John W. Stockstill

Survey of orthodontic residency programs: Teaching about occlusion, temporomandibular joints, and temporomandibular disorders in postgraduate curricula

INTRODUCTION Teaching orthodontic postgraduate students about occlusion and the temporomandibular joint is a fundamental component of their education, but faculty members are confronted with disputes and controversies about these topics. The purpose of this study was to ascertain where the orthodontic teaching community currently stands on the topics of occlusion, temporomandibular joint, and temporomandibular disorder. METHODS A 46-question survey was sent to every orthodontic program director in the United States and Canada (n = 69). Responses were submitted by 46, and the results were tabulated. RESULTS Three interrelated topics (normal or ideal temporomandibular joint, normal or ideal occlusion, and management of temporomandibular disorder) are being taught in diverse ways in these postgraduate orthodontic programs. CONCLUSIONS The results of this survey will help us to understand and improve how these topics are being taught at accredited orthodontic programs in the United States and Canada. Perhaps a standardized curriculum can be developed.

Orthodontics and temporomandibular disorders: A curriculum proposal for postgraduate programs

In a previous article, we reported the results of a survey of American and Canadian orthodontic postgraduate programs to determine how the topics of occlusion, temporomandibular joint, and temporomandibular disorders were currently being taught. Based on the finding of considerable diversity among those programs, we decided to write a curriculum proposal for temporomandibular disorders that would be compatible with and satisfy the current curriculum guidelines for postgraduate orthodontic programs. These guidelines arose from a combination of the requirements published by the American Dental Associations Commission on Dental Accreditation and the written guide (July 2010) of the American Board of Orthodontics for the its clinical examination. The proposed curriculum, based on the latest scientific evidence in the temporomandibular disorder field, gives program directors a template for covering these subjects thoroughly. At the same time, they can focus on related orthodontic issues, so that their future graduates will be prepared to deal with patients who either have or later develop temporomandibular disorder problems.

Management of TMD Signs and Symptoms in the Orthodontic Practice

Like all other dentists, orthodontists are likely to encounter some patients with TMD signs and symptoms in their practices that require some form of professional treatment. These patients may come into their office as referrals from other dentists, or they may develop TMD problems while under the orthodontist’s care. While some benign TMD signs and symptoms may be present in new patients, or may arise in patients under treatment, not all of these need to be treated (see Chap. 3). However, as discussed in Chap. 2, there are a number of significant TMD conditions that need to be properly diagnosed and appropriately treated.

Static and Functional Anatomy of the Human Masticatory System

In accordance with the primary intent of this book, part one of this chapter will address the basic and common occlusal concepts and terminology used in dental practice in general, and orthodontic practice in particular. Because so much of the controversy about temporomandibular disorders (TMDs) revolves around these occlusal concepts, the authors will address those relationships wherever appropriate. This also will set up the framework for similar discussions in other chapters throughout this book. Due to the many controversies and “philosophical” explanations reported in the literature regarding occlusal concepts, our intent will be to enlighten the reader rather than to argue about belief systems. Evidence-based explanations and definitions will be offered rather than teleological explanations, and the emphasis will be on physiology rather than philosophy.