Sir, I write regarding the continuation of an inaccuracy cited in the article Unexplained orofacial pain – is an early diagnosis possible? (BDJ 2008; 205: E6). The article questions evidence of successful resolution of pain symptoms with occlusal adjustment. Cited are literature review papers. These reviews have overlooked published work by Kerstein et al.1,2,3,4,5,6,7 The success of occlusal adjustment is dependent on timing of disclusion and occlusion, not ultimate force. It is the medium used by clinicians, namely articulating paper, that limits success. If a higher degree of precision is delivered, the evidence does suggest a significant success rate can be expected.
Dr Vishal Aggarwal responds: Many thanks for your feedback. My main comment to Mr Holland's letter is that to practise evidence-based dentistry we have to follow a hierarchy of evidence and the strongest evidence is from systematic reviews, particularly Cochrane systematic reviews which pool together the results of high quality randomised controlled trials. Such a review conducted by Koh and Robinson which we have quoted in our paper has shown occlusal adjustments cannot be used in the treatment and prevention of TMD as no evidence was found when all trials investigating this intervention were pooled together. I also believe the GDC looks seriously at cases of occlusal adjustment carried out to treat TMD and practitioners should approach with extreme caution when using such treatments. Rather, non-invasive treatments would be better as they have the potential to provide benefit without resulting in harm. Cognitive behaviour therapy has been shown to be effective as a non-invasive treatment. 9, 10, 11, 12, 13, 14, 15
I would recommend that readers must critique evidence very thoroughly before accepting the results of any studies and the FDGP UK have developed critical appraisal guidelines for this very purpose.
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Holland, D. Work overlooked. Br Dent J 205, 414 (2008). https://doi.org/10.1038/sj.bdj.2008.897
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DOI: https://doi.org/10.1038/sj.bdj.2008.897
