Dentaltown January 2017 - 60

fact is that very little is understood about
the physiology of muscle pain, and it is
realized that trigger points are more likely
a central sensitization issue, as opposed to a
true peripheral physiological phenomenon.22

Occlusion vs occluding:
The stipulation of occlusion

Learn more
about occlusion
for CE credits

Dr. Barry Glassman's two-hour
online course gives useful,
common-sense advice and
reviews TMD concepts so
common patient reports of
pain and dysfunction can
be more readily diagnosed
and conservatively treated.
To take the course and earn
2.5 hours of CE credit, visit
dentaltown.com/onlinece and
search for "Occlusion."

60

JANUARY 2017 // dentaltown.com

It may seem, then, that there's an
argument for the hypothesis that there's no
relationship between occlusion and pain.
From a clinical standpoint, this would be
a very difficult argument to make, because
every dentist has adjusted an occlusion and
noted a significant change in a reported pain
pattern. Every dentist has created a high spot
in a restorative technique that led to a patient
complaint that was then resolved with an
occlusal adjustment. The issue, then, isn't if
occlusion matters, but when and how it matters.
Looking specifically at the mechanisms that
cause occlusion to be a factor in pain and
dysfunction becomes the real issue.
As dentists, our education leads us to the
tendency to "stipulate" occlusion: We tend
to think of the maxillary and mandibular
teeth as units that "fit" together. When
given maxillary and mandibular stone
models, the first thing dentists tend do is
put them together and evaluate how they
"fit" in a goal to determine the quality
of the "occlusion." In reality, maximum
intercuspation rarely occurs during function.
There is some form of dental contact on
an average about 20 minutes total in a
2- hour period.23 "Occluding" actually rarely
occurs, as evaluated by articulating models.
Occlusion as noted by articulating models
occurs only in patients when their elevators
go into contraction and stay contracted. This
occurs when we ask a patient to voluntarily
"close," but not commonly in function.
Dentists often check lateral movements on
an articulator as though lateral excursions

occur in function. Again, this is a result of
the stipulation of occlusion being an essential
part of the dental education.
As a result, when thinking about occlusion, we have suggested that we consider
not just the occlusion itself, but when this
"occlusion" occurs. We refer to the noun
of occlusion as becoming a factor when it
becomes the verb of occluding. In addition, we
have suggested that maximum intercuspation
is actually, in some ways, pathological.
This concept has often been misinterpreted as though it's being suggested
that occlusion doesn't matter. Of course
it does! What's being proposed is that the
stipulation of occlusion is at the heart of
the empirical science of the 20th century,
and a contributing factor that prevents the
evidenced-based information from becoming
part of the dental knowledge base. This
"stipulation" makes the role of occlusion
and the anecdotal changes we observe
easy to explain, and many of the myths
associated with occlusion are dependent on
such stipulation. Clearly, then, the occlusal
changes can be related to the symptomatic
changes, but the mechanism of that change
needs to be reconsidered.

Why are the old maps followed,
rather than being rewritten?
Alvin Toffler has written: "The illiterate
of the 21st century will not be those who
cannot read and write, but those who cannot
learn, unlearn, and relearn."
It's a generally accepted fact that temporomandibular joint dysfunctions, as well
as nonodontogentic pain patterns, are not
points of emphasis in the undergraduate
dental setting. Without exception, our general
dental residents confirm this. Many of the
"old maps" created the basis for various TMD
philosophies taught by pioneers. These old
maps became the guidelines for the concepts
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Table of Contents for the Digital Edition of Dentaltown January 2017
