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Response to Letter to the Editor, “Impact of Overloading on Temporomandibular Joint Osteoarthritis”

We appreciate the letter to the editor from Drs. Galvão-Moreira and Branco-de-Almeida (2016) in response to our review entitled “Current Understanding of Pathogenesis and Treatment of TMJ Osteoarthritis” (Wang et al. 2015). We asserted in this review that the majority of temporomandibular joint osteoarthritis (TMJOA) is difficult to attribute to overload, although we also discussed experimentally excessive mechanical stress as a possible cause of TMJOA. We acknowledge that our assertion is primarily based on clinical experience and the interpretation of the existing literature. Therefore, given the current knowledge base, we had to make some interpretations of the evidence. Here, we would like to give the reasons for our assertions: First, according to our clinical experience and the literature, TMJOA is more frequently seen in females aged 20 to 40 y than in males and more in urban than in rural areas. Females or urban people usually consume less hard and tough foods and generally experience less joint overload (Palinkas et al. 2010). Second, it remains inconclusive whether a higher prevalence of temporomandibular joint disorder (including TMJOA) correlates with factors indicating joint overload, such as bruxism, impaired occlusion, or dental attrition (Pullinger and Seligman 1993; Magnusson et al. 2012). Third, and most important, the exaggerated occlusal interference or maximal mouth opening in animal models (Ikeda et al. 2014) still does not adequately mimic the clinical condition of TMJOA patients. The etiology of TMJOA is multifactorial. We thank Drs. Galvão-Moreira and Branco-de-Almeida for emphasizing the influence of overload on TMJOA pathophysiology. The role of overload in TMJOA remains to be further investigated, especially from a clinical standpoint.