The Role of Occlusal Adjustment in the Management Of

8/17/2019 The Role of Occlusal Adjustment in the Management Of

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h e r o le o f o c c l u s a l a d j u s t m e n t in th e m a n a g e m e n t o f

t e m p o r o m a n d i b u l a r d i s o r d e r s

P e n t t i K i r v e s k a r i , D O d o n t , a T u r k u , F i n l a n d

INSTITUTE OF DENTISTRY, UNIVERSITY OF TURKU

The use o f occlusal ad justme n t as a t reatmen t fo r tem porom andib u lar d iso rders ha s been quest ioned beca use

of lack o f ev ide nce that occlusal facto rs p lay an e t io log ic role ; lack o f ev idence that th is i r revers ible t rea tmen t modal i ty

has sufficient efficacy, w hen revers ible modalities are availa ble; the self-limiting cha racte r of the disorders; an d the

pos sibi l i ty of adverse ef fects. Howeve r, con trol led c l inica l t r ials have yielded resul ts that are di f f icul t to ex plain un less

occlusal factors have a causal role in temp orom and ibular disorders. Control led c l inica l t r ials also suggest an ef fect for

occlusal adjustment on ch ronic headaches and on chron ic neck and shoulder pain in comparison wi th conv ent iona l

t reatments. Moreover, no adverse effects of properly conducted occlusal adjustments have been reported. In vie w of the

pos sibi l i ty that occlusal factors have a causal role in temp orom and ibular disorders, research ef forts on the role o f

occlusion should be intensi fied, and teaching should be revised accordingly. Oral Surg Ora l Meal Ora l Pathol Oral Radiol

E n d o d 1 9 9 7 ; 8 3 : 8 7 - 9 0

O c c l u s a l a d j u s t m e n t m a y r e f e r t o a v a r i e ty o f p r o -

c e d u r e s . I n t h i s a r t i c l e , o c c l u s a l a d j u s t m e n t r e f e r s t o

r e s h a p i n g o f t h e t e e th b y p r e c i s i o n g r i n d i n g a s

d e s c r i b e d b y D a w s o n . 1 T h e i d e a w a s p r e s e n t e d b y

R a m f j o r d a n d A s h 2 in 1 9 6 6.

R e l a t i v e t o t h e i m p o r t a n c e a t t r ib u t e d t o t h e v e r i f i-

c a t i o n o f c e n t r i c r e l a t i o n a n d t h e p r e c i s i o n o f t h e r e -

s h a p in g e m p h a s i z e d b y D a w s o n , 1 m a n y i f n o t m o s t

r e p o r t s o n o c c l u s a l a d j u s t m e n t f a l l s h o rt o f D a w s o n ' s

g o a l . B e c a u s e o c c l u s a l a d j u s t m e n t p u r p o r t s t o e l i m -

i n a t e p r e s u m e d s t r u c t u r a l r i s k , c o n c l u s i o n s w i t h

r e s p e c t t o t h e s i g n i f i c a n c e o f s u c h r i s k a r e w a r r a n t e d

o n l y i f t h e r i s k r e a l l y i s e l i m i n a t e d o r s i g n i f i c a n t ly

r e d u c e d b y t h e o c c l u s a l a d j u s t m e n t .

D i s t r i b u t io n o f o c c l u s a l r i s k f a c t o r s i n th e p o p u l a -

t i on i s c o m m o n l y o v e r l o o k e d i n s t ud i e s o n o c c l u s io n .

D a w s o n ' s I g o a l o f o c c l u s a l a d j u s t m e n t i s o f t e n

r e j e ct e d a s u n n a t u r a l o r u n r e a l i s t i c . H o w e v e r ,

t h e t e x t b o o k o c c l u s i o n h a s r e p e a t e d l y b e e n s h o w n t o

b e a h y p o t h e t i c a l c o n s t r uc t , a m a l o c c l u s i o n f r o m t h e

v i e w p o i n t o f e v o l u t io n a r y b i o l o g y . 3 0 c c l u s a l r i s k

c o u l d t h e r e f o r e b e u n i v e r s a l i n t h e i n d u s t r i a l i z e d

c o u n t r i e s a n d a p r i m e s u s p e c t i n th e s e a r c h f o r c a u s a l

a g e n t s o f t e m p o r o m a n d i b u l a r d i s o r d e r s ( T M D s ) . 4

E r r o n e o u s c a u s a l i n f e r e n c e is c o m m o n i n t h e m e d -

i c a l l i te r a t u re . 5 W e a k c o r r e l a t i o n s b e t w e e n o c c l u s a l

v a r i a bl e s a n d T M D s , c o v a r i a t i o n b e t w e e n T M D s a n d

p s y c h o s o c i a l s t r e s s , a s w e l l a s t h e ra p e u t i c s u c c e s s o r

f a i l u r e i n o c c l u s a l a d j u s t m e n t a r e n o t v a l i d c a u s a l a r -

g u m e n t s . I f o c c l u s a l r i s k i n d e e d i s u n i v e r s a l a n d t h e

r e l a t i o n i s n o t l i n e a r , s t u d i e s o n o c c l u s a l c a u s a l i t y o f

aAssociate Professor.

Copyright © 1997 by Mosby-Ye ar Book, Inc.

1079-2104/97/55.00 0 710178326

T M D s n e e d t o b e l o n g i t u d i n a l a n d t o i n v o l v e i n t e r -

v e n t i o n .

A c a u s a l r o l e o f o c c l u s i o n , i f p r o v e n b e y o n d r e a -

s o n a b l e d o u b t , w i l l a f f e c t t h e c h o i c e o f t r e a t m e n t

m o d a l i t i e s e v e n w h e n e f f i c a c i o u s s y m p t o m a t i c t r e a t-

m e n t m e t h o d s a r e a v a i la b l e . I n g e n e ra l , h o w e v e r , a

c a u s a l r o l e i s n o t i n v a r i a b l y a s u f f i c i e n t r e a s o n f o r a

p a r t i c u l a r t h e r a p y .

OCCLUS L F CTORS IN THE ETIOLOGY OF

T M D s

O c c l u s a l a d j u s t m e n t h a s b e e n u s e d i n d e n ti s t r y f o r

d e c a d e s . T h e u n d e r l y i n g a s s u m p t i o n i s th a t u n f a v o r -

a b l e o c c l u s a l c o n t a c t s a r e a r i s k t o o r a l h e a l t h . T o t e s t

c r i t i c a l l y t h e h y p o t h e s i s o f o c c l u s a l c a u s a t i o n , t h e

s t u d y d e s i g n a n d m e t h o d m u s t a l l o w t h e p o s s i b i li t y o f

a n o u t c o m e c o n t r a d i c t in g t h e n u l l h y p o t he s i s .

D u r i n g t h e p a s t t w o d e c a d e s , s e v e r a l r a n d o m i z e d

c l i n i c a l t r i a l s o n o c c l u s i o n h a v e e v a l u a t e d t h e a s s o c i -

a t i o n b e t w e e n t h e u s e o f s i c k l e a v e a n d t h e f u n c t i o n a l

s t a te o f th e s t o m a t o g n a t h i c s y s t e m 6 a s w e l l a s t h e e f -

f e c t o f o c c l u s a l a d j u s t m e n t o n t h e n e e d f o r s i c k

leave.7 , 8

T h e r e a r e d i f f e r e n t o p e r a t i o n a l d e f i n i t i o n s f o r t h e

g o a l o f o c c l u s a l a d j u s t m e n t e v e n a m o n g t h o s e w h o

c o n s i d e r o c c l u s i o n a r is k f a c to r . B e c a u s e w e a r e u n -

a b l e t o i d e n t i f y p r e c i s e l y t h e s t r u c t u r a l r i s k f r o m o c -

c l u s io n , t h e a d o p t i o n o f D a w s o n ' s 1 g o a l i n o c c l u s a l

a d j u s t m e n t a p p e a r e d m o s t l o g i c a l t o u s f o r s t u d y .

A n y t h i n g l e s s r i g o r o u s w o u l d i n v o l v e a n i n c r e a s e d

r i s k th a t h a r m f u l o c c l u s a l c o n t a c t s w o u l d b e l e f t u n -

c o r r e c t e d. F o r s e v e r a l , m a i n l y p r a c t i c a l, r e a s o n s , w e

h a v e b e e n u n a b l e t o e l i m i n a t e a l l i n t e r f e r e n c e s i n o u r

s t u d i e s , d e s p i t e a s y s t e m a t i c e f f o r t t o d o s o . T h e r e f o r e

w e h a v e h a d t o a c c e p t a r i s k o f f a l s e - n e g a t i v e r e s ul t s.

8


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BB Kirveskari OR L SURGERY OR L MEDICINE OR L P THOLOGY

January 997

T o t e s t t h e l o n g - t e r m e f f e c t o f o c c l u s a l i n t e r f e r -

e n c e s o n t h e i n c i d e n c e o f s y m p t o m s a n d s i g n s o f

T M D , 6 9 h e a l th y d e n t a l s tu d e n t s w e r e r a n d o m l y a s -

s i g n e d t o a t r e a tm e n t g r o u p u n d e r g o i n g o c c l u s a l a d -

j u s t m e n t o r t o a p l a c e b o c o n t r o l g r o u p u n d e r g o i n g

m o c k g r i n d i n g . 9 T w o y e a r s l a t e r, t h e i n c r e a s e i n t h e

s u b j e c t iv e s y m p t o m s c o r e w a s s i g n i fi c a n t ly g r e a t e r in

t h e p l a c e b o g r o u p t h a n i n t h e t re a t m e n t g r o u p . M o r e -

o v e r , t h e n u m b e r o f m u s c u l a r s it e s t e n d e r t o p a lp a t i o n

r o s e s i g n i f i c a n t l y o n l y i n t h e p l a c e b o g r o u p .

I n a n o t h e r , e x t e n s i v e d o u b l e - b l i n d i n t e r v e n t i o n

s t u d y , t h r e e c o h o r t s o f h e a l t h y c h i l d r e n w e r e s t u d i e d

o v e r t i m e . T h e o l d e s t c o h o r t , 1 5 y e a r s o ld , w a s f o l -

l o w e d u p f o r 2 y e a r s , 1° a n d t h e t w o y o u n g e r g r o u p s ,

5 a n d 1 0 y e a r s o l d , w e r e f o l l o w e d u p f o r 5 y e a r s , u

H a l f o f t h e c h i ld r e n u n d e r w e n t a n a n n u a l e l i m i n a t i o n

o f o c c l u s a l i n t e r f e r e n c e s , a n d t h e o t h e r h a l f u n d e r -

w e n t m o c k g r i n d i n g . T h e n u m b e r o f c h i l d r en f r e e o r

a l m o s t f i 'e e f r o m o c c l u s a l i n t e rf e r e n c e s g r e w v e r y

s l o w l y b u t g r e w s u f f i c i e n t l y t o d i s c l o s e a s y s t e m a t i c

a n d s i g n i fi c a n t a s s o c ia t i o n b e t w e e n i n t e r fe r e n c e s a n d

s ig n s o f T M D , m u s c u l a r t e n d e r n e s s i n p a r ti c u la r ,

f r o m t h e t h i r d a n n u a l e x a m i n a t i o n t o t h e e n d o f t h e

s t udy .

T h e t e s t o f s i g n i f i c a n c e o f o c c l u s a l r i s k i n t h e e t i -

o l o g y o f T M D s r e q u i r e s a h e a l t h y g r o u p o f y o u n g

s u b j e c t s w i t h a n d w i t h o u t t h e p r e s u m e d r i s k a n d a

f o l l o w - u p p e r i o d l o n g e n o u g h t o p e r m i t a s u f f i c i e n t

n u m b e r o f c a s e s o f T M D ( r e q u e st s f o r tr e a t m e n t ) t o

a c c r u e f o r a m e a n i n g f u l s t a t i s t i c a l c o m p a r i s o n . T h i s

t y p e o f s t u d y i s c u r r e n t l y b e in g c o n d u c t e d . T h u s f a r ,

r e q u e s t s f o r tr e a t m e n t h a v e c o m e a l m o s t e x c l u s i v e l y

f r o m t h e p l a c e b o c o n t r o l g r o u p ( K i r v e s k a r i P , u n -

p u b l i s h e d o b s e r v a t io n s ) .

T h e e f f i c a c y o f o c c lu s a l a d j u s t m e n t o n m a n i f e s t

c h r o n i c p a i n s y m p t o m s h a s b e e n t e s t e d i n t w o

r an do m i ze d c l i n i ca l t r i a ls . I n t he f i r s t , 12 pa t i en t s

s e e k i n g t r e a t m e n t a t th e U n i v e r s i ty o f T u r k u N e u r o -

l o g i c a l C l in i c f o r h e a d a c h e s w e r e g i v e n o c c l u s a l a d -

j u s t m e n t o r m o c k g r i n d i n g . T h e p l a c e b o g r o u p w a s

e v a l u a t e d a b o u t 4 m o n t h s a n d t h e t r e a t m e n t g r o u p

a b o u t 8 m o n t h s a f t e r t h e t re a t m e n t . C l a s s i c m i g r a i n e

a p p e a r e d t o b e u n a f f e c t e d b y o c c l u s a l a d j u st m e n t , b u t

d i f f e r e n c e s i n r e s p o n s e w e r e o b s e r v e d i n p a t i e n t s

h a v i n g t e n s i o n h e a d a c h e o r c o m b i n a t i o n h e a d a c h e .

T h e f r e q u e n c y o f h e a d a c h e d i m i n i s h e d s i g n i f ic a n t ly

i n a s u b g r o u p o f p a t ie n t s i n w h o m o c c l u s a l a d ju s t -

m e n t s h o w e d s a t is f a c t o ry i m m e d i a t e r e s u l ts ( s ta b l e

o c c l u s i o n s u b g r o u p ) . T h e i n t e n s it y o f h e a d a c h e a l so

d i m i n i s h e d s i g n i f i c a n t l y .

I n t h e s e c o n d r a n d o m i z e d c l i n i c a l tr i a l 13 ( c u r r e n t l y

a v a i l a b l e o n l y i n F i n n i s h ) , 4 0 p a t i e n t s s e e k i n g t r e a t -

m e n t f o r c h r o n i c n e c k a n d s h o u l d e r p a i n w e r e g i v e n

a r o u t in e s e t o f p h y s i c a l t h e r a p i es . T h e c o m p a r i s o n s

b e t w e e n o c c l u s a l a d j u s t m e n t a n d m o c k g r i n d i n g w e r e

m a d e b e t w e e n c a r e f u l l y m a t c h e d p a i r s. T h e s h o r t-

t e r m r e s p o n s e w a s e q u a l l y g o o d i n b o t h g r o u p s , b u t

a t 1 2 - m o n t h a n d 6 0 - m o n t h f o l l o w - u p e x a m i n a t i o n s ,

t h e t r e a t m e n t g r o u p f a r e d s i g n i f i c a n t l y b e t t e r t h a n t h e

p l a c e b o g r o u p w i t h r e s p e c t t o a l m o s t a l l o f t h e o u t -

c o m e v a r ia b l e s.

D I S U S S I O N

T h e c o n t r o v e r s y o v e r o c c l u s io n h a s u n u s u a l c h a r -

a c t e r is t i c s . T h e r e h a v e b e e n s i g n i f i c a n t c h a n g e s i n th e

u n d e r s t a n d i n g o f w h a t c a n b e c o n s i d e r e d a s n o r m a l ,

p a t h o g e n i c , o r t h e r a p e u t i c o c c l u s a l s c h e m e s . N e v e r -

t h e l e s s , o c c l u s a l t h e r a p y , i n c l u d i n g t h e a d j u s t m e n t o f

t h e n a t u r a l d e n t i t i o n , h a s r e m a i n e d a n i m p o r t a n t

t r e a t m e n t m o d a l i t y . T h e u n d e r l y i n g a s s u m p t i o n i s

t h a t u n f a v o r a b l e o c c l u s a l c o n t a c t s a r e a r i s k t o o r a l

h e a l th a n d m a y b e a s s o c i a te d w i t h T M D s . A v a i l a b l e

e v i d e n c e o n t h e e t i o l o g y o f T M D s h a s b e e n c o n s i d -

e r e d t o f a v o r n o n o c c l u s a l c a u s a ti o n . 14 H o w e v e r , e v -

i d e n c e c o n t r a d i c t i n g a n o c c l u s a l c a u s a l r o l e i s s t i l l

missing.15, 16

T h e e t i o l o g i c r o l e o f o c c l u s io n h a s b e e n c h a l l e n g e d

i n a s t u d y a p p l y i n g t h e o d d s r a t i o t o e s t i m a t e t h e r e l -

a t i v e r i s k f r o m s e v e r a l o c c l u s a l f e a t u r e s . 17 T h e

a u t h o r s l is t s o m e o f t h e c r u c i al a s s u m p t i o n s o n w h i c h

t h e i r a n a l y s i s d e p e n d s . T h e a n a l y s i s a p p e a r s t o w o r k

w e l l o n c r o s s - s e c t i o n a l e p i d e m i o l o g i c d a t a, b u t w h e n

a p p l i e d t o d a t a f r o m a p o p u l a t i o n i n w h i c h t h e r e i s a

f u l l r a n g e o f v a r i a t i o n i n o c c l u s a l r i s k ( a n d a b s e n c e

o f r i s k ) , t h e a n a l y s i s y i e l d s e n t i r e l y d i f f e r e n t r e s u l t s,

s u g g e s t i n g t h a t t h e a s s u m p t i o n o f t h e a d d i t i v e e f f e c t s

o f t h e p r e s u m e d e t i o lo g i c f a c to r s m a y n o t b e c o r -

r ec t .

8

S e v e r a l a u t h o r s h a v e s u g g e s t e d t h a t o c c l u s a l a d -

j u s t m e n t s h o u l d n o l o n g e r b e u s e d i n t h e m a n a g e m e n t

o f T M D s . 19, 2 o T h e i r a r g u m e n t s i n c l u d e t h e i r r e v e r s -

i b i l i ty a n d i n v a s i v e n e s s o f o c c l u s a l a d j u s t m e n t , t h e

l a c k o f e v i d e n c e f o r t h e c a u s a l r o l e o f o c c l u s a l f a c -

t o r s , t h e r e p o r t e d g o o d s h o r t - t e r m r e s u l ts o f r e v e r s i b l e

t h e r a p i e s , a n d t h e h i g h p r o b a b i l i t y o f s p o n t a n e o u s r e -

c o v e r y . I n a d d i t i o n , t h e ri s k o f p o s s i b l e a d v e r s e

e f f e c t s i s o f t e n m e n t i o n e d .

T h e c o n c e p t o f r e v e r s i b l e t re a t m e n t i s d o u b t f u l .

W h e n t h e t h e r a p i s t , a f t e r a t h o r o u g h c a s e h i s t o r y a n d

c l i n i c a l e x a m i n a t i o n , p r e s c r i b e s a m a n a g e m e n t p r o -

g r a m t o r e d u c e t h e p a t i e n t ' s st r es s r e a c t i o n , t h e p a t i e n t

i n e v i t a b l y d r a w s c o n c l u s i o n s a s t o t h e l i k e l y c a u s e o f

t h e d i s o rd e r . T o r e v e r s e t h e c o n c l u s i o n i n t h e m i n d o f

t h e p a t i e n t m a y b e i m p o s s i b l e . R e c o n s t r u c t i n g t h e

t e e t h t h at h a v e u n d e r g o n e o c c l u s a l a d j u s tm e n t t o t h e i r

o r i g i n a l m o r p h o l o g i c s t r u c t u r e i s p r o b a b l y e a s i e r .

T h e i n v a s i v e n e s s o f o c c l u s a l a d j u s t m e n t i s

c o m m o n l y u n d e r s t o o d a s a p o t e n t i a ll y d e s tr u c t i v e


3/4

OR L SURGERY OR L MEDICINE OR L P THOLOGY i r veskar i 9

V o l u m e 8 3 N u m b e r 1

f a c t o r o r a r i s k i n i t s e l f. T h e r o o t s o f t h i s f e a r a r e f o u n d

i n t h e e r r o n e o u s c o n c e p t o f b i o l o g i c a l l y n o r m a l

o c c l u si o n . T h e a n a t o m y - t e x t b o o k o c c l u s i o n i s a c t u-

a l l y a m a l o c c l u s i o n . 3 A c t i v e a d a p t a t i o n t o t h e d e -

m a n d s o f f u n ct i o n t a k e s p l a c e a t t h e c r a n i o m a n d i b u -

l a r a r ti c u l a t i o n s , i n c l u d i n g t h e T M J , s k u l l s u tu r e s , a n d

p e r i o d o n t a l l i g a m e n t s . 21 T h e r e a l i z a t i o n t h a t o c c l u d -

i n g t e et h , a s o n e o f t h e c r a n i o m a n d i b u l a r a r t i c u l a -

t i o n s , h a v e l o s t th e i r c a p a c i t y f o r p a s s i v e a d a p t a t i o n

b y m e a n s o f n o r m a l f u n c t i o n a l w e a r b r i n g s a b o u t a

n e w i n t e r p r e t a t i o n o f o c c l u s a l c o n t a c t r e l a t io n s . T h i s

p r a c t i c a l l y u n i v e r s a l s t r u c tu r a l r i s k f a c t o r i s t o l e r a t e d

b y s o m e p e o p l e b u t n o t b y a l l. O c c l u s a l a d j u s t m e n t i s

s i m p l y a c o r r e c t i o n o f a s e l f - i n f l i c t e d s t ru c t u r a l h e a l t h

r i s k .

T h e r e q u i r e m e n t t h a t a t r a d i t i o n a l t r e a t m e n t m o -

d a l i ty m u s t h a v e c o m p e l l i n g e v i d e n c e ' ' s ° fo r i t s

c o n t i n u e d u s e i s u n d e r s t a n d a b l e i f s u c h a m o d a l i t y h a s

b e e n s h o w n t o r e s u l t i n a d v e r s e e f f e c t s o r i f n e w ,

c l e a r l y s u p e r i o r m o d a l i t i e s a r e a v a i l a b l e . A d v o c a t e s

o f o c c l u s a l a d ju s t m e n t d e n y a d v e r s e e f fe c t s b e y o n d

t r a n s i e n t t o o t h s e n s i t i v i t y . A d v e r s e e f f e c t s o f o c c l u s a l

g r i n d i n g d o o c c u r , b u t t h e r e a s o n i s l ik e l y t o b e a n i n -

a p p r o p r i a t e a p p l i c a t i o n o f t h e p r o c e d u r e .

T h e s e l f - l i m i t i n g c h a r a c t er o f T M D s i s a n a r g u -

m e n t n o t a d e q u a t e l y t e s te d . F l u c t u a t io n o f s y m p t o m s

i s r e p o r t e d b y p a t i e n t s a n d b y i n v e s t i g a t o r s . E v e n i f

T M D s d i d n o t p r o g r e s s a t a l l, t h e y c o u l d b e a s i g n if -

i c a n t h e a l t h p r o b l e m i f t h e s a m e p e r s o n s a r e r e p e a t -

e d l y a f f e c te d . P r o p e r l y c o n d u c t e d l o n g i t u d i n a l

s t u d i e s a r e n e e d e d t o a d d r e s s t h e q u e s ti o n . A c c o r d i n g

t o p r e l i m i n a r y i n f o r m a t i o n f r o m a n e p i d e m i o l o g i c

s t u d y in S w e d e n , w o m e n i n p a rt i c u la r w h o r e p o r t

s y m p t o m s d o s h o w a s t r o n g t e n d e n c y t o r e m a i n i n th e

s y m p t o m a t i c g r o u p w h e n t h e s t u dy i s r e p e a t e d y e a r s

l a t e r . 22 I n a d d i t i o n , t h e f l u c t u a t i o n o f e s t i m a t e d t r e a t -

m e n t n e e d i n r e p e a t e d e x a m i n a t i o n s i s r e m a r k a b l y

s m a l l . 23 B e c a u s e t h e p r o p o r t i o n o f t h e g e n e r a l p o p u -

l a t io n s e e k i n g tr e a t m e n t f o r T M D - r e l a t e d s y m p t o m s

i s 2 % t o 1 0 % ( d e p e n d i n g o n t h e c ri t e r i a u s e d ) , t hi s

d i s o r d e r c a n n o t b e c o n s i d e r e d a n i n s i g n i f i c a n t h e a l t h

p r o b l e m . I n s o m e p a ti e n ts T M D b e c o m e s a m a j o r

p r o b l e m . P r e v e n t i o n o f T M D s r e q u ir e s k n o w l e d g e o f

t h e i r c a u s e s. I n s t e a d o f r e j e c t i n g a n o c c l u s a l c a u s a l

r o l e a n d t r y i n g t o d i s c o n t i n u e t h e u s e o f o c c l u s a l a d -

j u s t m e n t , i n v e s t i g a t o r s a n d c l i n i c i a n s s h o u l d d i r e c t

e f f o r t s t o w a r d m o r e e f f i c i e n t r e s e a r c h o n o c c l u s i o n

a n d t o w a r d t h e t e a c h i n g o f t h e re q u i r e d s k i ll s .

T h e f e a r o f e v e n t u a l l o n g - t e r m d e l e t e r i o u s e f f e ct s

i s p e r h a p s t h e l e a s t r e a s o n a b l e a r g u m e n t a g a i n s t o c -

c l u s al a d j u s t m e n t i n T M D s . A n y e v i d e n c e o f s u c h e f -

f e c t s o u g h t t o a l e r t t h e d e n t a l p r o f e s s i o n t o e x a m i n e

t h o r o u g h l y t h e c o n s e q u e n c e s o f p r o p h y l a c t i c t re a t-

m e n t s , s u c h a s t h e u s e o f f i s s u r e s e a l a n t s, o f a l m o s t

a l l d e n t a l r e s t o r a t i v e w o r k , a n d o f a n y o t h e r t r e a t m e n t

h a v i n g t h e s l i g h t e s t ef f e c t o n o c c l u s a l c o n t a c t r e l a -

t i o n. T h e r e i s s o m e e v i d e n c e t h a t r e s to r a t i v e d e n t a l

w o r k m a y i n d e e d i m p a i r h e a l th . 24 N o s u c h c a u t i o n h a s

b e e n i s s u e d , h o w e v e r .

I n c o n c l u s i o n , s e v e r a l c o n t r o l l e d c l i n i c a l t r ia l s h a v e

f a i l e d t o d i s p r o v e t h e e t i o l o g i c r o l e o f o c c l u s i o n i n

T M D s . I n p a r t i c u l a r , m u s c u l a r p a i n s e e m s t o b e d e -

p e n d e n t o n t h e p r e s e n c e o f o c c l u s a l r i s k . L o n g - t e r m

s t u d i e s h a v e d i s c l o s e d n o a d v e r s e e f f e c t s o f o c c l u s a l

a d j u s t m e n t a p a r t f r o m t r a n s i e n t t o o t h s e n s i t i v i t y i n a

v e r y s m a l l n u m b e r o f c a se s . I n s t e ad o f d i s c o u r a g i n g

o c c l u s a l a d j u s t m e n t , w o r l ~ er s i n th i s f i e l d s h o u l d d i -

r e c t e ff o r t s at m o r e r e s e a r c h a n d a t i m p r o v e m e n t i n

t e a c h i n g p r o g r a m s .

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January 1997

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Reprint requests:

Pentti Kirveskari, DOdont

Institute of Dentistry

University of Turku

FIN-20520 Turku

Finland

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