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October/November 2009
Volume 6, Issue 1
I wish you all a pleasant Thanksgiving!
Sincerely,
Terrie Cowley
President
Arthrocentesis and Lavage for Treating Temporomandibular Joint Disorders
The Cochrane Collaboration, a highly regarded international agency that conducts scientific reviews of clinical interventions and products used in the diagnosis, prevention, or treatment of diseases, has recently completed a review of Arthrocentesis and lavage for treating temporomandibular joint disorders. Two trials, unclear due to high risk of bias, were included in the review. To see what the authors had to say about this TMJ treatment, click here.
Study says Gabapentin (Neurontin) May Block Formation of New Synapses
Neurontin is a frequently prescribed medication to treat neuropathic pain and epilepsy. We've heard from many TMJD patients suffering with chronic pain who are on this medication. A recent study indicates that this drug may be blocking the formation of new synapses (a point of connection between two nerve cells) in the brain. The concern is that pregnant women could put their fetus at harm by taking this medication. To read the full article click here.
Clinical Study Using Non-Surgical Treatment Techniques
A clinical study on TMJ disorders is being conducted in the Dallas, Texas area. The purpose of the study is to evaluate whether early non-surgical treatment techniques such as biofeedback, stress management and self management coping skills training, reduces jaw pain or discomfort during treatment and thereafter.
Supervised by Baylor College of Dentistry, Texas A&M University, this clinical trial is being conducted at 5 community based dental clinics in Dallas. Click here to review the informed consent form. If you would like more information, contact Dr. Robert Gatchel, Principal Investigator at 817-272-2541 or Robbie Haggard, Program Coordinator at (214) 645-8749.
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CFC# 12102
Remember The TMJ Association this fall during the Combined Federal Campaign (CFC), United Way, and other non-profit corporate donor programs. Simply write in The TMJ Association on your donor form.
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Stress Taking a Toll on Teeth
A recent article in the New York Times and a CBS video/article report that dentists are seeing an increase in patients with bruxism (teeth grinding), which they attribute to increased stress in troubled economic times. Even in the absence of stress, it's estimated that 10 to 15 percent of adults are bruxers, and may be unaware of their habit because it occurs subconsciously, often during sleep. Whatever the cause, moderate to severe grinding can take a toll on teeth, wearing down the enamel and even fracturing teeth.
Beware! Although the article suggests that bruxism may lead to TMJ problems, the jury is out on that score. According to the National Institutes of Health brochure on TMJD, “the roles of stress and tooth grinding as major causes of TMJ disorders are also unclear. Many people with these [TMJ] disorders do not grind their teeth, and many long-time tooth grinders do not have painful joint symptoms. Scientists note that people with sore, tender chewing muscles are less likely than others to grind their teeth because it causes pain. Researchers also found that stress in many persons with jaw joint and muscle disorders is more likely the result of dealing with chronic jaw pain or dysfunction than the cause of the condition.”
The CBS video nicely explains how bruxism is not a dental problem per se, but originates in the central nervous system and manifests in the oral tissues. However, be aware that a number of treatments for bruxism mentioned in the articles such as acupuncture, Botox injections and new over-the-counter night guards have not been tested in clinical trials. Traditionally, bruxism has been treated with an occlusal splint worn at night. This is usually a custom-made hard plastic covering fitted over the upper or lower teeth to prevent the teeth from making contact during sleep.
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Need a Holiday Gift Idea?
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FDA Wins Court Case Against TMJ Implants, Inc. — Manufacturer to Pay $340,000 in Civil Money Penalties
On October 27, 2009, the United States Court of Appeals Tenth Circuit ruled in favor of the FDA in a civil money penalties case against TMJ implant device manufacturer TMJ Implants, Inc. and President Dr. Robert W. Christensen, for failure to submit 17 medical device reports. Click here to read the article that appeared in FDA Law Blog.
"FDA has explained the purpose of the reporting requirement and its broad scope: To carry out its responsibilities, the agency needs to be informed whenever a manufacturer or importer receives or otherwise becomes aware of information about device problems. Only if FDA is provided with such information will it be able to evaluate the risk, if any, associated with a device and take whatever action is necessary to reduce or eliminate the public's exposure to this risk" (pg. 4).
"Dr. Christensen contended that in each of the disputed events TMJI's devices were not explanted because of any inherent problem with the device itself; rather, natural progression fo the TMJ disease necessitated removal of the device" (pg. 9).
"Dr. Christensen and his colleagues also expressed concern that filing MDRs would expose TMJI to civil lawsuits and provide their competitors with an unfair advantage" (pg. 10).
Dr. Christensen offered to file the required MDRs if FDA promised to drop the Civil Money Penalties of $340,000. The judges state:
"offering to abide by the law only after being punished for not doing so does not mitigate the culcability of the initial unlawful conduct..." (pg.26).
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TMJ Bioengineering Conference
The second TMJ Bioengineering Conference was held November 4-7, 2009, in Boulder, Colorado. The conference focused extensively on various strategies to bioengineer the temporomandibular joint as well as TMJ - associated pain, inflammation, infection, etc.
The organizers of the meeting hoped to advance the field by strengthening the collaboration among clinicians, scientists and bioengineers.
Terrie Cowley represented The TMJ Association; expect to learn more about this meeting in upcoming communications. We applaud the organizers for bringing scientific attention to this neglected orthopedic joint.
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Almost all TMJ patients experience jaw/face pain. Many of us also experience other pain conditions—fibromyalgia, chronic headache, irritable bowel syndrome, vulvodynia, chronic fatigue syndrome, etc. We're encouraged to see the increased focus on pain research.
The National Institutes of Health (NIH) Blueprint for Neuroscience Research has announced a funding opportunity that will support partnerships between scientists from the pain and neuroplasticity fields. These partnerships are expected to lead to insights into the dynamic changes in nervous system structure and function that occur during the transition from acute to chronic pain. In the next two years, this Blueprint initiative will be expanded to promote these partnerships, and to train new investigators in state-of-the-art methods for studying pain.
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