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Date: Wednesday, May 1, 1996 FOR IMMEDIATE RELEASE Contact: Bill Hall,(301)496-4819 or Pat Sheridan,(301)496-4261
An independent panel convened by the National Institutes of Health today recommended a conservative and reversible approach to treatment for the vast majority of patients with temporomandibular disorders (TMD).
"The absence of reliable scientific data has led to confusion among dentists and physicians regarding when and how to treat TMD," said panel chair Judith E.N. Albino, Ph.D., President Emerita and Professor of Psychiatry at the University of Colorado Health Science Center in Denver. "The good news, however, is that for most people initial TMD pain is not a signal that a serious problem is developing. Only a small percentage will develop significant, long-term symptoms," she said.
Temporomandibular disorders comprise a group of painful conditions that affect the jaw joint (temporomandibular joint) and the muscles that control chewing. The panel estimated that more than 10 million Americans have symptoms associated with TMD, which is most often seen in women 20 to 40 years of age.
TMD treatment falls into two main categories: conservative/reversible and irreversible. Conservative treatments do not invade the tissues of the face, jaw, or joint. These treatments are as simple as possible and are used most often because most patients do not have severe, degenerative TMD. Conservative approaches include self care practices such as eating soft foods, applying heat or ice packs, and avoiding extreme jaw movements like wide yawning, singing, and gum chewing. Learning special techniques for relaxing and reducing stress may also help patients deal with pain that often comes with TMD problems. Other conservative therapies may include education, pain control medication, and physical therapy. Reversible treatments do not cause permanent changes in the structure or position of the jaw or teeth.
Irreversible treatments for TMD, which include surgical procedures, result in permanent alterations to the jaw joint or teeth. The panel emphasized that surgical treatments are only indicated in a small percentage of patients. When such treatment is necessary, however, it is essential the patient fully understand the reason for the treatment, the risks involved, and other types of treatment that may be available. For patients who have already undergone surgery, additional operations should be considered only with great caution, as the probability of success decreases with each additional intervention.
A form of occlusal adjustment irreversibly alters tooth structure by grinding down teeth to bring the bite into balance. The panel noted that there are no clinical trials demonstrating that this treatment is superior to noninvasive therapies. They recommended that more research is needed to clarify the role of occlusal adjustment in the management of TMD.
TMD has been used to characterize individuals with a wide variety of symptoms and signs, such as pain in the face or jaw joint area; headaches, earaches, and dizziness; clicking sounds in the jaw joint; or locking of the jaw. The severity of these symptoms may range from painless clicking to serious debilitating pain and dysfunction.
The 15-member panel noted that there are significant problems with some of the present diagnostic categories for TMD, since they appear to be based on signs and symptoms rather than cause and epidemiological information. The panel called for carefully designed population studies to identify the prevalence of TMD signs and symptoms as a basis for the development of a more precise classification system. Such a system could lead to new diagnostic techniques to identify disease subtypes. These new, more specific disease categories could permit the elimination of the term "TMD", which has become emotionally-laden and contentious.
The panel noted that universally accepted, scientifically based guidelines for diagnosing and managing TMD are not available and that consequently practitioners sometimes have attempted to respond to their patients' needs with a variety of unproven diagnostic and therapeutic approaches. Concerns about the safety and effectiveness of these approaches, as well as potential for harm, led the panel to recommend studies to assess the accuracy, reliability, and cost effectiveness of currently used diagnostic tools.
The panel concluded that there are questions about the effectiveness of most treatments now used for TMD. Most have not been adequately evaluated in long-term studies and virtually none in randomized clinical trials. The group called for clinical trials on the efficacy of non-invasive therapy versus placebo and research on the self-management of TMD signs and symptoms. In addition, the panel strongly encouraged professional education to insure proper and safe practice in the treatment of TMD, particularly with regard to medications, surgery, and understanding the psychological and social aspects of these TMD problems. The panel pointed optimistically to new research developments in tissue engineering and microbiology, which promise exciting advances in the future management of TMD.
The panel made their recommendations at the conclusion of the 3-day NIH Technology Assessment Conference on Management of Temporomandibular Disorders. The conference was convened by the National Institute of Dental Research and the NIH Office of Medical Applications of Research.
The conference was cosponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute of Neurological Disorders and Stroke, the National Institute of Nursing Research, and the NIH Office of Research on Women's Health.