I cannot believe that we are even having this debate in Point/Counterpoint about occlusion and temporomandibular disorders (TMDs) (Slavicek R. Relationship between occlusion and temporomandibular disorders: implications for the gnathologist [Point/Counterpoint]. Am J Orthod Dentofacial Orthop 2011;139:10-5; and Greene CS. Relationship between occlusion and temporomandibular disorders: implications for the orthodontist [Point/Counterpoint]. Am J Orthod Dentofacial Orthop 2011;139:11-6.). We went through the same nonsense back in the mid 1990s, when orthodontists were falling all over themselves to deny any relationship. An entire issue of the ADO-JO desperately tried to support this notion. Here we are again, in the next generation, and we haven’t done any better with educating orthodontists about occlusion. In fact, I think we’re doing worse.
Listen, out there, once and for all: TMDs are occlusally related. End of story. Nothing else to say. If the “evidence” doesn’t agree, then your “evidence” is poorly contrived, either by design or lack thereof. I and many others manage TMDs every day with occlusal therapies—and successfully. You just need to take the time and effort and get the education that you’re not getting in graduate school to understand occlusion.
There are Roth/Williams affiliates out there or more general practitioner-oriented groups such as Orognathic Bioesthetics International and Pankey that (for the most part) tell the same story. Get Dawson’s seminal text. Listen to Spear or Kois. But do something. I think it’s inexcusable for orthodontists to ignore the interrelationship between occlusion and TMDs, especially when our general practitioners are going in the other direction and looking for answers.
To dismiss TMDs as biopsychosocial and to advise orthodontists to “just say NO” is simply wrong. My patients, who get off their Paxil or Zoloft or Effexor because of misdiagnosis and mistreatment, will happily testify. My advice is to find people who know what they’re talking about and get out there and LEARN. Stop hiding your heads in the sand.
Ron Roth must be turning over in his grave.