Understanding occlusion as it relates to the temporomandibular joint--the fourth molar paradigm

In the typical dental office, at least one third of the patients present with indications for an occlusal appliance. Eighty percent of craniomandibular patients observed in general practice can and should be treated by the general practitioner. Unfortunately, because of time constraints in dental school curricula and prevailing controversies concerning occlusion, many dentists lack the skills and confidence necessary to provide these services. In this article, the authors use the Fourth Molar Paradigm and the Dental Joystick Paradigm to facilitate an understanding of how occlusion relates to the temporomandibular joint and craniomandibular disorders. This knowledge is necessary to correctly interpret temporomandibular radiographs, diagnose and treat craniomandibular disorders, and plan and execute any dental therapy that alters the mandibular position. In addition, in the absence of scientific research to confirm or disqualify the Occlusion Hypothesis, which states that malocclusion is a risk factor for craniomandibular disorders, the authors offer the stated paradigms to support the Occlusion Hypothesis.