J CranioMand Func 6 (2014), No. 4 10. Nov. 2014
J CranioMand Func 6 (2014), No. 4 (10.11.2014)
Page 317-332, Language: English/German
Are occlusal treatments still possible and appropriate methods in clinical dentistry?
Le Bell, Yrsa
For years, many different concepts of etiology and resultant treatment recommendations for temporomandibular disorders (TMDs) have been presented. Unfortunately, a clear consensus has not been achieved. For the time being, much effort has been focused on the understanding and treatment of TMD as a chronic pain problem with subsequent affective, emotional and cognitive distress, including all possible psychosocial factors. This enlarged, comprehensive aspect of TMD has been stressed by several researchers, as well as many clinicians. It has added a new dimension towards a more individualized treatment regimen for the TMD patient, which has been highly appreciated. The use of a variety of simple, conservative and non-invasive therapies has been evaluated and strongly advocated. Unfortunately, this has led to a situation where clinically well-functioning treatment concepts that have been used for many years have been discarded. In particular, all kinds of irreversible modalities, including occlusal adjustment, have been rejected. Recently, even legal, moral and ethical aspects concerning irreversible interventions for treating TMD problems have been more widely discussed. From having been the most important factor for the development of TMDs, occlusion and occlusal factors are nowadays more or less neglected as causal factors, and occlusal treatments are not appreciated by many leading authorities. This has led to a controversy between clinicians still using occlusal treatments when needed, in addition to conservative modalities, and researchers who do not accept occlusal treatments as relevant in the treatment of TMD. On the other hand, most authorities, dental textbooks and other literature sources regard occlusal factors to be of great importance in all other dental treatments to achieve a good treatment outcome. What should the clinician think? Why is there a difference between TMD and other clinical areas in dentistry? Do we have evidence for continuing to use occlusal treatment modalities in clinical dentistry, including TMD?