Journal of Oral Rehabilitation 2000 27; 367 – 379 Review Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders. Part I. Occlusal interferences and occlusal adjustment J. A. DE BOEVER*, G. E. CARLSSON † & I. J. KLINEBERG ‡ *Department of Fixed Prosthodontics and Periodontology, Facial Pain Unit, University of Gent, Belgium, † Department of Prosthetic Dentistry, Go ¨teborg University, Go ¨teborg, Sweden and ‡ Jaw Function and Orofacial Pain Research, University of Sydney, Westmead, Australia SUMMARY This review, divided into two parts, for the role of occlusion in the aetiology of TMD. evaluates the literature on the relationship be- Experienced clinicians also repudiate the need for occlusal adjustment in the management of TMD, tween dental occlusion and temporomandibular disorders (TMD) and the need for occlusal therapy whereas (less experienced) general dentists adhere in the management of TMD. The first part of the to a concept focusing on the occlusion in diagno- sis and treatment of TMD. There is a consensus review focuses on the aetiological importance of that generalized prophylactic occlusal adjustment occlusal interferences and the place of occlusal ad- is not justified. There is an obvious need for re- justment in the management and prevention of signs and symptoms of TMD. This has long been a search with evidence-based methods, to be able to controversial issue, which has not yet been re- answer the many remaining questions in this field. solved. The literature does not give strong support Introduction Temporomandibular disorders (TMD) are, according to the Guidelines of the American Academy of Orofacial Pain, ‘a collective term embracing a number of clinical problems that involve the masticatory musculature, the temporomandibular joints and associated structures, or both’ (Okeson, 1996). TMD is a cluster of analogue disorders that are characterized by pain and symptoms of dysfunction. Since TMD is no longer considered to be one syndrome with one common aetiology, or as a syndrome with a multifactorial aetiology, the differential diagnosis is of particularly importance. The aetiology of TMD has been considered to be one of the most controversial issues in clinical dentistry. One of the conflicts that has attracted most attention has been the role of occlusal factors in TMD signs and symptoms. Several recent reviews and studies have not found any strong support for an occlusal aetiology (McNamara, Seligman & Okeson, 1995; Okeson, 1996). Nevertheless, a majority of dental practitioners believe that occlusal disturbances can cause or are closely related to TMD, and many therefore also include occlusal adjustment as an initial treatment for TMD, whereas most TMD experts hold opposing views (LeResche et al., 1991; Glaros, Glass & McLaughlin, 1994; Arbree et al., 1995). There is thus a divergence of opinions indicating that this issue de- serves further discussion. However, there are also con- troversies among experts regarding the role of occlusion among the aetiological factors (Alanen & Varrela, 1997; Clark et al., 1997; Kirveskari, 1997; Roth, 1997). It is therefore the purpose of this paper to review the litera- ture on the relationship between occlusion and TMD and to consider recommendations on the need of both occlusal and prosthodontic treatment in TMD manage- ment. © 2000 Blackwell Science Ltd 367