ETHESDA (Reuters) - An independent, multidisciplinary panel convened by the National Institutes of Health said yesterday afternoon that there are no scientific data to support the effectiveness of any one method for the initial treatment of temporomandibular disorders (TMD). The 15-member panel recommended a conservative, noninvasive approach to clinical management. Panel chair Judith E. N. Albino of the University of Colorado warned that, because there are no clear guidelines for diagnosis and treatment, "many patients and practitioners may attempt therapy with new and inadequately tested approaches."
Specifically, the panel warned against the use of implants that have not been tested in rigorous clinical trials and called for more research to clarify the gaps in TMD knowledge. In some TMD patients who received alloplastic implants, the "results have been disastrous." Some patients with the implants even had to have them removed following a Food and Drug Administration recall in the mid-1980s, Dr. Albino noted.
The controversy surrounding TMD management was evident even among panel members, who could not agree on incidence or clinical management of the syndrome. Dr. Albino said the figure of 10 million is a "very rough" estimate of the number of patients with TMD. Dr. Albino added that the entire area of TMD is "fraught with questions, with controversies and with a variety of concerns."
Only about 5-15% of patients with TMD will develop severe symptoms that require corrective surgery, Dr. Albino said. Initial treatment should include patient education, stress reduction and relaxation techniques. Additional therapy might include the tricyclics and hypnotics to alleviate pain and insomnia associated with the syndrome. Occlusal adjustments that irreversibly alter tooth structure, such as grinding teeth down to bring the bite into balance, have not been demonstrated to be more effective than noninvasive clinical management.
WASHINGTON (Associated Press) - Jaw joint pain is a billion dollar problem in America, and medical science is still uncertain how to fix it, but thousands have suffered surgical disasters that left some unable to chew or talk, a panel of experts said yesterday.
A committee selected by the National Institutes of Health (NIH) reported that medical science is so uncertain how to treat jaw pain that the disorder has not been accurately diagnosed or described - and no one is sure whether it should be treated by doctors or dentists, or both.
"Not only is there not good agreement on what to call it, there also is no common understanding of what [jaw pain] represents," said Judith E. N. Albino of the University of Colorado Health Science Center in Denver, who was the chairman of the NIH committee. "We're dealing with problems that have no clear diagnoses."
Jaw pain is classified under a generalized title of temporomandibular disorders (TMD). The conditions can include symptoms ranging from aches in the jaw, ears and head to dizziness, pain while chewing, a limited ability to open or close the mouth and just clicking and popping sounds when the jaw works.
Patients spend about $1 billion a year on medical care and drugs for TMD, according to figures from the National Institute of Dental Research. Treatment has ranged from doing nothing to a dozen operations or more - and doing nothing is medically the most successful, the committee found.
"Most individuals will get better," Albino said. "It is only a small minority that will have problems that persist for years." The committee estimated that 10 million Americans suffer from TMD, in one form or another, and that 5% to 10% of them have persistent problems. For the others, TMD is "self-limiting"; it goes away, often after modest, non-invasive treatment.
Surgery has been tried on many patients, and often, the committee reported, "the results have been disastrous."
"In spite of the concerns raised by these dramatic treatment failures, the absence of clear guidelines for diagnosis and treatment means that many patients and practitioners continue to experiment with new and inadequately tested approaches," the committee report said. Since almost no scientifically valid, clinical studies have established the best treatment for TMD, the committee urges doctors and dentists to use great caution, particularly in the use of surgery.
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.
Irreversible treatments of 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 structures 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 populations 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 the 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 non0-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 understand 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 of Temporomandibular Disorders. The conference was convened by the National Institute of Dental Research and the NIH Office of Medical Applications Research.
The conference was co-sponsored 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.
Copies of the full technology assessment statement also can be obtained by calling the NIH Consensus Program Information Service at 1-800-NIH-OMAR (644-6627).
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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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