THE EDITOR'S CORNER
An interesting report appeared in the October, 1981 issue of the ADA journal. In an article entitled "Mandibular position and upper body strength", a group at the University of Pennsylvania Hospital attempted to submit to a scientific experiment the idea that has received attention in the public press and adherence in certain holistic health circles that a mandibular splint will, among other things, increase the upper body strength of athletes. The investigators found no significant difference in machine-tested shoulder adduction strength with a mandibular splint with occlusal coverage, with a "placebo" splint with no occlusal coverage, or with no splint at all. They conclude that it is likely that "reports of increased strength are related to a placebo effect, rather than to the direct result of the appliance" They also point to a study by Laskin and Green, which demonstrated a 40% remission of myofascial pain in patients who wore a placebo splint.
The investigators call the splint with no occlusal coverage a "placebo" splint, but pains were taken in the experiment to eliminate the placebo effect by keeping the subjects in the dark about the nature of the test. Thus, they were testing just the difference among the three test conditions and found none. Now, the delicious part of all this is that both the scientific and the holistic adherents denigrate the placebo effect, which may be the better part of the effectiveness of a very large percentage of many cures. The holistic people would rather believe that the adjustment of the position of the mandible is responsible for numerous effects. The scientists would prefer to believe and to prove that it does not. Yet, the holistic people may be correct that the appliance is effective, when the placebo effect is allowed to come into play, incorrect in attributing the effect to positioning of the mandible by the appliance. The scientific people may be correct that it is not the repositioning by the appliance and incorrect in eliminating the placebo effect.
Scientists have been using the placebo for so long to validate the "real" effects of a procedure or medication, that they have negative thoughts about placebo. Yet, the lowly placebo probably is holistic medicine. The holistic people involved in that aspect of kinesiology that uses adductor muscle strength testing and which believes that it shows the positive effect of splint positioning of the mandible still are hung up on the cause and effect relationship of scientific experimentation and also reject the lowly placebo.
It would have been instructive if the U. of P. investigators had used a fourth group to validate the extent of the placebo effect, merely by emphasizing with that group what the appliance was expected to do; and that could have been done with appliances of both designs. It might also have been supplemented with just clenching with no appliance in place.
Athletes have been using a variety of psychological and physiological devices for ages to prepare for an athletic performance. The explosive grunts of a Jimmy Connors and the elaborate ritual of weightlifters come to mind. Something is going on internally. In my own case it was a very. deep yawn before getting down to the starting blocks. There is so much of those kinds of preparation involved in upgrading the confidence of an athlete that he is ready to perform, that it is really no miracle that a device that he believes will improve his strength to lift weights, to wrestle, to hit a ball will "work" And if it works, the athlete could not care less why it works; and it is left to others to interpret or misinterpret the reason.
Doctors feel guilty about using a placebo, because they think they are fooling somebody. They ought rather to feel that they are awakening the patient's own body medicine with one of the most powerful medical tools--the placebo effect. There undoubtedly have been numerous studies of the placebo effect and many may show that the effect is not sustained. This is a problem when one uses the effect for a serious medical problem, such as MFPD, as compared with preparing an athlete for competition. It is a problem if the placebo effect is stimulated in a variety of ways in palliation of problems for which a more substantial and lasting corrective procedure is available.
This discussion of "Mandibular position and upper body strength" should in no way be construed as an argument against the scientific method. In the end, even placebo effects will be evaluated by a scientific method. However, it is interesting to ponder that it is possible for both sides to a question to miss the essential point in their zeal to use science or intuition to prove a point; and the lowly placebo will continue to do what it has done for centuries in fulfillment of its Latin derivation--"I shall please"
