Do people need occlusal stop distal to the first molars?
Yes they do!
I have been creating bites and adjusting occlusion for 43 years and my opinion is that occlusal stops are necessary in the region of the 2nd molars.
Today I say a patient for her annual recall visit. At night time she wears a maxillary Hawley retainer with bite blocks distal to the first molars to replace the missing 2nd molars. She also wears a mandibular primary TMJ splint. This set up serves her well since I completed her orthodontic treatment 8 years ago and there are no TMJ symptoms even though she still bruxes her teeth. I know that she is still bruxing because her Masseter muscles are as hard as the table I working at.
Another situation to illustrate the need of an occlusal stop distal to the first molars is a patient I saw with a unilateral TMJ problem. There was clicking and jaw pain only on the left side. The lower left second molar was missing. I inserted an upper and lower TMJ splint system with a bite block in the lower splint in the region of the missing second molar. Of course the problem went away immediately.
Although these two stories are anecdotal and not evidence based with statistical data, I feel that this perspective has served me and my patients well over the past decades.
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