I am writing about the Point/Counterpoint articles in the January 2011 issue (Relationship between occlusion and temporomandibular disorders. Am J Orthod Dentofacial Orthop 2011;139:10-6), in which Professor Slavicek and Dr Greene debated each other.
First, I congratulate you for inaugurating this kind of new format of exchanging ideas and standpoints. I really like the idea that functionally oriented dentists, like Professor Slavicek, and orthodontists can get together and discuss the long (scientifically) neglected field of TMD, bruxism, and occlusion.
I very much like Professor Slavicek’s point of view, explaining the development of the masticatory organ from a phylogenetic perspective as a “new generation tool,” because in our ancestral history it is now becoming more and more important in terms of stress management as times get more hectic. Clenching and grinding (bruxism) are physiologic functions of the human organism that dentists must deal with. I see this necessity daily in treating patients.
I also agree with Dr Greene’s statements that dentists and orthodontists must understand the individual development of the skull and the body. The care of every patient must involve individualized treatment and careful follow-up to detect upcoming problems, so that we can differentiate adaptation from decompensation and know whether we must take the therapeutic initiative or not.
I can also, from a clinical standpoint, accept Dr Greene’s opinion of looking at bruxism or parafunction as a sort of social-psychologic disease. I am certain that to some extent he is right. What I cannot accept is his attitude of completely denying the contribution of occlusal causal factors and drawing the conclusion that in these cases any treatment of occlusion should be strictly avoided.
He emphasized his opinion scientifically, quoting publications, and criticized Professor Slavicek’s citing of “outdated” literature; at the same time, he ignored recent literature in this field. More than half of the articles cited by Professor Slavicek (references 19-33) are recent, highly valuable scientific works dealing with this topic. Most of the older cited literature is still state of the art.
I encourage Professor Greene to take a serious, closer, second look at these articles, and then I would welcome an open discussion with him.