I just returned from a whirlwind three day visit to Capitol Hill while representing the American Alliance of TMD Organizations as their current chairman. The delegation wanted to learn more about funding for National Institutes of Health (NIH) and National Institute of Dental and Craniofacial Research (NIDCR) for temporomandibular joint (TMJ) clinical research. Some of the facts that I uncovered are worthy of sharing. They include the dollars, i.e. $317 million that (NIDCR), which has the lead role in TMJ research, gives out for all requests each year. Also, since they function under the NIH umbrella, it is helpful to know that the NIH budget is some $27 billion dollars each year. The field of TMJ or TMJ disorders (TMJD) received (from the NIDCR) $16 million in 2003 and an estimated $17 million in 2004 and $18 million in 2005. Although TMJD received the largest percentage of discretionary funding for new initiatives from NIDCR over the past two years most grants go for didactic research. The multidisciplinary arena gets support from NIH as well. That seems promising since ten new multidisciplinary grants were funded in the past two years, other grants include support for the TMJ and Muscle Disorders Interagency Working Group (TMJDIWG) which is chaired by NIDCR. This large group is charged with various goals. One is to focus and bring together indepth information from various programs represented by the member organizations. A second goal is to be a catalyst for the initiation of projects and a third is to guide the progress of projects involving several agencies. Established in 1998, this agency functions to provide a forum for the exchange and dissemination of information and activities of the Department of Health and Human Services (DHHS) as it relates to TMJD issues. The organization’s membership roster reads like a who’s who in medicine.* Funds were also made available for a TM Implant Registry program. Grants for biomimetrics (using micro technology to observe biological systems on a cellular level) and tissue engineering for treating and repairing TMJ tissues have been awarded. Stem cell technology research for soft tissue repair and to regenerate condyles in the TMJ also received grant awards. Pain grants were numerous, and although not necessarily directed specifically to the TMJ areas, they could pay off in other research information that will aid relief of craniofacial pain the future. How much of the money actually trickles down to assist wet-fingered doctors in their offices who daily treat patients suffering from TMD problems? Very little! In order to demonstrate, let us look at financial support for research articles published in CRANIO: The Journal of Craniomandibular Practice (CRANIO). Over the past seven years from 1998 through 2004, our review of financial support shows that only 4% of these articles were funded by NIH or NIDCR grants. Out of 237 published articles during those seven years, only nine were listed as having grant money from NIH or NIDCR. Eleven percent (11%) were supported by foreign governments (Japan, Sweden, Chile, to name a few). Two percent (2%) were funded by US manufacturing firms. I recognize that CRANIO is not the only journal producing TMJ information, but it is the largest and leads the field in the number of articles from clinicians and researchers who actually treat patients. Therefore, if the scientific information is not getting into CRANIO, then it cannot be benefiting patients, and the US government is spending millions of dollars annually. What about stem cell research and biomimetrics? Sure we need to do some of this futuristic/promising research. However, not at the exclusion of practical measures that will benefit patients and keep them pain free. Even if we grow a new condyle, it still must allow the joint to function normally and what will a new full sized regenerated condyle head do to patients’ worn occlusion? We have not appropriately studied occlusion in the past due to a lack of funding. How will we prepare to study new issues, which may vary from the traditional, and yet have logical steps in place in advance of developing new technologies? The federal government is appropriating significant funds annually for TMJD research. We suggest that a fair amount of this funding should go where it would benefit suffering patients (those same patients whose tax dollars pay for the research). The thirteen members present on the 168th 2002 panel of the National Advisory Dental and Craniofacial Research Council (NADCRC) approved in one day 294 applications for a total cost of over $69 million. There were 368 applications considered at a total request of $84,404,029. This is staggering information. More money needs to be directed to astute clinical TMD research. More money needs to be allocated on research into womens’ illnesses since over 80% of our TMJD patients are female. We need less money spent on drugs and more support for manipulative and repositioning therapy especially in the area of internal derangements. We have recent advances in good clinical approaches, but funds are needed for better follow-up and broader controlled studies.
We need competent individuals appointed to peer review committees for NIH and NIDCR who have extensive clinical expertise in TMJD diagnosis and treatment and who can readily evaluate the clinical relevance of grant requests. This is an election year. We need to elect the best and brightest representatives who understand the needs of our suffering patients—their voting constituency.
*Federal members of TMJDIWG:
1. Department of Health and Human Services (DHHS)
National Institutes of Health (NIH)
Office of Research on Woman’s Health (ORWH)
National Center for Complementary and Alternative Medicine (NCCAM)
National Heart, Lung and Blood Institute (NHLBI)
National Institute of Allergy and Infectious Diseases (NIAID)
National Institute of Arthritis and Musculoskeletal Research (NIAMR)
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
National Institute of Deafness and Communication Diseases (NIDCD)
National Institute of Dental and Craniofacial Research (NIDCR)
National Institute of Drug Abuse (NIDA)
National Institute of Neurological Diseases and Stroke (NINDS)
National Institute of Nursing Research (NINR)
Agency for Healthcare Research and Quality (AHRQ)
Centers for Disease Control and Prevention: National Center for Health
Statistics (NCHS)
Food and Drug Administration
Centers for Medicare and Medicaid Services (CMS), formerly HCFA
2. Department of Defense
National Naval Medical Center (NNMC)
Non-federal Observers
1. Academia
University of Cincinnati
2. Private Organizations
The TMJ Association
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