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TMJ RoundTable Update - June 2017

From the time of the June 16, 2016 meeting, until last month, progress has been slow. However, over the past couple of months we have the following accomplishments to share with you.

Pain Drawings: An Important Tool for Health Care Practitioners

Last year we shared with you a study in which investigators found patients with more severe and chronic TMD are likely to experience other persistent pain conditions in other parts of the body, seemingly unrelated to problems in the jaw or face. Yet patients often do not mention these "overlapping" or "comorbid" pain conditions when they see a dentist or health care provider.

Primary Temporomandibular Disorders and Comorbid Conditions

The aim of this study is to evaluate the distribution of the most common comorbid conditions associated with chronic temporomandibular disorders, and the pharmacological agents which play an integral role in the overall management of temporomandibular joint disorders. Abstract: INTROD

Overdiagnosis and Unnecessary Therapy

Many dental practitioners continue to use radiographic or magnetic resonance imaging (MRI) findings in the temporomandibular joint (TMJ) as the sole means of establishing that there is a pathology present that requires treatment.

TMD Self-Management Programs

Self-management (SM) programs in temporomandibular disease (TMD) are a core component of pain management of TMD throughout its course and are often given to patients as a first essential step after diagnosis.

TMJ News Bites, July 2015

  • Oct 27, 2016


 
 

July 2015

Volume 5, Issue 7

 

We hope you are enjoying the summer.  This month we ask for your help in completing our annual survey as we plan the TMJA's 2014 activities.   In Scientific News we report on exciting research being done at Duke University that may lead to potential new drug targets for TMD.  Body posture, dental occlusion, and TMD had been thought to be connected; now we bring you the latest research on this topic.  NSAIDs are the most common medication prescribed by doctors for chronic pain, but you need to be aware of the risks of taking these medications on a regular basis.  This month we Iraida tells us of her struggle with TMJ implant devices and her words of wisdom for patients.  Additionally, we report the results of our TMD/Celiac disease poll as well as a number of ways you can help spread awareness of TMD among your family, friends, and the public. 

 

 

ACTION ITEM

 

Your Opinions and Concerns Are Important to the TMJA

Each year we ask you to tell us what is on your mind regarding Temporomandibular Disorders and The TMJ Association's activities.  This year your participation is exceptionally important, because in the coming months we will be meeting to discuss how we can best address your concerns. Your voice is vital to this planning process. Click  here to take the survey and let your voice be heard.

 

The August 2013 cover of Pain features the research of the  Liedtke-Lab at Duke University, Durham, NC

SCIENTIFIC NEWS

 

When It Hurts to Chew

As many TMD patients know, it often hurts to bite down hard on foods, so they resort to a soft diet and less strenuous muscle forces when their TMD pain kicks in.  Now, a team of investigators led by Dr. Wolfgang Liedtke at Duke University Medical Center in Durham, NC have taken advantage of that observation to detail changes in the brain that can account for that reduced biting force.

 

Using a mouse model, they injected a chemical compound into the TM joint that is well known to generate joint inflammation and associated pain.  As controls, another group of mice was injected with a control compound. Dr. Liedtke suspected that a protein, TRPV4, found on the surface of sensory nerve cells in the trigeminal ganglion of the brain (which supplies the TM joint) might be critical. He had discovered the protein in the year 2000 and noted its involvement in response to mechanical stimulation and also in response to pain and inflammation.

 

TRPV4 is an ion channel, which, when activated, allows calcium to enter a nerve cell, exciting it to fire an electric charge. It turns out that in response to joint inflammation and pain, not only was there increased expression of the TRPV4 ion channels on sensory neurons in the brain in parallel with the severity of inflammation and pain, but when the mice were tested using a bite force measuring apparatus, they showed a reduction in bite force in comparison with controls.

 

In contrast, when the mice were injected with an agent that blocked TRPV4 ion channels, the biting forces returned to more normal levels.  As a further test of the key role of the TRPV4 channel, the Duke team tested mice genetically engineered to lack the gene (called TRPV4) that codes for the protein. These mice also were resistant to the effects of TM inflammation on bite force. The researchers also determined that the presence of TRPV4 had the effect of re-programming the trigeminal ganglion to be more “pro-pain” and also acted as a “switch-on”mechanism in pain-sensing neurons in the ganglion.  

 

The bottom line is that the TRPV4 protein appears to be an attractive target for the development of new drugs to treat TMD.

 

Source: Chen Y, Williams SH, McNulty AL, Hong JH, Lee SH, Rothfusz NE, Parekh PK, Moore C, Gereau RW 4th, Taylor AB, Wang F, Guilak F, Liedtke W., Temporomandibular joint pain: A critical role for TRPV4 in the trigeminal ganglion, Pain.2013 Aug;154(8):1295-304.

 

No Connection: TMD, Body Posture & Dental Occlusion

Patients should be cautious when considering TMD treatments that claim to provide relief by correcting occlusal and postural abnormalities. Not only can these treatments be extensive and expensive,  but, more importantly, scientific literature does not support them. Instead, the literature concludes that a mechanical approach to treating TMD by means of irreversible methods such as occlusal adjustments, full mouth dental reconstructions, or orthodontics is not justified from a scientific viewpoint.  Here are the latest studies regarding this topic:

  • Marini, I., Gatto, M. R., Bartolucci, M. L., Bortolotti, F., Alessandri Bonetti, G. and Michelotti, A. (2013), Effects of experimental occlusal interference on body posture: an optoelectronic stereophotogrammetric analysis. Journal of Oral Rehabilitation, 40: 509–518. doi: 10.1111/joor.12064. 
  • Manfredini, D., Castroflorio, T., Perinetti, G. and Guarda-Nardini, L. (2012), Dental occlusion, body posture and temporomandibular disorders: where we are now and where we are heading for. Journal of Oral Rehabilitation, 39: 463–471. doi: 10.1111/j.1365-2842.2012.02291.x

 

NSAIDs Often Prescribed by Physcians

A recent research study by the University Of Missouri Kansas City School Of Pharmacy, Children’s Mercy Hospital, Kansas City and University Health System, San Antonio, found Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) to be the most common treatment prescribed to treat chronic pain.  


In our June issue of TMJ News Bites we told you about the  findings from another study that linked high dosages of NSAIDs to increased risks for heart failure, kidney and liver damage, and high blood pressure. Because of these risks, as well as the high prevalence of physicians prescribing these medications to TMD patients to help relieve pain, it's important that you use NSAIDs while under a medical doctor's supervision. Aspirin, naproxen (Aleve) and ibuprofen (Advil, Motrin) are examples of over-the-counter NSAIDs.

 

Iraida

PATIENT VIEWS

 

Iraida's TMD Story 

I underwent bilateral TMJ implant surgery in 2009, hoping to get relief from severe pain. Following the operation, my struggle became more than just coping with the daily pain, but was made worse by the lack of compassion and understanding from health care professionals. Instead of lending an ear to my struggles, my complaints were (and are) ignored. Seeking to alleviate the pain from the first implant surgery, I underwent a second surgery to replace one of the implants, but, damage to the trigeminal nerve had already been done. As a result, I became a trigeminal neuralgia (TN) patient. In short, I sought help for TMJ pain, underwent multiple surgeries, and ended up with permanent nerve damage and constant excruciating pain How did this happen?  This is my story. Click here to read more.

 

Here's What You Had to Say Regarding Celiac Disease and Gluten Sensitivity

In our last issue of TMJ News Bites, we told you that we have heard from a number of TMD patients that they had been diagnosed with Celiac disease and are sensitive to gluten products.  In response, we asked you to take part in our survey.  Click here to view the results. Thanks again to all of you who took time to participate!

 

 

BE AN ADVOCATE

 

TMJ aWEARness

Do you need a new beach cover-up?  Do you have a child or pet in your life who could use some TMJ gear?  Does your car need a new bumper sticker?  Visit our online TMJA store for some great TMJ aWEARness items.  Help spread TMJ aWEARness and support the TMJA with your purchase. 

 

TMJA Needs Your Support

We rely on YOU, our supporters, for your financial contributions to help sustain our advocacy efforts.   Please help with your donation today! The TMJA is a 501(c)(3) nonprofit organization whose mission is to improve the quality of health care and the lives of everyone affected by Temporomandibular disorders.

 

Free Educational Brochure: A Resource Guide for Temporomandibular Disorders

This brochure is a straightforward, easy-to-read guide for patients to help them with their health care decisions. The printed brochure is available from the TMJA by mail or PDF from our website.  We encourage you to share this brochure with your friends, health care professionals, and family.


This newsletter was funded through a restricted educational grant from Purdue Pharma L.P. The content is solely the responsibility of The TMJ Association, Ltd. and does not necessarily represent the official views of Purdue Pharma L.P.

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In Treating TMJ

To view or order a free booklet about TMJ Disorders, visit the National Institutes of Health website.

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES
National Institutes of Health
National Institute of Dental and Craniofacial Research
Office of Research on Women's Health