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National Academy of Medicine Study on Temporomandibular Disorders

The first meeting of the National Academy of Medicine Committee on Temporomandibular Disorders (TMD): From Research Discoveries to Clinical Treatment will be held Tuesday, January 29, 2019 at the National Academy of Sciences building in Washington, D.C.&

Attention Canadian TMJ Implant Patients

The Trial of the Class Action brought by Canadian patients who were implanted with Vitek Proplast TMJ implants, against Health Canada, alleging negligent regulation starts on April 1, 2019 in Toronto.

Long-term Changes in Biopsychosocial Characteristics Related to Temporomandibular Disorder: Findings from the OPPERA Study

The following article by Roger B. Fillingim, Gary D. Slade, Joel D. Greenspan, Ronald Dubner, William Maixner, Eric Bair, and Richard Ohrbach was published in the journal of Pain, November 2018. We are grateful to Dr. Fillingim for writing the following

National Academy of Medicine to Conduct a Study on Temporomandibular Disorders

We want you to be among the first to know that because of the advocacy efforts of The TMJ Association, the National Academy of Medicine (NAM) will conduct a first-ever study on Temporomandibular Disorders (TMD).

Dentists in Distress

Fear of the dentist is practically a rite of passage in youth. Growing up, I wasn't exactly afraid of the dentist; rather, any excuse to leave school early was a powerful incentive. These days, I have a more complicated relationship with dentistry: I go to get answers and try to feel better, but I always pop a prophylactic ibuprofen or two in case my jaw protests from the oral gymnastics.

What should you do if your jaw locks?

  • Nov 9, 2016

Although it is not the most common of TMJ problems, closed lock is very frightening for those who have it. In its most acute stage, the mouth is almost impossible to open because of both a physical block by a displaced disk and great pain. Because of this, surgery has long been the treatment of choice, since it was assumed that this was the only way to get the disk back in place. However, it was also known that symptoms can improve with simple symptom management, or a combination of symptom management and physical therapy. This prompted a group at the University of Minnesota to carry out a randomized clinical trial of four treatments for Closed Lock which we’ve posted for your review below.

Treatment of Closed Lock of the TMJ

A report on a paper by Schiffman, E.L. et al., Journal of Dental Reseach 86: 58-63, 2007

Written by Dr. James P. Lund, Professor, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada

Although it is not the most common of TMJ problems, closed lock is very frightening for those who have it. In its most acute stage, the mouth is almost impossible to open because of both a physical block by a displaced disk and great pain. Because of this, surgery has long been the treatment of choice, since it was assumed that this was the only way to get the disk back in place. However, it was also known that symptoms can improve with simple symptom management, or a combination of symptom management and physical therapy. This prompted a group at the University of Minnesota to carry out a randomized clinical trial of four treatments for Closed Lock: (Medical management); Rehabilitation,; Arthroscopy; and Arthroplasty. Medical management (MM) was pharmacological treatment of pain and inflammation with anti-inflammatory agents and analgesics, while Rehabilitation was a combination of MM with dental splints, physical therapy and psychology. Arthroscopy means inserting a small tube into the joint so that the surgeon can see inside, wash out the joint (lavage) and remove small pieces of tissue. In Arthroplasty, the joint is cut open so that the surgeon can remove larger pieces of tissue, which could be the whole TMJ disc and make repairs.

The scientists used two measures to quantify signs and symptoms, the Craniomandibular Index and Symptom Severity Index. The first measures movement, joint noises, tenderness of muscles and joints, while the second measures the pain- its intensity, tolerability, frequency and duration. They took measurements before treatment began, then at increasing intervals from the end of treatment to 5 years after treatment.

The main finding was that all four groups were much better 3 months after treatment, and that small improvements occurred out to 5 years. However, there was no difference between the four groups at any time during the study, which surprised a lot of people.

The authors concluded that, ”Primary treatment for patients with closed lock should consist of medical management  or rehabilitation” . However, it is hard for me to understand why they recommended rehabilitation because medical management is simpler, takes less time and costs much less. So there is really no justification in this study for anything more than managing inflammation and pain, which can be done by either a dentist or a physician.

 

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The TMJ Association, Ltd. (TMJA) is the leading national resource for information on temporomandibular disorders (TMD). For over 25 years the TMJA has been raising awareness of TMJ problems, expanding research, advocating for safe and effective treatments, and providing support to TMJ patients and their loved ones.

Our hope is that everyone that visits our website will become part of the TMJ Community. You don't have to suffer from these disorders yourself to empathize and support those that do. Everyone has a role in supporting sufferers and demanding effective research and treatments for TMJ disorders.

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Comments:

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ilshapira - Friday, July 31, 2015
When a patient develops an acute close-lock it is possible to reduce it by stimulating the gag reflex. During a gag all the elevators of the mandible relax and the depressors and posterior cervical muscles contract . In the process the jaw opens straight down and can alleviate an acute close-lock. Sometimes no other treatment is necessary other than temporarily preventing full closure. This prevents the need of future invasive procedures. Symptom management without reduction of close lock is possible but reduction of the lock is superior It is essential to avoid, whenever possible invasive procedures to the TMJoint.