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New Report on Temporomandibular Disorders: Priorities for Research and Care

Over a year and half ago, the National Academy of Medicine (NAM) began the most comprehensive study ever undertaken on Temporomandibular Disorders (TMD). The study assessed the current state of TMD research, education and training, the safety and efficacy of clinical treatments, and associated burden and costs.

Statement by NIDCR Acting Director on the National Academies of Sciences, Engineering, and Medicine Report on Temporomandibular Joint Disorders

I am pleased to announce the release of the National Academies of Sciences, Engineering, and Medicine (NASEM) report, Temporomandibular Disorders: Priorities for Research and Care. As underscored by the comprehensive report, temporomandibular joint disorders (TMJDs) are a diverse and still poorly understood set of complex, painful conditions affecting the jaw muscles and tissues, temporomandibular joints, and associated nerves. Clearly, there is much more to be understood, and these conditions continue to confound medical and dental health care providers and researchers.

Have you seen the film Dark Waters?

The Film. Dark Waters is about attorney Robert Billott's real-life 20 year legal battle against DuPont chemical for releasing toxic waste - perfluorooctanoic acid, or PFOA - into Parkersburg, West Virginia's water supply, with devastating health effects on the townspeople and livestock. PFOA, also known as C8, is a man-made chemical. It is used in the process of making Teflon and similar chemicals known as fluorotelomers.

Online TMD Diet Diary Research Project

Online TMD Diet Diary Research Project The TMJ Association received the following request from Professor Justin Durham and his research team at Newcastle University. We encourage TMJ patients to participate in this project as it is an under researched

Drug Induced Bruxism

The authors of this article state that orofacial movement disorders (bruxism) are treated typically by dental professionals and not by those specialists (neurologists) researching and treating the other movement disorders (Parkinson's disease, Huntington's disease, tremors, etc.). Again, this is more evidence of the complexity of TMD and the need for multidisciplinary research and treatment in TMD.

Mandibular Repositioning as TMD Treatment– A Guide for Patients

  • Oct 13, 2015

Patients who develop symptoms of temporomandibular disorders (TMDs), face certain challenges when weighing the benefits and risks of new treatments. Because the TMD field is well known for having diverse opinions, different practitioners may offer a wide variety of treatment options for the same condition. Some of those options may be relatively conservative, while others are rather invasive. This difference is often represented as a choice between reversible and irreversible treatment.  In a recent paper, Drs. Greene and Obrez have suggested a novel way of assessing the choice between the proposed treatments. Their paper, entitled “Treating temporomandibular disorders with permanent mandibular repositioning: is it medically necessary?” focuses on a central issue in the TMD treatment controversy: should the position of the lower jaw (mandible) be irreversibly changed as a part of treating these conditions?

It should be pointed out that no other joint in the human body can have its parts permanently repositioned except for the temporomandibular joint (TMJ).  Therefore, no such controversy exists in orthopedic medicine. Indeed, like all other joints, the TMJ is constantly undergoing minor changes as we age.  But because the arrangement of the teeth can be changed by a variety of dental techniques (bite adjustments, crowns and bridges, orthodontics, and even surgery), it is possible to substantially change the position of the lower jaw (condyle) relative to the skull (fossa).

In their paper, the authors argue that there already exists a lot of evidence that most TMD patients can be successfully treated without doing such invasive procedures. The new element they add to this discussion is described as homeostasis, which refers to the body’s ongoing attempts at maintaining a balance within the systems. In the case of the TMJs, this refers to the balance between the teeth, the muscles, and the joints. This represents a more biological concept that supports the clinical decision-making process. The authors then set up a series of six criteria to determine whether jaw repositioning can meet the test of being medically necessary:

1. The medical condition (i.e., mandibular malposition) is generally recognized as a valid health problem or a disease.

2. The diagnostic tests used to assess whether the patient has this condition are valid with acceptable specificity (getting a correct diagnosis) and sensitivity (avoiding a false positive diagnosis).

3. The patient’s condition will get worse unless a particular procedure is done.

4. The clinical procedure itself has specificity (proven value from good clinical studies) for addressing the patient’s particular problem.

5. The procedure is clinically effective according to evidence-based criteria (i.e., not just a placebo effect).

6. The disease or disorder cannot be resolved by performing a less invasive procedure, thus justifying the invasiveness of the clinical procedure based on its benefit-to-risk ratio.

Their conclusion is that criterion #1 above has not been met, since there is no valid diagnosis called “mandibular malposition.” Therefore, treating TMD with permanent jaw repositioning procedures does not meet these medical necessity criteria, and yet many practitioners may still continue to do some or all of those procedures. For TMD patients, this represents a danger of being over-treated with an irreversible therapy.  Therefore, they would be wise to seek second opinions if this approach is being offered to them. If an oral splint is being proposed as part of their treatment, they should ask the dentist whether this will lead to bite-changing and jaw-repositioning procedures afterward.

 As the authors state in their final paragraph: “In summary, we have concluded that permanent mandibular repositioning procedures do not fulfill any of the six criteria of medical necessity as the appropriate and medically acceptable treatments or management options for patients with various TMD conditions. This conclusion also has ethical implications, as discussed in the recent paper by Reid and Greene. According to ethical standards, a physician is expected to offer patients the best treatment options with the least risk possible, even if that approach results in less ideal financial returns for the practitioner.”

©2015 The TMJ Association, Ltd. All rights

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In Treating TMJ

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

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