Dental Sleep Medicine Insider November DSM Insider | Page 28

BARRY GLASSMAN, DMD TRUTH, MYTH, LORE, & MORE O cclusion is one of the most potentially confusing and con- troversial subjects in dentistry. As a result, the occlusal chang- es that can be associated with oral appliance therapy become confusing and controversial, leading to fear, which tends to prevent treatment, or at least a concern that compromises treatment. Much has been written and taught about the need to main- tain an ideal occlusion in all of dentistry. Creating or estab- lishing an occlusion as close to ideal has been taught as one of the goals of therapy for every patient in every dental school. The goal of ideal occlusal schemes remains standard in dentistry until this very day de- spite the predominance of the literature that makes it clear there is no direct relationship between malocclusion and pain or dysfunction. There has never been any relationship established between Angle’s classification and pain or dys- function, and myths that asso- ciate deep bites with condylar position and joint dysfunction have been debunked. Despite the science of occlu- sion and pain and/or dysfunc- tion and the fact that the vast majority of patients have some form of “malocclusion”, the occlusal myths continue to be taught. It is therefore understandable how disconcerting it would be to a dentist to be respon- sible for a treatment regimen that has the potential to create what would be considered a malocclusion. We know that a percentage of our patients using oral appliance therapy to treat their sleep disturbed breathing may in fact develop, among other possibilities, a posterior open bite. If one isn’t well trained in terms of masti- cation, the inability to bring the posterior teeth together may make it seem as though this would be problematic. Unfor- tunately, not only are dentists taught myths that continue to be propagated about occlusion, but we are not well trained in the masticatory process. The vast majority of patients who develop posterior open bite ex- perience no masticatory com- promise, and are only aware of DR. BARRY GLASSMAN, DMD Barry Glassman maintains a private practice in Allentown, PA, which is limited to chronic pain, temporomandibular joint dysfunction and dental sleep medicine. He is a Diplomate of the Board of the Academy of Dental Sleep Medicine. He is on staff at the Lehigh Valley Hos- pital Sleep Disorder Center. INTERESTED? JOIN ME AT THE NADSM SYMPOSIUM. REGISTER NOW the occlusal changes when the concerned dentist brings it to their attention. An honest, evidenced based look at occlusion will help in the management of the occlu- sal changes with oral appliance therapy and put occlusion in a new perspective in your gen- eral dental practice. This will lead to an appropriate discus- sion of risks and benefits of oral appliance therapy so that the risk/benefit quotient can be accurately discussed with patients to help you work with your patients making intelli- gent well-informed decisions.