Sir, I write to respond to Dr Marks' letter (BDJ 2005, 198: 351). We are indeed privileged to be working in a profession that can make a real difference to the quality of our patients' lives. Dr Marks' letter is an enlightening one and it is indeed his patient's good fortune that he recognised the importance of muscle dysfunction in chronic head, neck and facial pain.
Whilst it has been shown that contact of the anterior teeth (and perioral tissues) may 'shut down' strong muscle activity of masseter and temporalis1,2 the therapeutic goal of any treatment regimen is to return the body to an optimal (and stable) state of comfort and function.3 In this case harmony between muscles, joint and posture (as the teeth are but innocent bystanders).
The interested practitioner is encouraged to review the scientific and objective recording of centric relation (CR)4,5 and also the importance of head posture.6 The jaw joint plays more of a supportive role usually7,8,9 and internal derangements and their significance were being discussed in The Lancet 150 years ago.9
Dentistry owes a great debt to the pioneers of the mechanically based gnathological principles and theories. In this millennium we need to move on from this excellent historical foundation and I believe it is vital to pursue a 'scientific basis' to its approach via anatomy and physiology in order to serve our profession and patients best in the future.10
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Bray, S. Scientific basis. Br Dent J 198, 698 (2005). https://doi.org/10.1038/sj.bdj.4812445
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DOI: https://doi.org/10.1038/sj.bdj.4812445
