Dr. David Hornbrook interviews Dr. Peter Dawson...
Otto A Horger_Jr
Otto A. Horger Jr.
Re-posted: On 03-09-01
The diverse and/or varying dental-occlusion
concept-(diagnostic/treatment)-models with their many
(clinically/technologically) associated application complexities have had
collective-dentistry embroiled in
an ongoing, yet unresolved TMJ, TMD, and TMJ-D muscular-pain related quandary.
oah...@my-deja.com
~~~~~~~~
Original posting from: "Otto A. Horger Jr." <oa...@my-deja.com>
Subject: -- Re: Nothing more to do about that
Date: Wed, 19 Jul 2000 05:54:21 GMT
=======================================================
On 7-19-2000
From original posting:
Re-posted with edit: oah_jr
Dr. David Hornbrook interviewed Dr. Peter Dawson
There are many false assumptions concerning these TMJ/ TMD, Occlusion related
issues, held by some Usenet contributors.
In addition, many Usenet flame-war relatable incidences that had occurred in the
past had a logical association.
I believe the often less than civil exchanges that had occurred had been,
brought into play because of these false assumptions and/or positional stances
on various sides of the arguments.
Organized Dentistry carries much of the blame as well, for its inadvertent
oversight of a very real occlusion based problem that is, only-now--once
again--being-recognized more comprehensively.
(See below for some major points to consider in this current, most relevant
on-topic big picture overview.)
In the July/August 2000 issue of the "Dental Practice Report" in the Clinical
Management, section the following article had been, published.
~~~~~~~~~~~~~~~~
Dr. David Hornbrook interviews Dr. Peter Dawson
"Occlusal forces: Confronting the Controversy"
Page 41
Hornbrook:
"Until recently, the average clinician population has largely ignored occlusion
and its related studies.
The reason: Dental schools traditionally have not provided much training to
doctors on the subject, and
what training they did provide was often times difficult to understand and
appeared irrelevant to restorative
dentistry.
Even today, for many restorative dentists, checking occlusion often involves
little more than asking patients how their bite feels and making adjustments to
balance out the occlusal scheme in intercuspal position. Other doctors may go a
step further in ensuring the presence of anterior and canine disclusion during
laterotrusive movements."
Cut…
Hornbrook:
"Many doctors have become concerned about the development of occlusal schemes
that will ensure long-term
predictability and function of newly placed restorations. They want to
understand why and how things work to
ensure these restorations last. Educational facilities that have traditionally
focused solely on teaching clinical technique in esthetics procedures have
responded to this need by including occlusion-related topics and programs
as part of their curriculum."
"As with most areas of dentistry, there are many schools of thought and
philosophies on the teaching of occlusion. Although the ultimate measure is
clinical success, we must adhere to certain fundamental principals as we plan
cases. These principals are based on more than 40 years of clinical and
scientific research and experience
and have established an excellent baseline for the further evolution of the
concepts of occlusion as they pertain
to the placement of conservative, bonded restorative dentistry."
"As the leaders and mentors of these topics are reviewed, few would argue the
tremendous contributions that Dr. Peter Dawson has shared with us. He has
written many articles and the textbook that has become the standard reference
for many universities and other leaders in dentistry. With this in mind, I have
asked Peter to comment on some of the principals that are being discussed today
and how their importance can affect the way we should be practicing."
Cut…
Hornbrook:
"This is the very best time to be a dentist; dentistry offers us so much more
than at any other time in history.
Esthetics has driven many changes, including dentinal adhesion, improved
materials and techniques and superior overall dentistry. The fact that it has
played a significant role in increasing the desire of so many clinicians to
better understand function is just one more feather in the cap."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"A conversation with… Dr. Peter Dawson"
Page 42
Hornbrook:
"Clinical debates have been raging of late about occlusion and how it relates to
TMD and esthetics.
Controversy also has been swirling around various diagnostic and occlusion
adjustment techniques
being espoused by various lecturers. In all of these discussions, research has
been cited to support
the various authors' positions. So how does one make sense of it all? To help
shed some light on the
issue, Dr. David Homebrook, our clinical editor, spoke at length with one of the
pioneers in occlusion
research, Dr. Peter Dawson. In this interview, Dr. Dawson discusses research
findings on how the jaws
work, the role proper occlusion plays in solving some types of oro-facial pain
and its significance
in case-planning for esthetic outcomes."
~~~~~~~~~~~~~~~~
Hornbrook:
"Many articles have been written claiming that occlusion is not a factor in
temporomandibular
dysfunction (TMD) and warning dentists to avoid alteration of occlusion. Could
you give us your
viewpoint on this statement?
"Dawson:
First of all, the popular concept that occlusion is not a factor in TMD is based
on some extremely invalid articles in the literature that break all the rules of
evidence-based dentistry. The first rule of evidence- based research is that
you must clearly define the disorder you are studying, and many of the articles
are based on research that has not defined a specific type of TMD. TMD is not a
disorder, nor is it a multifactorial disorder. It comprises many different
disorders, each of which may be multifactorial. Therefore, in relating
occlusion to TMD, if you don’t specifically clarify the disorder, the research
is not valid."
~~~~~~
Hornbrook:
"I know you're a proponent of rebuilding the dentition in (CR). You seem to
place a great deal of importance on CR.
How do you respond to statements that jaws don't work on hinges or hinge axes
and that CR is not physiologic?"
"Dawson:
The concept that jaws don't work on hinges is absurd. Of course jaws work on
hinges. Anyone who would make a statement to the contrary has never done a
kinematic hinge axis recording, which not only can show
the jaw working on a hinge, but can determine the precise location of that
hinge--- it runs through the medial poles of both condyles. If we don't record
the hinge, we can't correctly alter vertical dimension on any type of
instrument,
so it's extremely important that the correct axis of condylar rotation is
located along with a centric relation bite record.
Those who support the concept that centric relation is not physiologic also fail
to consider that coordinated musculature will routinely position the condyles
into centric relation in the absence of occlusal interferences.
Even in the presence of occlusal interference the jaw still repeatedly goes into
relation as is evident by the fact
that the facets of wear always go to that position. If the Jaw didn't function
in centric relation, the facets of wear wouldn’t be worn to that point."
~~~~~~
Hornbrook:
"Obviously you place a great deal of importance on centric relation and have
advocated determination of a precisely accurate centric relation. Yet, some
clinicians claim that few dentists can master this technique because it is
difficult and, furthermore, that centric relation is not a repeatable position
anyway. How do you respond to these claims?
~~~~~~
"Dawson:
It's a mistake to base the importance of centric relation on misconceptions
about who can master the technique. It is not that difficult to learn.
Cut…
~~~~~~~
Hornbrook:
"As I review the literature, I see that there have been several definitions of
centric relation over the past several decades. What is the difference between
these definitions? How has the evolution ended with what you are teaching now?"
"Dawson:
Originally centric relation was defined as the most retruded that was pretty
well accepted as the standard
definition for years. Many years ago, I started to promote the concept that
centric relation was the most superior position of the properly aligned
condyle-disc assemblies against the eminentia. There was much blood on the
walls over trying to change the old "most retruded" definition, however.
About 30 years ago, a group of 40 nationally recognized clinicians met in Las
Vegas to see what we could do about clarifying the definition of centric
relation. We met and debated centric relation until the wee hours of the
morning. By the end of the meeting, the group reached unanimous agreement that
the definition should be changed, and it has been in the glossary of
prosthodontic terms ever since that time. No one who understands centric
relation reefers to it as the most "retruded position" any more."
Cut…
~~~~~~
Hornbrook:
"As I mentioned earlier, occlusion is becoming a hot topic, especially in terms
of restorative dentistry because we
want these restorations to last many years. What do you see occurring in dental
education regarding occlusion and functional principles?
"Dawson:
I've been appalled at how little graduating dentists understand about occlusion
or the temporomandibular joint. I think that dentists today should be trained
as physicians of the total masticatory system. Unless they understand the
physiology and biomechanics of jaw movement, or the effect that the harmony of
the total system has on the masticatory musculature, they can never understand
occlusion properly. My hope is that dental educators
will start teaching more occlusion and graduating students who not only have an
understanding of occlusion, but who also have developed skills in refining
occlusion. Until they do, we're going to continue to see fringe-type approaches
aimed at solving problems that are diagnosable and predictably correctable by
knowledgeable clinicians.
we also might see a more sensible approach to diagnosing oro-facial pain wherein
we find solutions rather than blame everything on the psychological condition of
the patient. These disorders are invariably related in some way to structural
disorders that commonly produce signs as well as symptoms. Dentists should be
trained to know the difference."
~~~~~~~
Hornbrook:
"Is there anything else you want to add?"
"Dawson:
There currently is a great deal of divisiveness in the field of occlusion and
oro-facial pain. Charges and countercharges are being hurdled. I'd really like
to see dentistry rise above that. That way we can talk very specifically about
our differences of opinion without the feeling that we're questioning somebody
else's parentage.
The rules of evidence- based dentistry are going to eliminate much of the hype
and get down to factual statements that are better researched. There's a great
deal to be done, but I'm optimistic about the direction I see things going."
End…
Cut the rest…
"Ignorance is bliss"
Silent awareness is hell!
Voiced or expressed awareness, at least is, therapeutic.
oah...@my-deja.com
Otto A Horger_Jr
ema...@dictionaryhill.com
Sabra
Otto A Horger_Jr
<3aa96a63...@news.dictionaryhill.com>, ema...@dictionaryhill.com stated...
>
>Welcome back, Otto, with thoughts of you and your family.
>
>Sabra
Hi Sabra,
Thank you, for the welcome back and your kind thoughts, although sadly for us,
after the loss of our dear dad and cherished grandfather, we all will miss him.
------------------------------------ Dr. Otto A. Horger *1912 B +2001 USA
Sincerely,
Otto
Posted on: 03-10-2001
Otto A Horger_Jr
<3aa96a63...@news.dictionaryhill.com>, ema...@dictionaryhill.com stated...
>
>Welcome back, Otto, with thoughts of you and your family.
>
>Sabra
ema...@dictionaryhill.com
wrote:
>On Fri, 09 Mar 2001 23:42:59 GMT, in article
Dear Otto,
Please accept our deepest sympathy for the sad loss of your loving
father and the children's grandfather. I know how much you will be
missing someone you held so dear. I also know that you were a
wonderful son to him... and I hope this helps to ease some of your
pain...
With gratefulness to the internet for having made our friendship
possible,
Sabra and family
Otto A Horger_Jr
<3aaa977b...@news.dictionaryhill.com>, ema...@dictionaryhill.com
stated...
Dear Sabra,
Thank you for your supportive words and thoughts.
You are a true mensch and your friendship is very much, appreciated.
Otto
On 03-11-2001
=============