Date: Wednesday, May 1, 1996
NIH PANEL MAKES RECOMMENDATIONS
An independent panel convened by the National Institutes of Health today recommended a conservative and
reversible approach to treatment for the vast majority of patients with temporomandibular disorders (TMD).
"The absence of reliable scientific data has led to confusion among dentists and physicians regarding when
and how to treat TMD," said panel chair Judith E.N. Albino, Ph.D., President Emerita and Professor of
Psychiatry at the University of Colorado Health Science Center in Denver. "The good news, however, is that
for most people initial TMD pain is not a signal that a serious problem is developing. Only a small percentage
will develop significant, long-term symptoms," she said.
Temporomandibular disorders comprise a group of painful conditions that affect the jaw joint
(temporomandibular joint) and the muscles that control chewing. The panel estimated that more than 10
million Americans have symptoms associated with TMD, which is most often seen in women 20 to 40 years
of age.
TMD treatment falls into two main categories: conservative/reversible and irreversible. Conservative
treatments do not invade the tissues of the face, jaw, or joint. These treatments are as simple as possible and
are used most often because most patients do not have severe, degenerative TMD. Conservative
approaches include self care practices such as eating soft foods, applying heat or ice packs, and avoiding
extreme jaw movements like wide yawning, singing, and gum chewing. Learning special techniques for
relaxing and reducing stress may also help patients deal with pain that often comes with TMD problems.
Other conservative therapies may include education, pain control medication, and physical therapy.
Reversible treatments do not cause permanent changes in the structure or position of the jaw or teeth.
Irreversible treatments for TMD, which include surgical procedures, result in permanent alterations to the jaw
joint or teeth. The panel emphasized that surgical treatments are only indicated in a small percentage of
patients. When such treatment is necessary, however, it is essential the patient fully understand the reason for
the treatment, the risks involved, and other types of treatment that may be available. For patients who have
already undergone surgery, additional operations should be considered only with great caution, as the
probability of success decreases with each additional intervention.
A form of occlusal adjustment irreversibly alters tooth structure by grinding down teeth to bring the bite into
balance. The panel noted that there are no clinical trials demonstrating that this treatment is superior to
noninvasive therapies. They recommended that more research is needed to clarify the role of occlusal
adjustment in the management of TMD.
TMD has been used to characterize individuals with a wide variety of symptoms and signs, such as pain in
the face or jaw joint area; headaches, earaches, and dizziness; clicking sounds in the jaw joint; or locking of
the jaw. The severity of these symptoms may range from painless clicking to serious debilitating pain and
dysfunction.
The 15-member panel noted that there are significant problems with some of the present diagnostic
categories for TMD, since they appear to be based on signs and symptoms rather than cause and
epidemiological information. The panel called for carefully designed population studies to identify the
prevalence of TMD signs and symptoms as a basis for the development of a more precise classification
system. Such a system could lead to new diagnostic techniques to identify disease subtypes. These new,
more specific disease categories could permit the elimination of the term "TMD", which has become
emotionally-laden and contentious.
The panel noted that universally accepted, scientifically based guidelines for diagnosing and managing TMD
are not available and that consequently practitioners sometimes have attempted to respond to their patients'
needs with a variety of unproven diagnostic and therapeutic approaches. Concerns about the safety and
effectiveness of these approaches, as well as potential for harm, led the panel to recommend studies to
assess the accuracy, reliability, and cost effectiveness of currently used diagnostic tools.
The panel concluded that there are questions about the effectiveness of most treatments now used for TMD.
Most have not been adequately evaluated in long-term studies and virtually none in randomized clinical trials.
The group called for clinical trials on the efficacy of non-invasive therapy versus placebo and research on the
self-management of TMD signs and symptoms. In addition, the panel strongly encouraged professional
education to insure proper and safe practice in the treatment of TMD, particularly with regard to
medications, surgery, and understanding the psychological and social aspects of these TMD problems. The
panel pointed optimistically to new research developments in tissue engineering and microbiology, which
promise exciting advances in the future management of TMD.
The panel made their recommendations at the conclusion of the 3-day NIH Technology Assessment
Conference on Management of Temporomandibular Disorders. The conference was convened by the
National Institute of Dental Research and the NIH Office of Medical Applications of Research.
The conference was cosponsored by the National Institute of Arthritis and Musculoskeletal and Skin
Diseases, the National Institute of Neurological Disorders and Stroke, the National Institute of Nursing
Research, and the NIH Office of Research on Women's Health.
FOR IMMEDIATE RELEASE
Contact: Bill Hall,(301)496-4819 or Pat Sheridan,(301)496-4261
FOR TEMPOROMANDIBULAR
DISORDERS
ANGELS UNITED IS UN-COVERING THE TRUTH ON TMJ!
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WE ARE ANGELS UNITED ON TMJ!
TMJD_SAFE_HAVEN_4_LIFE_ISSUES ยท TMJ SUPPORT GROUP
This TMJD Support Group is intended to be a Safe Haven and provide a place where people with TMJ pain can come and offer and receive support from people who know what they are going through. This is not a medical group and we do not have medical degrees or medical backgrounds. However, with the variety of members in here, there is bound to be someone who has been there and done that and can answer your questions.
This group is in memory of Debbie Ward whom suffered from TMJD & died of unknown causes.
There are many types of members with TMJD. Some have been treated medically, some treated with various splint therapies and physical therapies as well as some with surgical treatments ranging from Arthroscopy to full jaw joint replacements. Everyone with any degree of TMJD or has a family member that deals with it is welcome to join and offer and receive support that we all so badly need to get through each day with the pain we have to live with.
It is YOUR place to cry, scream or vent on the pain you are dealing with and how it is affecting your life and the lives of your loved ones. The group is MODERATED to avoid the unsolicited advertisements and spam. We are all in pain and do not need to have to deal with that too.
TMJ SURGERY FAMILY!.
A Great Place to Share Information! This site is for sharing and is not a substitute for the advise of your physician/oral surgeon. Please consult with your health care professional.
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