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TMJ News Bites
July 2012
Volume 4, Issue 7
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NIH Workshop to Focus on Temporomandibular Disorders
The
focus of The TMJ Association's (TMJA) last three scientific meetings has
been on Temporomandibular Disorders (TMD) and pain conditions that a
patient might get before or after being diagnosed with TMD. The
recommendations from these meetings and advocacy action by members of
the
Chronic Pain Research Alliance have prompted the National Institutes of Health (NIH) to form a
trans-NIH committee to address these issues.
Terrie
Cowley, President of the TMJA and other members of the Chronic Pain
Research Alliance have been invited to participate in a panel discussion
addressing patient/patient advocate concerns regarding diagnosis and
treatment of patients with these conditions and the most fruitful
research directions that could be taken to advance our understanding of
these complex disorders.
Conditions to be addressed at the workshop include chronic fatigue syndrome, chronic headache, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, low back pain, temporomandibular disorders and vulvodynia. The goals of the workshop are to:
- Determine the state-of-the-science in chronic overlapping pain conditions;
- Develop
a coordinated research strategy in order to identify standard features
of chronic overlapping conditions that will drive the development of
research diagnostic criteria;
- Improve
and develop new research strategies to identify underlying mechanisms
of etiology; trajectories of disease; risk factors for disease onset,
progression and reversal; and outcome measures for these conditions.
Bioengineering the Temporomandibular Bone
Biomedical
engineers at Columbia University have been successful in using stem
cells to grow grafts of bone in the shape of the TM joint. As Dr.
Gordana Vunjak-Novakovic who heads the team remarked in a
National Institutes of Health interview:
"Today,
surgeons typically extract a piece of rib or bone from your leg. They
then very precisely carve the bone in the surgery room, reinsert it into
the problem area, and wrap muscle around the graft to cushion it and
enhance blood flow. It’s just not the optimal approach. That’s why I
don’t want to settle for incremental improvement. That said, I’m not
talking here about engineering a huge, integral graft. We are looking at
the pieces that are most needed. We also are looking very much into a
modular approach, so that you can sort of construct what you need from
individual pieces and make the surgeon’s life easier. You always try to
make a difference. I want to change the way people are reconstructing
bone."
This
research will someday help patients who have had TMJ implants or may be
contemplating implant surgery down the road. The bioengineered bone
grafts are currently being tested in an animal model, but Dr.
Vunjak-Novakovic believes the commercial technology is only a few years
away.
Click here to read more about this research.
Gordana
Vunjak-Novakovic, Ph.D. is a professor of biomedical engineering and a
professor of medicine at Columbia University in New York, where she
serves as director of Columbia’s Laboratory for Stem Cells and Tissue
Engineering and is the co-director of the Craniofacial Regeneration
Center. Dr. Vunjak-Novakovic also is an associate director of a
National Institutes of Health (NIH) Resource Center for Tissue
Engineering.
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Patient Spotlight - Katherine's Story
Katherine's
story is an excellent example of the complexity of TMD as well as the
lack of scientific research/knowledge on things such as C-Reactive
protein in TMJ patients.
"I
was diagnosed with TMD over 15 years ago. I was only in the 8th grade
and really didn't know what was going on, except that my jaw sometimes
locked open and popped or cracked if I chewed gum for a long time.
There wasn't a lot of pain. The pain didn't start to get bad until I
was in graduate school in 2007. Maybe it was the stress of grad school
that exacerbated the symptoms or maybe it was just a coincidence; I'll
never know.
"Over
the last 5 years I have been through every kind of test, physical
therapy, massage therapy and occupational therapy. I've missed days of
work because of injections and because the pain and exhaustion kept me
from doing my daily duties. In October 2010, I started becoming
extremely fatigued−I was literally unable to keep my eyes open while
driving to work. This went off and on for two years before I was finally
able to see a doctor. I am a recipient of Obamacare−I qualified for a
pre-existing condition insurance plan (PCIP). My pre-existing
condition, according to private insurers, was the TMD. Ironically, my
PCIP doesn't cover treatment for TMD."
Read more.
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Is It Wise to Remove Your Wisdom Teeth?
A recent
systematic review conducted by the Cochrane Collaboration
finds insufficient evidence to support or refute the removal of
asymptomatic impacted wisdom teeth. An impacted wisdom tooth is called
trouble-free, (disease free or asymptomatic) if the patient does not
experience signs or symptoms of pain or discomfort associated with it.
Over
the years we've heard from many TMJ patients who report that their TMD
symptoms began shortly after wisdom teeth removal or they had their
wisdom teeth removed as a form of treatment for TMD. (We also heard
that TMD had begun after other types of dental treatment).
It’s
important to note wisdom teeth do NOT cause TMD. These teeth only need
to be removed when local events justify their extraction. This
includes inflammation of the gums around the wisdom teeth, or their
negative impact on the neighboring teeth. Wisdom teeth should NOT be
extracted for a TMD problem.
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A Snapshot of Susan's Day and Some Helpful Tips
Last
month we asked our readers to share a “snapshot of your day with
TMD”. We received wonderful responses and plan to highlight each
submission in upcoming issues. This month we'd like to share with you
Susan's day with TMD.
"What
an unhappy surprise in the last few months to visit two different
dentists and walk away with TMD in both TMJs! Having spent 30
years as a speech-language pathologist, I am grateful to have a
seasoned ability to devise strategies to help me through the day.
Wow! Working at what others and I have taken for granted
(speaking and even just looking around, for example) gives me a new
respect for how amazing the human body is!
"One
adjustment I've used is pretending to be a 'modified
ventriloquist'. I overuse my tongue and lips to speak when
my jaw and neck muscles are exhausted by too much talking."
Click here to read more.
Renowned Scientist to Lead New Multidisciplinary NIH Pain Program
Dr. Catherine Bushnell has served on the TMJA's scientific advisory board and we congratulate her on this new appointment.
Dr.
Catherine Bushnell, an internationally recognized pain and neuroscience
researcher, has been appointed scientific director of a new research
program focusing on the role of the brain in perceiving, modifying,
and managing pain. Based in the National Center for Complementary and
Alternative Medicine (NCCAM), part of the National Institutes of
Health, this collaborative effort will complement basic science and
clinical research efforts of other ongoing intramural neuroscience,
imaging, and mental and behavioral health research programs on the NIH
campus.
Read more.
For the Scientist -NIH Research Grant Opportunity
NIAMS Building Interdisciplinary Research Team Revision Awards -
RFA-AR-13-003
The
National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS) solicits applications that promote building new
interdisciplinary teams among independent investigators for basic or
translational research. These teams should pursue a clear and
significant scientific opportunity in an area of shared
interest of relevance to NIAMS. Interdisciplinary teams
can undertake conceptually and technically novel approaches that would
be less likely to succeed if undertaken by a more narrowly
focused group of investigators. The NIAMS plans to provide up
to one year of Revision support to currently active NIAMS R01s
(parent grant) to establish such collaborations for high
innovation and potentially high impact research. It is
understood that such an application may entail high risk. Teams
developed under this award are expected to make significant
advances beyond the progress anticipated from the individual
researchers alone.
Action Needed for Temporomandibular Disorders
Who Funds Research on Temporomandibular Disorders (TMD)?
The
National Institutes of Health (NIH) is
the largest funding agency of scientific research for TMD. In
2010 approximately $17 million was spent on TMD research. Our hope for
relief lies in the answers only science can provide and that science is
largely funded by the NIH. However, funding at for the National
Institutes of Health (NIH) is at risk of being cut substantially over
the next ten years.
What You Can Do to See That This Research Continues!
Congress
is scheduled to break for recess from August 6 through September 7 and
during this time members of Congress will be back in their home states
to meet with constituents.
We urge you to
contact your representative and senators by scheduling a meeting,
sending a letter or e-mail,
or attending a town hall meeting. Talk with them about the benefits of
an increased investment in TMD and the importance of NIH-funded
research on these conditions. People suffering the pain and dysfunction
of TMD desperately need scientific research to improve understanding
of these conditions and develop safe and effective treatments—ones that
will not cause further pain and suffering.
Click here to read more.
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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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