My View Regarding the Role of Dental Occlusion in the Management of TMD

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Occlusion is the foundation to advanced dentistry. Temporomandibular dysfunctions become problematic when occlusion is not properly understood.

Occlusion is a fundamental element in dentistry that all departments of dentistry should be concerned with.  Occlusion is acknowledged as an important and key topic every generation of dentists have recognized. They have also realized there is confusion with various opinions about this matter as to how best to treat TMD and deal with the various occlusal problems.  Gneuromuscular (GNM) principles of occlusion are not new to the profession, but further builds on past gnathologic as well as present day technology that allow dentists to measures bio-physiologic responses of the masticatory system. From these scientific recordings the dental profession is able to be better informed and have a greater understanding of dental alignment, temporomandibular joint positioning and masticatory muscle problems when diagnosing and treating TMD cases.  In prosthetic reconstruction dentistry where the aim is artificial reconstruction of occlusion to harmonize the entire stomatognathic system, two major schools of thought have been advocated: One, the mechanical occlusion theory initiated by Dr. Gysi, where emphasis was placed upon mandibular movement.  The other is a theory of a functional occlusion system based on neuromuscular physiology, using electro-diagnostic instrumentation to measure the function of the stomatognathic occlusal system.

Oral physiology studies the functional occlusion system comprised of three major components: teeth, muscles and the temporomandibular joints.  Occlusion is maintained by the activities of the masticatory muscles which are controlled by neural integration of the feedback mechanism from the peripheral proprioceptors and the reflex mechanism of the central nervous system. Understanding these physiologic mechanisms of the stomatognathic system allows simplified clinical procedures that can be applied in all facets of dentistry including the TMD, orthodontics, cosmetic/restorative dentistry, prosthodontic, periodontists and pediatric dentistry. By understanding how these entities function in this manner the dentists are then able to treat patients with greater precision and predictability during growth, development and after growth process as stopped in the adult population.

Comprehensive dentistry goes beyond the occlusal perspectives how teeth articulate and where the centricity of condyle to glenoid fossa relationship exists. New knowledge and understanding of the influences of occlusal imbalance on the human body requires intimate knowledge of the histological, anatomic and physiologic realm of the neuromuscular complex.  The dentist should not only be the caretakers of the dentition, but of the health of all the structures innervated by and/or associated to the trigeminal nerve.  Is it not true that the 5th cranial nerve, the trigeminal nerve, has been taught to dentist as the dentist’s nerve?  Then why do we find that a majority of dentists within the profession know very little about the fifth cranial nerve and how it relates to the dental occlusion and all its many facets of TMD problems?

When transitioning from academic knowledge to clinical treatment, the dentist realizes:

1) An optimal bite relationship is needed to begin a proper diagnosis for comprehensive treatment and care.

2) The importance of protocols to properly management the bite relationship during the initial stabilization stage (phase I) to the finalizing stages of orthodontics and/or restorative treatment (phase II) are required, and

3) Proper bite transfer and detailed inter occlusal management of the occlusion must be maintain, managed and precisely replicated to the proven and tested jaw relationship. In order to implement proper finishing techniques, the physiologic parameters (objectively measured and quantified) are validated to confirm the quality of function and stability of this healthy occlusal relationship.

Unfortunately, the traditional functional occlusal concepts do not teach dentists how to achieve these neuromuscular measured outcomes, neither do they have this kind of thinking.  They continue to struggle, give excuses and rationalize their ways, focusing mainly on the mechanical and geometric occlusal perspectives. The lack of scientific interest understanding dental bio-physiology, supported by objective measuring principles, that link the patient’s pathologic conditions of their teeth, muscles and joints to the dentist’s clinical observations of the dental problem, continues to this day. Regardless of the fancy rhetoric, teachings and excuses given by the majority of our profession on the bases of “evidence-based dentistry”, a firm theoretical and experimental basis of occlusion should no-longer be hypothetical.  Sound occlusal teachings and techniques that are foundationally based in bio-physiology exist today allowing dentists to strategically address the underlying problems with effective treatment strategies of the dental organism. A focal point when correcting any occlusal problem is to regain a healthy muscle mandibular position that better connects the mandible, condyle and disc and skull to the associated body parts optimally.

This physiologic approach to occlusion implements protocols and techniques that are based on scientific objectively measured recordings. It has brought new dimensions of understanding not only to patients suffering from stomatognathic pain, but also to dentists seeking to understand what true occlusion is about. Our research has further developed these concepts and teachings. 

Distinguished clinicians who have learned these objectively measured technologies have now recognized these established GNM protocols, methods and clinical techniques work effectively based on scientific validation.

Clayton A. Chan, D.D.S. – Founder/Director

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