Dear Dr. Tanganeli,
Here are my brief responses to your questions:
1- What’s your opinion about the relationship TMD/occlusion? Something new?
The relationship between occlusion and TMD is complicated. Early on we had the belief that occlusion was the main reason for orofacial pain. With the evidence we now have it is obvious that this is only one factor for us to consider. As dentists we need to understand this relationship since if the patient has a TMD related to the occlusion we are the only healthcare providers who can help the patient, since we are the only profession who change occlusion. On the other hand if the patient has a TMD unrelated to the occlusion, we should not be directing therapy towards changing the occlusion. This is a heavy burden on the shoulders of the dentists because we must decide for our patients. This relationship is not simple and likely has to do with the dynamics of orthopedic stability and acute changes in the occlusal condition. Unfortunately I cannot elaborate on my thoughts in this brief email. If someone would like my opinion on this dynamic relationship, I would refer them to the new 7th edition of my TMD book in where I elaborate on this in a very revised discussion in Chapter 7. This text will be available in April 2012 in English.
2- And about Evidence Based Medicine?
Evidence is the only way we can better understand the diseases and disorders we treat. The better our evidence, the more effective we will be in reducing the suffering of our patients.
3- Some Dentists are afraid that the specialty TMD/OFP will be out of the hands of the Dentistry. What do you think about the future of OFP in Dental practice?
In my opinion dentists will always have a place in managing TMD and orofacial pains. Perhaps not every orofacial pain but the clinician needs to be able to differentially diagnosis the pain condition. I some instances, the dentist will be the primary caretaker, in other instances the dentist may wish to refer the patients to other health care providers. As orofacial pain practitioners better understand all of orofacial pain, we will be playing a bigger role in patient management.
4- What do you expect about Oppera?
OPPERA is a multicenter research project funded by the National Institute of Health (NIH) to better understand risk factors for orofacial pain. Some of the finest researchers in the area of orofacial pain have participated in these studies and I believe they have and will continue to provide a better understanding of orofacial pain. Work such as this leads to a better appreciation for mechanisms, risk factors and eventually new and more effective treatments options.
I hope you find my brief comments interesting.
Best wishes to your Facebook Group.
Jeffrey P Okeson, DMD
Provost’s Distinguished Service Professor
Professor and Chair, Department of Oral Health Science
Director, Orofacial Pain Program
College of Dentistry, University of Kentucky
800 Rose Street
Lexington, Kentucky 40536-0297, USA