Relationship between occlusion and temporomandibular disorders: Implications for the orthodontist

Abstract

A I want to thank the editor of the AJO-DO for inviting me to respond to the essay by Professor Rudy Slavicek. Unlike him, I won’t be starting at the time period of 5 to 6 million years ago. Instead, I want to focus on the current situation in the orthodontic field in regard to disorders of the masticatory complex and adjacent structures; these usually are collectively described as temporomandibular disorders (TMD). However, I noticed that Professor Slavicek used this term only twice in his essay. My main concern for many years has been the role that orthodontists think they should play in dealing with various types of TMD. As Okeson pointed out, “It is difficult to imagine a specialty that routinely and significantly changes a patient’s occlusal condition would not have a powerful effect on the masticatory structures [eg, the temporomandibular joints (TMJs)] and their functions.” This obviously correct observation has, in my opinion, been used to justify both appropriate and inappropriate behaviors by orthodontists as they encounter TMD in their practices. The need for orthodontists to constantly monitor and evaluate the relationships between their occlusion-changing procedures and the well-being of the TMJs cannot be disputed; it is the very essence of their daily work. As I like to tell my orthodontic students, “You are in the occlusion-disrupting business, so you must have reasonable treatment objectives and procedures to move every patient’s dentition to a new set of occlusal and craniomandibular relationships that will be biologically acceptable.” However, the above truisms do not automatically translate into a conclusion that failure to produce