Leaders in the fields of Temporomandibular Disorders (TMD) and its accompanying overlapping pain conditions presented their latest findings at the Seventh Scientific Meeting of The TMJ Association, September 7-9, 2014, in Bethesda, MD. The meeting was co-sponsored by The TMJ Association and the National Institutes of Health. Topics of the scientific sessions included epidemiology and diagnostic criteria, basic mechanisms of chronic pain including the genetic and epigenetic basis of chronic pain, and the development of novel drugs for treatment of these conditions. Discussions were directed toward formulating a set of recommendations to advance research in this field.
Epidemiology and diagnostics of TMD and overlapping pain conditionsTemporomandibular disorders are characterized by pain and dysfunction in one or both jaw joints and/or their associated bone, cartilage, and muscle tissues. Mild cases may resolve over time, but more severe and chronic cases occur with a number of other pain conditions at a higher frequency than would be expected by chance. These overlapping pain conditions include chronic headache, endometriosis, fibromyalgia, interstitial cystitis/painful bladder syndrome, irritable bowel syndrome, low back pain, myalgic encephalomyelitis/chronic fatigue syndrome, and vulvodynia. These disorders predominantly affect women in their child-bearing years, giving rise to moderate to severe pain and dysfunction in individuals over the course of a lifetime.The presentations at the meeting emphasized that the diagnosis and treatment of TMD and overlapping pain conditions has progressed in very small increments over the past 50 years, citing at least four reasons: 1. TMD is currently associated with dentistry; however research indicates TMD to be a complex medical condition, best served through an interdisciplinary medical home. Currently, neither physicians nor dentists are effectively trained to address TMD. As a result there are no scientifically based standards of care or best practices. 2. The safety and effectiveness of any of the more than 50 treatments currently prescribed are unknown and in some cases can lead to iatrogenic complications that worsen the condition. 3. TMD and its overlapping pain conditions are stigmatized and patients, mostly female, are often not taken seriously. 4. The research, whether epidemiologic, basic, clinical or translational has been compartmentalized, focusing largely on the end organ affected. This has greatly hampered the sharing of diagnostic approaches and collaborative research which might lead to fresh insights into mechanisms and potential therapies.Status reports on two major clinical studies were presented. The OPPERA (Orofacial Pain: Prospective Evaluation and Risk Assessment) study is a large, prospective study designed to identify risk factors for the development of TMD. Results of this study indicated that the observed rate of first-onset TMD in 2,737 participants with no history of TMD at enrollment was 3.5% per year. However, those who reported su...
