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Multidisciplinary Research on the Temporomandibular Joint: Structure and Function in Health and Disease

Integrative Biology and Infectious Diseases Branch
Division of Extramural Research

Objective:
The goal of this initiative is to expand multidisciplinary, contemporary research focused on temporomandibular joint (TMJ) biology. This research will 1) bring new expertise and technological approaches to advance our understanding of temporomandibular joint tissue interactions, 2) discover underlying etiology of disease onset and progression, and 3) inform mechanism-based approaches for successful treatments of temporomandibular joint disorders (TMJDs). The current NIDCR portfolio in TMJ research emphasizes studies on pain sensation and pain regulation in the trigeminal system. This initiative aims to increase TMJ research that is focused on TMJ structure, joint tissue interactions, and TMJ function. There is a significant need to nurture TMJ research that will bring in new ideas and research approaches to address emerging opportunities in basic research and translational approaches. An expected outcome of this initiative is a sophisticated understanding of the structure and function of the TMJ that, in turn, will lead to novel, effective treatments for this disorder.

Background:
TMJDs comprise a group of conditions that cause pain in the jaw joint and the muscles that control jaw movement and lead to jaw dysfunction. Recent epidemiological data suggest that between 5-10% of the US adult population experience TMJDs. It is more common in women than men. Some people develop a long-term, chronic TMJ condition that can be debilitating and difficult to treat. Effective therapies for TMJDs are less than satisfactory due to our incomplete understanding of the etiology and pathological mechanisms involved in the disorders. Some recent results suggest that chronic TMJDs are not a localized orofacial pain condition, but rather, a more complex disorder involving central nervous system dysfunction. Subjects with chronic TMJDs may present with other chronic pain conditions affecting other areas of the body, consistent with a central nervous system dysfunction.

The TMJ, or “jaw joint”, is a modified hinge-type joint between the mandible and the temporal bones. The articular disc, composed of fibrocartilage, separates the condyle of the mandible from the mandibular fossa of the temporal bone. The TMJ is one of only a few synovial joints in the body to have an articular disc. Three main ligaments connect the mandible to the temporal bone and help to stabilize the joint, serve as a hinge, and prevent excessive movements of the mandible. Major muscles acting on the joint include the masseter, temporalis, and lateral and medial pterygoids. Sensory innervation of the joint originates from the mandibular branch of the trigeminal nerve. Surrounding tissues are innervated by proprioceptive and mechanosensitive nerve endings, which are important in initiating movement and controlling the mechanics of the joint. Blood supply to the joint and surrounding muscles is provided from the external carotid and maxillary artery and its branches. Interestingly, the articular disc of the TMJ is not innervated and the central portion of the disc does not contain a blood supply. Disc dysfunction due to disc displacement, perforation, or inflammatory degeneration for example is thought to be an early sign leading to TMJ pain.

Recent research efforts on TMJDs have focused on mechanisms underlying the development and persistence of orofacial pain, pain modulatory pathways in the trigeminal system, genetic and genomic studies, novel analgesic approaches and behavioral treatments. This research has provided a wealth of information on the function of sensory systems in the TMJ and identified biological and psychological risk factors for development of chronic TMJDs. Research on tissue regeneration and repair of damaged or dysfunctional TMJs is focused on engineering the disc complex and developing multi-tissue interfaces such as a bone-cartilage interface. The development of better approaches for repair of dysfunctional joints, regeneration of new joint structures, scaffold design and materials, and a more detailed understanding of tissue mechanics, joint tissue interfaces, neurological control, inflammatory joint processes, and stem cell mobilization are needed. In short, the biology of the TMJ in health and disease must be delineated. This information will be useful in developing new, efficacious treatments for TMJDs and in preventing onset and reversing pathology of disease.

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This page last updated: February 26, 2014