I read with interest the article ("Treating Bruxism and Clenching," February JADA) by Dr. Gordon J. Christensen. While Dr. Christensen did emphasize several of the most important therapeutic modalities (for example, splint therapy), there is no mention of the importance of the patient being informed about mandibular rest position (with teeth out of contact, only lips touching) and the use of isokinetic stretching exercises.1
In the mandibular rest position with the teeth slightly out of contact and only the lips touching, it is impossible to contract the masticatory muscle, thus avoiding myalgia or load in the temporomandibular joint with the resulting joint pathology of disk dislocation, synovitis or capsulitis. The patient is told that usually the teeth should only be in contact during chewing and swallowing predominantly.
The isokinetic exercises referred to are based on an article authored by Lewit and Simons.1 The principle involved is maintaining skeletal muscles in a stretched position for an extended period; in the case of masticatory muscles, [that is] 20 seconds for five times or a total of 100 seconds. This greatly relaxes the previously shortened muscle fibers.
With the masticatory muscles being relaxed in this fashion, it is much easier for the patient to use mandibular rest position. These subjects are discussed in detail in an article I authored.2
Based on my practice of 53 years, much of it involving TMD research and treatment, emphasizing the importance of rest position and isokinetic exercises have been invaluable in "controlling bruxism."
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