This is the first in a five-part series about intellectual debate in dentistry.
By Susan Richards
Since the advent of modern dentistry in the 18th century, there has been a steady patter of lively debate covering all aspects of the practice. From rudimentary extractions to high-tech lasers, this business has always fielded new techniques and theories to explore, embrace, debate, or discard.
The arena for potentially heated discussions has also evolved over the centuries, traveling from village taverns to peer journals, to the strident pages of social media.
One of the most prominent and often contentious of these intellectual battles was the debate over occlusion in general, and centric relation, more specifically. The – ahem – stellar shorthand was known by many dentists as “Jaw Wars.” While most professionals acknowledge the importance of good occlusion as a conduit to oral and even physiological health, there is so much disagreement about the diagnosis and treatment that many practitioners omit addressing it from their practice.
Muscle vs. Bone
Occlusion is simply the relationship between the maxillary and mandibular teeth when they approach each other, either while chewing or at rest. However, everyone tends to choose a side when determining who’s in charge of that relationship – the muscles in the jaw, or the bones themselves. (Some research has even thrown in posture as a contributing factor, but without nearly as much traction.1)
Neuromuscular dentistry, which approaches all the components of teeth, muscles (associated nerves), and joints as an interdependent unit, still remains a controversial topic in dentistry – although no one argues the impact of joints and muscles on occlusion.
The area that sparked the most debate during the occlusion wars, was the concept of centric relation (CR). Initiated in the prosthodontic field, it defined the search for a reproducible mandibular position for rehabilitation. Research in CR for the past century has resulted in dozens of definitions since the term was first developed, which only added to the controversy. In some circles, the philosophies became more political than scientific, furthering the gap.
Some doctors believe that occlusion is more of a gray area, a dynamic state that changes from day to day. One prosthodontist, in practice for many years, cites some of the many conditions that can alter tooth movement, and thus occlusion, including extraction without restorative dentistry, dental wear based on materials used, carious lesions, and more.2
When examining occlusal design with relevance to these varying conditions, as well as muscle fatigue, posterior wear, or temporomandibular dysfunction (TMD), dentists may come to their own conclusions, and they might differ.
The ever-constant evolution of education and technology in our field, which can include corporate third-party influences, will probably keep the occlusion debates in steady rotation in Facebook groups, if not the pages of industry journals.
Is there a winner? Definitely. When dentists are pushed out of their comfort zone of one belief or the other, and they’re open to other valid perspectives, it can only benefit them – and ultimately their patients. Because at the end of the day, that’s who we’re fighting for.
Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan’s career includes award-winning feature writing, as well as creating content with context for a wide variety of industries.