What Is The Connection? — a 30 Year Perspective
When I left my dental training, like many dentists even today, I lacked a clear understanding of dental occlusion. My concept of my responsibility to my patients was mostly about teeth and gums. My introduction to classic concepts of dental occlusion began in the early 1970s. But even that training was primarily focused on how teeth should fit together and little about the normal and abnormal function of the jaw system. Those classic perspectives were more mechanical in concept than physiologic. Although that early training was foundational, there was a lot missing.
In those early years there were several shortcomings in our thinking. We tended to think and talk primarily about “ideals” in dental occlusion. There is important value in understanding ideals as general principles. However, the study of dental occlusion has historically tended to be more theoretical than practical and it has been difficult for many dentists to transfer those “ideal” theoretical concepts into practical clinical application.
Since perhaps the early 1980’s there has been a progressive and much needed evolution in our understanding, beginning with a new awareness of normal and abnormal temporomandibular joint anatomy and function, that has broadened our perspective of what has been referred to as dental occlusion. For more on TMJ anatomy, see “Anatomy of the Temporomandibular Joints“. More recent thinking is oriented more toward understanding the physiologic function of the entire masticatory system, not just how teeth should fit together. This has included a deeper understanding of the physiology and functional integration of its three key components, the health and function of the temporomandibular joints, the physiology of the muscles that are the primary source of function and loading of that system, and the teeth, through which that loading takes place.
• “To Understand the Abnormal, We Must First Understand the Normal.”
• “To Understand Dysfunction, We Must First Understand Function”
• Occlusion and Temporomandibular Disorders — A Play in 3 Acts
My Committment To My Patients
Having addressed patients’ temporomandibular disorders the past 30+ years has given me the opportunity to observe the consistency with which occlusal factors play a significant role in the function and the dysfunction of masticatory physiology. In spite of there being only limited sound support in the scientific literature, (a great deal of it is flawed and does not meet the stringent requirements of Science regarding demonstration of ‘causation’), it is very clear to me that without the incorporation of appropriate occlusal therapy in the management of temporomandibular disorders, we would have very limited ability to resolve these patients’ problems in a definitive manner that will limit their return over time. Treatment that addresses only the symptoms, and not the underlying factors that produce those symptoms, is insufficient.