occlusion in TMD patients.” Manfredini further informed us that the information from his group’s other articles and studies as cited by Dr Hudson was also misrepresented. Space does not permit a full discussion of these and several other details at this time, but the point should be clear enough.
In writing our article, we did not intend to suggest that all discussion of occlusal variables in relation to TMD should be ended, nor that orthodontic treatment is totally unrelated to TMD issues. Therefore, quoting snippets about these topics from Rinchuse and Kandasamy’s classic articles from 2007 and 2009 does not undercut our conclusions as presented in 2018. Discussions about the occlusion-TMD issue are not limited to the orthodontic specialty, and currently there is widespread agreement in the expert TMD research community that occlusion may be a minor etiologic factor in some patients—but no more than that. We are glad that Dr Hudson appreciates the importance of genetics, patient vulnerability, and chronic pain as key factors in 21st century discussions about TMD. However, he still seemed determined to persuade us not to forget about “the importance of paying attention to orthopedic instability and lateral guidance” so that “some day we will have a better understanding of what occlusal factors are the most significant.”
In conclusion, we are comfortable with the “scope” of what our article covered by summarizing and analyzing the conclusions from 120 review articles. We hope that readers of this Journal have found this information to be useful in their clinical practices, and we appreciate the opportunity to respond to Dr Hudson’s letter.
∗ The viewpoints expressed are solely those of the author(s) and do not reflect those of the editor(s), publisher(s), or Association.