a special program of the National Emergency Medicine Association (NEMA)
Transcripts: 537-4 and 537-5
Week: 537.4 Guest: Dr. Judith Albino, University of Colorado Health Science Cntr, Denver Topic: TMD's or Jaw Pain- What is it? Part One of Two Producer/Host: Steve Girard
NEMA: It's one of those maladies, or should I say, group of maladies that has health care professionals and researchers gnashing their teeth. Temporomandibular disorders is the name, or TMD's for short...otherwise known as jaw pain. It's a billion dollar problem in the United States, and science is trying to find some answers. Today, we're with Dr. Judith Albino of the University of Colorado Health Science Center in Denver, who recently chaired a committee on the issue under the auspices of the National Institutes on Health. Doctor, are there certain types of pain, or restrictions of movement that classify someone with TMD?
ALBINO: Well Steve, one of the problems is that TMD presents in so many different forms...and the pain may be in the jaw itself, or it may be pain referred to other areas of the body. And its very difficult to diagnose as a result of that. People come in because they have pain, but also because they have noises, or difficulty in chewing or swallowing...and often, these problems look like something else. So, the problems are there in terms of definition, in terms of diagnosis, and of course, treatment..
NEMA: With all those parameters, how does a doctor diagnose the condition?
ALBINO: They look carefully at all of the signs and symptoms, and of course they use all of the diagnostic tools available to them, including imaging. It's very important, sometimes, to use professionals from different areas, and that's why physicians and dentists, and also psychologists, physical therapists, audiologists and other professionals have been involved in this area. What we need is a very good classification system that will communicate clearly what the signs and symptoms are, what the different types of TMD are, and then give some guidelines for treatment...because, indeed, in some cases, more invasive and non-reversible kinds of treatment have been used than perhaps were necessary.
NEMA: What different kinds of treatments have been used around the country to treat this pack of disorders?
ALBINO: Well, certainly everything from relaxation techniques, to drugs that help people to relax, to drugs that simply manage pain, all the way to surgical procedures...in some cases the entire joint has been replaced. What we've learned is that in most cases of TMD, the problems will resolve themselves, they will get better with virtually no treatment. So, what the panel has recommended is that in most cases, people should be very cautious about accepting invasive treatment....that in most cases, the least treatment is the best treatment, and this does not address the fact that there are some people who have severe conditions that will continue to deteriorate, and will require more urgent kinds of treatments and the kinds of treatment that will involve surgery in some cases.
NEMA: No wonder its a billion dollar problem...a wide array of symptoms, and a medical community still looking for a system of classification and treatment, to tell those who have serious problems from those whose jaw pain will go away.Dr. Judith Albino, from the University of Colorado Health Science Center, will join us again next program to talk about the recommendations of the special NIH panel on TMD. I'm Steve Girard.
Week: 537.5 Guest: Dr. Judith Albino, University of Colorado Health Science Cntr, Denver Topic: Report on National Institute on Health's conference on jaw pain, Part Two Producer/Host: Steve Girard
NEMA: When the National Institutes on Health appointed a special committee to examine the billion dollar problem called Temporomandibular Disorders - TMD's...or simply known as jaw pain...little did they know that it would become the best attended fact-finding conference ever convened by the NIH. And there's a reason for that....jaw pain comes in many areas, for many reasons, and health professionals often find themselves in a quandary about diagnosis and treatment. With us again is Dr. Judith Albino, of the University of Colorado Health Science Center....Doctor, tell us more about the committee and its job.....
ALBINO: Well, the NIH, put together what they call a technology assessment panel, and I chaired that panel...who come from all of the disciplines involved in understanding this particular problem area. But these 15 individuals are not people who have been researching or providing treatment for TMD, rather they're people put together as a panel to hear from the experts. And then we tried to pull together, from all of that, some recommendations for future research.
NEMA: What was the hardest part of the process for the panel?
ALBINO: The most difficult thing is that there is no register for this disease. There have been large scale health surveys in which people have been asked about pain in the jaw. But it's only from those self reports that we know what the extent of the problem is, and that's not very good or very detailed information. The private practitioners don't submit their information on their patients necessarily, because there's not a central place for doing that. And so, often, we don't know how well people have done with various treatments, but we do know at this point that most of the cases that present for treatment will, in fact, resolve themselves with some relatively conservative and non-invasive kinds of treatment.
NEMA: What did you hear at the conference from the patients?
ALBINO: People often don't know where to go. We heard from patients at the conference who had literally gone to dozens of different practitioners, looking for a solution to their problem. We heard from patients who had dozens of surgeries, trying to correct the problem. And one of the things the panel most urged is that we get guidelines for treatment and criteria for diagnosis, and that we come to some kind of understanding about where the treatment for this kind of problem should begin.
NEMA: Other recommendations your panel is making?...
ALBINO: We need epidemiological information, and we need more information about the causes of TMD. And that has to come from research. We need those longitudinal studies, as we call them, that allow us to better understand why it is these kinds of problems will often get better, and why it is in some cases they won't. On the other hand, we know today that under the supervision of a competent clinician, that drugs can be used that will control pain and will allow a person to be fully functional, and will help them get through what could be simply a difficult period of time with TMD.
NEMA: Dr. Judith Albino, who says until new materials are properly tested for the jaw, stay away from implants...and she recommends seeing more than one doctor for advice on your jaw pain...sometimes it will just go away with conservative treatment. I'm Steve Girard.