Sir, as a member of the British Society for the Study of Occlusion (www.bsos.org.uk) I was interested to read the case study on Temporalis Hypertrophy by S. Rokadiya and N. J. Malden (BDJ 2006; 201: 153–155). Perhaps as a mere GDP with an interest in TMD and occlusion I am missing something, but the facts that the lady claimed to 'bang her teeth together', was in 'a stressful period in her life' and showed painful hypertrophy in one of her muscles of mastication, would seem to point to a very obvious cause and effect? The fabrication of a Lucia Jig anterior deprogrammer would be an easy, non-invasive and inexpensive way to test this hypothesis as if this gave relief to her symptoms it would point to an occlusal cause for them. The Michigan splint provided later in this lady's treatment provided 'almost immediate reduction in pain as well as reduction in the prominence of her temporalis muscles'. The article does not say if this splint was fabricated using a face bow and leaf gauge deprogrammer and if the appliance was adjusted to centric relation so as to give correct posterior discussion in function and readjusted over time as the muscle spasm subsided. Nor does it say for how long it was worn, each day or in total.

I have seen many times with my own patients that their symptoms can be relieved by regularly wearing a Jig or correctly adjusted appliance, leading to final equilibration of their teeth, which is a much less expensive and invasive option than embarking on extensive investigations and treatment modalities such as CT scans, long term medication or surgery. Obviously if the symptoms are not relieved by the provision of a Lucia Jig then further investigation can be carried out to ascertain the cause of their symptoms. I would urge anyone who is interested in gaining a greater insight into treating such cases to attend the courses run by IPSO (International Partnership for the Study of Occlusion) via www.stockportdentalseminars.com.