Interview with Dr. Truelove – People Who Give Us Hope

Out of all the questions & comments we receive here at TMJ Hope, one in particular stands out. Why have hope? What exactly is there to be hopeful for?
When you have chronic pain, sometimes it is difficult to think too far in the future. Especially when you are first diagnosed with TMJ disorder, it’s hard to understand why this isn’t like many other conditions. Why can’t TMJ disorder patients just take a pill or have a surgery and be cured? This is also, as it happens, one of the most difficult questions to answer as a patient advocate (and a TMJD patient, myself). I seem to sit on the fence in a way – while I understand logically that we need more science, and the treatment out there needs to be more effective (and I support those things 150% percent)…. none of that really means anything when you are trying to eat a nice meal with your family (without pain). And that’s why we’re here today. I had the opportunity to talk with Dr. Edmond Truelove, a dentist and Professor of Oral Medicine at the University of Washington School of Dentistry.  What is there to be hopeful about in the world of TMJ disorder?
It turns out, there are many reasons to have hope!
The advancements in research and treatment for TMJ disorder patients highly depend on the type of issue the patient is dealing with.
For example, someone with what Dr. Truelove calls “mechanical jaw dysfunction,” (that is, someone who has mechanical limitations and cannot open their mouth, but no significant pain) will be looking at a different future than someone who can move their jaw well, but has significant pain. For patients with significant pain, Dr. Truelove explained that there is research emerging that suggests the area that supplies the pain, the trigeminal system, may not respond as well to chronic narcotics, and treating the pain this way may even add to it. So this suggests that in the future, opioids may not be as good of a treatment for this type of pain as people originally thought. There is basic research looking into alternative medications to treat this type of pain.
There are also some exciting developments around using the fMRI (functional MRI, which allows researchers to evaluate activity in the brain live, as it happens) to look at changes in the brain caused by pain. When pain exists for a long period of time, the brain can change or shrink, and this makes it even harder to recover from chronic pain – even if the source of the pain has been removed. This concept, called ‘central sensitization,’ means that the brain is actually generating the pain (instead of the TMJ itself).  Dr. Truelove explains how this offers hope for TMJ pain: “If you could know, that the person with TMJ pain has developed central sensitization for certain, you could say that surgery is a very bad decision  Because it’s notgoing to stop your pain….or occlusal changes from orthodontics are not going to help you because this is centrally generated pain. This would allow TMJ patients to avoid invasive costly treatments that in the end, become frustrating because they cost a lot of money and the patients end up being the same, or worse.”  
Another hopeful area of research is looking into the idea of reproductive hormones and their effect on TMJ pain. Some of the research at the University of Washington has shown that reproductive hormones play a significant role. Dr. Truelove believes that in the future, we will have the ability to treat these hormone issues, which could have an effect on people’s pain.
Thanks to the University of Washington, Dr. Truelove, his colleagues, and others like them, we now have a glimpse into the future of TMJ disorder and can see that there IS hope.

Dr. Edmond L. Truelove, Professor of Oral Medicine at the University of Washington School of Dentistry, retired as chair of the school’s Department of Oral Medicine on June 30. During his tenure as chair, which began in 1971, he is credited with building one of the nation’s leading departments of oral medicine, with an especially strong research component. A member of the American Dental Association’s Scientific Affairs Council, he has obtained more than three dozen funded grants, written more than 100 papers, and given more than 200 presentations and continuing-education lectures. He remains on the UW faculty and now devotes the bulk of his time to patient care, teaching and research. He is continuing his studies on oral dysplasia and lesions, with grants pending for work on pain and temporo-mandibular disorders as well as anti-microbial treatments for oral lesions and disease. He also is active in the Washington State Dental Association and Seattle King County Dental Society. A native of Indiana, he received his DDS degree from Indiana University, where he also was a postdoctoral fellow in the Department of Dental Genetics.