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QUESTIONING CHIROPRACTICS
COMMENTARIES
not go away. We dentists need to educate patients about the value of oral preventive and treatment procedures to make these procedures more desirable to them. Dentists should accomplish less aggressive treatment and fewer restorations. I agree, but with some educated reservations. How long do you wait before restoring an initial carious lesion? Can you actually see an initial interproximal lesion by using the low-radiation images of today? Most say you cannot see initial lesions on current digital or analog radiographs. When do you restore a tooth with a crown instead of an intracoronal restoration? My article attempted to answer that question. I would certainly prefer to have a conservative direct restoration in my mouth than to have most of the enamel removed from my teeth for a crown, but so many variables are present that a simple answer cannot satisfy the question. Crowns are a mainstay of restorative dentistry, and each practitioner must decide on his or her own requirements as to when a crown, an intracoronal restoration or no restoration at all is indicated. Gordon J. Christensen, DDS, MSD, PhD Director Practical Clinical Courses and Chief Executive Officer and Cofounder Clinicians Report and Diplomate American Board of Prosthodontics Provo, Utah
QUESTIONING CHIROPRACTICS
Dr. James DeVocht and colleagues’ October JADA article, “A Pilot Study of a Chiropractic Intervention for Management of Chronic Myofascial Temporomandibular Disorder” (JADA 2013;144[10]:1154-1163), is nonsense. After reading the article and noting the bibliography, it is “garbage in, garbage out.” Chiropractors evaluating patients with temporomandibular joint disorder?
Without citing Pankey or Dawson? When a reputable scientific journal like JADA starts including pap from a chiropractic school, with junk citations to support what we all know is quackery, the editorial board needs a makeover in science-based dentistry and the scientific method. These people wouldn’t know a pterygoid from a pterodactyl. I’m disappointed and ashamed for my profession. Carl John DiGregorio, DDS Milford, Mass.
is a chiropractic treatment using a small hand-held spring-loaded device that delivers a small impulse to the spine.5 The aim is to move, but not injure, the vertebrae. This requires the patient to lie in a prone position so the chiropractor can compare leg lengths. Does the ADA really believe that temporomandibular disorder diagnosis by leg-length measurement and treatment by pushing on the spinal vertebrae are legitimate techniques even to be investigated in a pilot study?
MORE ABOUT CHIROPRACTICS
I was surprised and disappointed at the publication of Dr. James DeVocht and colleagues’ October JADA article, “A Pilot Study of a Chiropractic Intervention for Management of Chronic Myofascial Temporomandibular Disorder” (JADA 2013;144[10]:1154-1163). The article ignores the American Dental Association’s evidence-based dentistry guidelines in that chiropractic is not only scientifically unsupported, but it violates basic biological principles.1 Specifically, chiropractic alleges that there is an “innate intelligence” that flows through the body’s nerves, and its interruption is the cause of all disease and dysfunction. Chiropractors believe that they can manipulate the spinal cord to release those “blockages” and thereby restore health.2 Several studies by Dr. Edgar Crelin (deceased), professor of anatomy and chairman of the Human Growth and Development Study Unit at the Yale University School of Medicine, have shown that “the subluxation of a vertebra as defined by chiropractic … does not occur.”3 In a subsequent study, Johnson and colleagues4 dissected 15 freshly obtained cervical spines and concluded that the ligaments that held them in place would not permit a range of motion that would cause impingement of the cord or spinal nerves and for impingements to occur, ligaments would have to be ripped apart and bones broken. In addition, the activator method
JADA 145(2)
John E. Dodes, DDS Forest Hills, N.Y. 1. American Dental Association. About EBD. http://ebd.ada.org/about.aspx/. Accessed Jan. 3, 2014. 2. Zwicky JF. Reader’s Guide to Alternative Health Methods. Milwaukee: American Medical Association; 1993:47. 3. Crelin ES. A scientific test of the chiropractic theory. Am Sci 1973;61(5):574-580. 4. Johnson RM, Crelin ES, White AA 3rd, Panjabi MM, Southwick WO. Some observations on the functional anatomy of the lower cervical spine. Clin Orthop Relat Res 1975;(111):192-200. 5. Fuhr AW, Menke JM. Status of activator methods chiropractic technique, theory, and practice. J Manipulative Physiol Ther 2005;28(2):e1-e20.
Response from the JADA Editor and the Associate Editor, Research: The rationale for publication of this article is that it helps inform both the general dental readership of JADA and temporomandibular disorder (TMD) researchers that undertaking a clinical trial of TMD is not a trivial matter and that pilot studies such as this are needed to inform the design of more definitive studies. Specifically, it will be clear to readers of this article that a substantial number of participants must be screened for such studies, that careful consideration must be given to specifying a clinically meaningful outcome, that the trial must have a sufficiently large sample size with acceptable statistical power to detect treatment differences, and that relatively small studies are not only unlikely to find any clinically meaningful differences but also are not generalizable to the overall population of patients with TMD. Regarding concerns that the “ac-
http://jada.ada.org
February 2014
127
not go away. We dentists need to educate patients about the value of oral preventive and treatment procedures to make these procedures more desirable to them. Dentists should accomplish less aggressive treatment and fewer restorations. I agree, but with some educated reservations. How long do you wait before restoring an initial carious lesion? Can you actually see an initial interproximal lesion by using the low-radiation images of today? Most say you cannot see initial lesions on current digital or analog radiographs. When do you restore a tooth with a crown instead of an intracoronal restoration? My article attempted to answer that question. I would certainly prefer to have a conservative direct restoration in my mouth than to have most of the enamel removed from my teeth for a crown, but so many variables are present that a simple answer cannot satisfy the question. Crowns are a mainstay of restorative dentistry, and each practitioner must decide on his or her own requirements as to when a crown, an intracoronal restoration or no restoration at all is indicated. Gordon J. Christensen, DDS, MSD, PhD Director Practical Clinical Courses and Chief Executive Officer and Cofounder Clinicians Report and Diplomate American Board of Prosthodontics Provo, Utah
QUESTIONING CHIROPRACTICS
Dr. James DeVocht and colleagues’ October JADA article, “A Pilot Study of a Chiropractic Intervention for Management of Chronic Myofascial Temporomandibular Disorder” (JADA 2013;144[10]:1154-1163), is nonsense. After reading the article and noting the bibliography, it is “garbage in, garbage out.” Chiropractors evaluating patients with temporomandibular joint disorder?
Without citing Pankey or Dawson? When a reputable scientific journal like JADA starts including pap from a chiropractic school, with junk citations to support what we all know is quackery, the editorial board needs a makeover in science-based dentistry and the scientific method. These people wouldn’t know a pterygoid from a pterodactyl. I’m disappointed and ashamed for my profession. Carl John DiGregorio, DDS Milford, Mass.
is a chiropractic treatment using a small hand-held spring-loaded device that delivers a small impulse to the spine.5 The aim is to move, but not injure, the vertebrae. This requires the patient to lie in a prone position so the chiropractor can compare leg lengths. Does the ADA really believe that temporomandibular disorder diagnosis by leg-length measurement and treatment by pushing on the spinal vertebrae are legitimate techniques even to be investigated in a pilot study?
MORE ABOUT CHIROPRACTICS
I was surprised and disappointed at the publication of Dr. James DeVocht and colleagues’ October JADA article, “A Pilot Study of a Chiropractic Intervention for Management of Chronic Myofascial Temporomandibular Disorder” (JADA 2013;144[10]:1154-1163). The article ignores the American Dental Association’s evidence-based dentistry guidelines in that chiropractic is not only scientifically unsupported, but it violates basic biological principles.1 Specifically, chiropractic alleges that there is an “innate intelligence” that flows through the body’s nerves, and its interruption is the cause of all disease and dysfunction. Chiropractors believe that they can manipulate the spinal cord to release those “blockages” and thereby restore health.2 Several studies by Dr. Edgar Crelin (deceased), professor of anatomy and chairman of the Human Growth and Development Study Unit at the Yale University School of Medicine, have shown that “the subluxation of a vertebra as defined by chiropractic … does not occur.”3 In a subsequent study, Johnson and colleagues4 dissected 15 freshly obtained cervical spines and concluded that the ligaments that held them in place would not permit a range of motion that would cause impingement of the cord or spinal nerves and for impingements to occur, ligaments would have to be ripped apart and bones broken. In addition, the activator method
JADA 145(2)
John E. Dodes, DDS Forest Hills, N.Y. 1. American Dental Association. About EBD. http://ebd.ada.org/about.aspx/. Accessed Jan. 3, 2014. 2. Zwicky JF. Reader’s Guide to Alternative Health Methods. Milwaukee: American Medical Association; 1993:47. 3. Crelin ES. A scientific test of the chiropractic theory. Am Sci 1973;61(5):574-580. 4. Johnson RM, Crelin ES, White AA 3rd, Panjabi MM, Southwick WO. Some observations on the functional anatomy of the lower cervical spine. Clin Orthop Relat Res 1975;(111):192-200. 5. Fuhr AW, Menke JM. Status of activator methods chiropractic technique, theory, and practice. J Manipulative Physiol Ther 2005;28(2):e1-e20.
Response from the JADA Editor and the Associate Editor, Research: The rationale for publication of this article is that it helps inform both the general dental readership of JADA and temporomandibular disorder (TMD) researchers that undertaking a clinical trial of TMD is not a trivial matter and that pilot studies such as this are needed to inform the design of more definitive studies. Specifically, it will be clear to readers of this article that a substantial number of participants must be screened for such studies, that careful consideration must be given to specifying a clinically meaningful outcome, that the trial must have a sufficiently large sample size with acceptable statistical power to detect treatment differences, and that relatively small studies are not only unlikely to find any clinically meaningful differences but also are not generalizable to the overall population of patients with TMD. Regarding concerns that the “ac-
http://jada.ada.org
February 2014
127