The spectrum of conditions known as Temporomandibular Joint Disorders and Orofacial Pain (TMJD/OP) are difficult to diagnose and manage because their etiologies and pathogeneses are poorly understood. Progress towards definitive therapies and rational diagnoses has been slow due to the complex nature of the disorders and the lack of scholars working in this field, many of whom utilize a very narrow "silo" approach to investigating these disorders. We propose training four high caliber clinician scientists and basic scientists per year to enhance the number and quality of interdisciplinary researchers that can appropriately unravel the mechanisms underlying TMJD/OP and identify the most effective treatments. Towards this objective, we will engage Scholars for interdisciplinary mentorship in TMJD/OP, with the goal of bridging bench to bedside and back, to better understand these conditions in three main areas of inquiry: (1) pain mechanisms and therapies;(2) TMJ pathogenesis;and (3) developmental biology, regeneration and tissue engineering of joint, muscle and ligaments. Where appropriate, embedded within each of these areas will be research and didactic experiences in contemporary methodologies, including bioinformatics, genomics, imaging and biomarkers. The Scholars will have a minimum of 75 percent protected time for research and research career development. An individualized career development plan will be customized with each scholar and their interdisciplinary research mentors and mentorship team. Each plan will include an intensive supervised research experience, didactic training including instruction and assistance in grant writing/submission and scientific writing, ongoing mentor feedback, formal annual evaluation, and instruction in the responsible conduct of research. The Scholars'mentoring teams, didactic coursework, and experiential learning will highlight the need to understand the entire translational continuum and the complex interplay between "peripheral" and "central" factors that contribute to complex chronic pain states. The training of interdisciplinary scholars under the mentorship of established investigators, including those working in related areas outside the field, will likely lead to novel discoveries and provide the needed momentum for innovations in the diagnostics and therapeutics for TMJD/OP. These include: 1) the ability to better "phenotype" these patients to identify sub-sets of individuals (i.e. endophenotypes) that respond to specific therapies;2) th identification and use of local or systemic biomarkers to diagnose disease or monitor improvements in therapy;3) the use of both "peripheral" and central nervous system, joint and muscle imaging technologies for earlier and more sensitive diagnostics;and 4) the use of biomedicine, biomimetics, and imaging to design and manufacture bioengineered joints. Collectively, this application offers a comprehensive and systems-based approach to training researchers in the TMJD/OP field.
TMJD and OP comprise a poorly understood spectrum of disorders that negatively impact eating, speech and facial functions, and are a substantial health burden in the United States. Scientific advances in molecular biology, genetics, imaging, biomarkers, and computational biology offer novel approaches to better understand these disorders. We propose assembling a unique interdisciplinary mentorship program to train the next generation of high caliber TMJD/OP investigators with the goal of enhancing the quality and specificity of patient care.
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