Occlusion – Controversies

The Truth About Occlusion 
Gene D. McCoy, D.D.S.   Download 528Kb

A commentary on the controversies regarding dentistry’s most important subject. 
Everyone agrees that a good understanding of occlusion is essential to ensure optimum dental health. Unfortunately, that seems to be the only point of consensus for this ambiguous subject. One cannot read a text or take a course on occlusion and walk away with an understanding of how the design of teeth and the way they touch each other affect the efficiency and function of the stomatognathic system. Consequently, there are many unanswered questions: primarily, the role that occlusion plays in the etiology of temporomandibular disorders (TMDs) and oral facial pain. The confusion is evident when we hear phrases such as “no one occlusal scheme will serve all patients” and questions like “which concept on occlusion is correct?” We are led to believe that, as general practitioners (GPs), we do not have the expertise to manage problems associated with this subject and are solicited to take specialized postgraduate courses at the Las Vegas Institute (LVI) or the Pankey Institute. However, each of these courses is costly in both tuition (at least $15,000) and time away from the offi ce (2–3 weeks), plus there is the cost of expensive instrumentation. 
Patients of dentists who follow such a stylized form of occlusal rehabilitation now have to share in the expense of the learning program, which limits treatment to the affl uent. What about the patients who cannot afford it? Most people have little or no dental restorative work done each year. Whether the reason is fi nancial, lack of accessibility, fear, or indifference, that’s the way it is. Those who do frequent their dentists on a regular basis usually restrict their work to limitations set by their insurance. Subsequent work has to wait until next year. 
Considering the circumstances, how can the GP take care of occlusal-related problems in a cost-effective way that will benefit patients with limited resources? In order to answer this question, we truly need to understand occlusion, and that is the problem. As it is being taught today, occlusion is incoherent. Taylor explains that, “due to the empirical nature of the literature, the study of occlusion has been extremely complex and troublesome to both pre- and post-doctoral students.”1 Simon likens searching for the truth in occlusion to Alice looking for the right path in Wonderland2 There are so many diverse opinions regarding this subject that it is not uncommon to witness discord among colleagues at professional meetings. So, what is the truth? http://toothcrunch.com/app/download/1676893404/THE_TRUTH_ABOUT_OCCLUSION.pdf

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