From the Editor
Gerard Kugel, DMD, MS, PhD
Dear Readers,
This month, Inside Dentistry takes an in-depth look at the controversy that has developed within one of the most heated discussion topics in dentistry: occlusion. Throughout the profession there has been confusion and conflict about which approach to restoring a patient’s occlusion is the ideal. As our cover feature suggests, as professionals we may want to consider the loyalties we have to the occlusion philosophy that we follow. Perhaps it’s time to be willing to accept that at any given time and for any given patient, there may be more than one approach that could be successful.
What Do You Believe? Talking about and developing occlusion reminds me of religion. We acknowledge and strive toward the same goal—patient comfort and function (ie, Heaven, for example). What we adamantly believe is the best and only way to get there—the theory of occlusion that we practice (ie, our religion)—is what varies. There are dental professionals who practice a muscle-related occlusal approach. Others emphasize a joint-related approach. Still other professionals focus on the positioning of the mandible prior to evaluating occlusion. The fact of the matter is, however, that no dentist can cure every problem with one solution. There is just too much variability in occlusal problems and patient presentations.
No Pain, No Problem. To me, a normal occlusion is any occlusion that allows a patient to function pain free. Although there is a general theme of what constitutes a good occlusion, any occlusion in which the patient can function and their quality of life is not affected by their bite is a good occlusion. And that may not fit into the “norm” of what we have traditionally learned. But generally speaking, a good occlusion is one in which the patient is hitting evenly on many of their teeth; they have bilateral, even contacts when they bite down; and they’re hitting on many of their teeth evenly without any discrepancies or interferences. However, we cannot assume that what works for one patient will work for another. Even a very minor occlusal discrepancy in some people can cause them great discomfort; others may not be bothered at all.
Dodging the Dogmatism. The different occlusal philosophies to which one can subscribe are probably more alike than they are different. The problem with occlusal problems—and their solutions—is that there is sometimes no right answer, or more than one right answer. But we are dentists, and we are trained to do things the correct way and avoid doing them the wrong way. However, we’ve all experienced cases for which the “right” way didn’t work. For this reason, it may behoove dentists to be trained in all of the different occlusion disciplines, because there may be a time, for example, when opening a vertical is appropriate, even if it’s not what a dentist is particularly accustomed to doing.
We hope you enjoy this issue and find that it broadens your understanding of the conflicts and confusion that surround the concept of occlusion in today’s dental practice. We also hope that it enables you to keep a more open mind when treating patients with difficult or complex presentations for whom one approach may not be appropriate or successful. Please send us your feedback to letters@insidedentistry.net. As I emphasize each month, your thoughts, opinions, and reactions motivate us to continually improve our clinical content and coverage of the topics impacting our profession. Thank you for reading and for your continued support.
With warm regards,
Associate Dean for Research
Tufts University School of Dental Medicine
gkugel@aegiscomm.com
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