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A STATEMENT FROM -

NATIONAL INSTITUTES OF HEALTH...

WHAT IS THE NATIONAL INSTITUTES of HEALTH ?

The National Institutes of Health is comprised of twenty-five separate Institutes and Centers. It is one of the eight health agencies that make up the U.S. Department of Health. Periodically, the NIH will make an exhaustive study of one of the many illnesses or diseases. These studies include a review of many various suggested treatments, and their statistical outcomes. In addition, research results from studies published in the scientific literature are added to the mix. The resulting document is reviewed and additions or deletions are suggested at many levels and by many health professionals, and then the finished product is finally published in a report that attempts to clarify treatments and expected results from that treatment.

As you might expect, with that many "experts" contributing to the final document, it sometimes becomes a very dilute, non-threatening product... a document that pleases no one and offends most who read it to some degree. But if the reader can overcome personal and professional bias, often there are statements contained in these reports that can give some direction to interested persons.

In 1996, the National Institutes of health published a statement on The Management of Temporomandibular Disorders (TMD ). As you might expect, there was considerable disagreement among health professionals concerning the findings and recommendations made in this report.

With all of that said, I do find certain statements in this report to be helpful to the public when evaluating proposed treatment recommendations for temporomandibular disorders (TMD ). So in summary form, here are several statements taken from this report. A full copy of the report ( 23 pages ) can be found on the web site of NIH, which is located at http://www.nih.gov. I have occasionally added italics, bold type, or bracketed words for clarity and/or emphasis.

* "In clinical case series studies in which conservative, reversible, noninvasive therapy was emphasized, the presenting signs and symptoms appeared to improve in the vast majority of patients."

* "At present the evidence is insufficient to warrant prophylactic [preventative] intervention for management of TMD, nor are their data providing clear evidence that orthodontic treatment prevents, predisposes to, or causes TMD. Even so, some practitioners have carried out occlusal adjustments [grinding on the teeth], extensive [crown and bridge] restorations, or management of joint sounds or displaced disks in the absence of pain or loss of function. Given current evidence, special emphasis should be placed on the avoidance of extensive restorative procedures to treat a disorder that may change over time."

* "... caution is urged with regard to use of invasive and other irreversible treatments, particularly in the initial management of TMD."

* " Many experts recommend that patients undergo education directed at eliminating certain behaviors perceived to be harmful, such as clenching or grinding. Some experts recommend exercise and stress management. Rest and dietary modifications may help some patients."

* " Physical therapy applications to TMD include a wide variety of evaluative and treatment modalities that are commonly used in the treatment of other neurological and musculoskeletal disorders. These therapies are generally conservative and non-invasive. Benefits to TMD patients have been described...".

* "Stabilization splints [intraoral orthotics ] are considered non-invasive and reversible and are recommended by many experts for early treatment of these patients."

* "Occlusal therapies are aimed at modification of the occlusion [ bite ] itself through alteration of the tooth structure. Given that this ... therapy is irreversible, and given that the superiority of this treatment over reversible therapies has not been demonstrated..., this form of occlusal (bite) adjustment probably will not represent the best practice for initial management of TMD."

* " It should be clearly realized that surgery is indicated in only a small percentage of patients."

In all fields of medicine, things change over time. Treatments are used today that were unknown only a few years ago. These recommendations may well change as new and exciting information becomes available, and research proves it’s validity. In the meantime this report should lead the informed patient to proceed with caution when it comes to invasive and irreversible treatment recommendations.

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