Temporomandibular Joint and Muscle Disorders: NIH Supports a Wide
Range of Research (04-APR-08, GAO-08-454R).			 
                                                                 
Temporomandibular joint and muscle disorders (TMJD) include a	 
heterogeneous group of disorders with overlapping--but not	 
identical--signs and symptoms. Symptoms of TMJDs vary, but	 
typically include pain in the jaw joint and surrounding muscles. 
Other symptoms may include limited or no movement of the jaw	 
joint, clicking or grating in the jaw joint when opening or	 
closing the mouth, headaches, and shoulder or back pain. Most	 
people with TMJDs have relatively mild forms of these disorders  
with symptoms that diminish without treatment. However, a small  
number of individuals develop significant, long-term problems,	 
including persistent and debilitating pain and loss of jaw	 
function. Although some TMJDs are due to a specific known cause, 
such as jaw injury or arthritis, the causes of many TMJDs are	 
unknown. While the level of understanding about these conditions 
has evolved with scientific advancements, diagnosis and treatment
are difficult because the exact causes and patterns of symptoms  
remain unclear. The National Institutes of Health (NIH), an	 
agency within the Department of Health and Human Services (HHS), 
funds research on the causes of, treatments for, and other	 
aspects of TMJDs. The NIH is organized into 27 institutes and	 
centers and the Office of the Director, each with its own mission
and functions. Through these institutes and centers, NIH supports
both extramural research--conducted at external research	 
institutions by scientists who are awarded funds to support their
work--and intramural research conducted by its own scientists. In
1996, NIH sponsored a Technology Assessment Conference that	 
included a panel of experts from a variety of fields, including  
clinical dentistry, medicine, surgery, immunology, behavioral and
social sciences, and pain management. The panel addressed, among 
other things, the effective management and treatment of patients 
with TMJDs and the most productive directions for future	 
research, including both applied and basic research. The panel	 
concluded there was a clear need for applied research on a number
of issues, including the prevalence of TMJD symptoms,		 
predisposing and precipitating conditions, diagnostic methods,	 
and treatment outcomes. It also concluded that there was a need  
for basic research in areas such as pain and biomechanics. Noting
that TMJDs continue to pose complex health problems for the	 
American public, you expressed interest in the progress that has 
been made in acting on the panel's conclusions. GAO is reporting 
on (1) TMJD-related research activities that NIH supported from  
fiscal year 2002 through fiscal year 2006, and (2) NIH's plans to
support future research on TMJDs.				 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-454R					        
    ACCNO:   A81566						        
  TITLE:     Temporomandibular Joint and Muscle Disorders: NIH	      
Supports a Wide Range of Research				 
     DATE:   04/04/2008 
  SUBJECT:   Agency missions					 
	     Biomedical research				 
	     Chronically ill					 
	     Disease detection or diagnosis			 
	     Diseases						 
	     Health research programs				 
	     Medical care evaluation				 
	     Medical procedures 				 
	     Medical research					 
	     Program evaluation 				 
	     Prosthetic devices 				 
	     Research and development				 
	     Research grants					 
	     Research program management			 
	     Research programs					 
	     Strategic planning 				 

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GAO-08-454R

   

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April 4, 2008: 

The Honorable Edward M. Kennedy: 
Chairman: 
Committee on Health, Education, Labor, and Pensions: 
United States Senate: 

Dear Mr. Chairman: 

Subject: Temporomandibular Joint and Muscle Disorders: NIH Supports a 
Wide Range of Research: 

Temporomandibular joint and muscle disorders (TMJD) include a 
heterogeneous group of disorders with overlapping--but not identical-- 
signs and symptoms.[Footnote 1] Symptoms of TMJDs vary, but typically 
include pain in the jaw joint and surrounding muscles. Other symptoms 
may include limited or no movement of the jaw joint, clicking or 
grating in the jaw joint when opening or closing the mouth, headaches, 
and shoulder or back pain. Most people with TMJDs have relatively mild 
forms of these disorders with symptoms that diminish without 
treatment.[Footnote 2] However, a small number of individuals develop 
significant, long-term problems, including persistent and debilitating 
pain and loss of jaw function.[Footnote 3] Although some TMJDs are due 
to a specific known cause, such as jaw injury or arthritis, the causes 
of many TMJDs are unknown. While the level of understanding about these 
conditions has evolved with scientific advancements, diagnosis and 
treatment are difficult because the exact causes and patterns of 
symptoms remain unclear. 

The National Institutes of Health (NIH), an agency within the 
Department of Health and Human Services (HHS), funds research on the 
causes of, treatments for, and other aspects of TMJDs. The NIH is 
organized into 27 institutes and centers and the Office of the 
Director, each with its own mission and functions. Through these 
institutes and centers, NIH supports both extramural research-- 
conducted at external research institutions by scientists who are 
awarded funds to support their work--and intramural research conducted 
by its own scientists. In 1996, NIH sponsored a Technology Assessment 
Conference that included a panel of experts from a variety of fields, 
including clinical dentistry, medicine, surgery, immunology, behavioral 
and social sciences, and pain management.[Footnote 4] The panel 
addressed, among other things, the effective management and treatment 
of patients with TMJDs and the most productive directions for future 
research, including both applied and basic research.[Footnote 5] The 
panel concluded there was a clear need for applied research on a number 
of issues, including the prevalence of TMJD symptoms, predisposing and 
precipitating conditions, diagnostic methods, and treatment outcomes. 
It also concluded that there was a need for basic research in areas 
such as pain and biomechanics.[Footnote 6] 

Noting that TMJDs continue to pose complex health problems for the 
American public, you expressed interest in the progress that has been 
made in acting on the panel's conclusions. We are reporting on (1) TMJD-
related research activities that NIH supported from fiscal year 2002 
through fiscal year 2006, and (2) NIH's plans to support future 
research on TMJDs. 

To identify TMJD-related research activities supported by NIH from 
fiscal years 2002 through 2006, we examined data provided to us by NIH 
that listed projects on, or related to, TMJDs that it funded during 
that time period.[Footnote 7] Because we learned that some NIH 
institutes and centers did not begin reporting TMJD-related projects 
until after fiscal year 2002 and that institutes and centers differed 
in their methods for determining whether projects were TMJD-related, we 
validated the list of projects NIH provided. We took several steps to 
do so. For each listed project, we reviewed an abstract or other 
documentation, such as a progress report, to confirm that it was TMJD- 
related. We also developed a list of potentially relevant projects 
through a keyword search of HHS's publicly available Computer Retrieval 
of Information on Scientific Projects (CRISP) database. We then 
compared NIH's list to those we identified through our CRISP search. 
When we identified discrepancies between the lists, we obtained 
clarifying information from NIH officials and reached agreement about 
whether to include or exclude specific projects. Based on these 
analyses and discussions, we determined that our final list of TMJD- 
related projects supported by NIH from fiscal years 2002 through 2006 
was sufficiently reliable and valid for our purposes. 

To identify NIH's plans to support future research on TMJDs, we 
reviewed targeted funding announcements--public announcements that 
describe specific areas of research that NIH is interested in funding-
-released from December 2005 through December 2007. We identified 
relevant funding announcements by conducting a keyword search of NIH's 
online Guide for Grants and Contracts that is available through NIH's 
Office of Extramural Research Web site.[Footnote 8] We discussed NIH's 
plans to support future research on TMJDs with agency officials. In 
addition, we interviewed representatives of three TMJD advocacy groups 
to help us understand their perspectives on research related to TMJDs. 
These three advocacy groups were the American Alliance of TMD 
Organizations, the Jaw Joints & Allied Musculo-Skeletal Disorders 
Foundation, and the TMJ Association. Enclosure I contains additional 
information about our scope and methodology. 

We conducted this performance audit from February 2007 through March 
2008 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. 

Results in Brief: 

NIH supported a wide range of TMJD-related research from fiscal year 
2002 through fiscal year 2006. We identified 170 TMJD-related projects 
supported by NIH during this time period. These projects varied in the 
types of research activities involved, the institutes and centers that 
supported them, and the questions the research was designed to 
investigate. Specifically, NIH supported a variety of different 
research activities through, for example, grants to support discrete 
projects performed by investigators in their specific area of interest 
and grants to support organized efforts of several investigators 
conducting related research projects. Most of the projects we 
identified were supported by NIH's National Institute of Dental and 
Craniofacial Research (NIDCR); nine other institutes and centers and 
the Office of the Director also supported TMJD-related projects. The 
research supported by NIH during this time period addressed a wide 
range of questions related to TMJDs. For example, research addressed 
questions about the prevalence of TMJD signs and symptoms, predisposing 
and precipitating conditions, gender differences in TMJDs, pain, and 
biomechanics. 

NIH officials told us that the agency plans to support future research 
on TMJDs by continuing to fund research it finds meritorious, including 
research applications submitted in response to targeted funding 
announcements. Several targeted funding announcements issued from 
December 2005 through December 2007 signaled NIH's interest in 
supporting research in areas involving TMJDs. These announcements 
either focused directly on TMJDs or addressed research areas, such as 
pain, that could include TMJDs. Specifically, NIH signaled interest in 
receiving applications in one area of research that directly focused on 
TMJDs--the co-occurrence of TMJDs with other chronic conditions, such 
as chronic fatigue syndrome. During the same 2-year time period, NIH 
signaled interest in receiving applications addressing 15 other areas 
of research that identified TMJDs as a possible focus, but did not 
require investigators to include TMJDs as a focus of their research 
proposal. NIH officials reported that they may issue additional 
targeted funding announcements to encourage future research on specific 
aspects of TMJDs. 

HHS provided technical comments on a draft of this report, which we 
incorporated as appropriate. 

Background: 

The goals of NIH-supported research are to advance the understanding of 
biological systems, improve the control of disease, and enhance health. 
NIH has recognized the need for research on TMJDs to develop a better 
understanding of the onset and natural course of these disorders and to 
develop new diagnostic and treatment approaches. NIH reported that its 
institutes and centers obligated about $90.6 million for TMJD-related 
extramural and intramural research in fiscal years 2002 through 
2006.[Footnote 9] 

Temporomandibular Joint and Muscle Disorders: 

Although much remains unknown about TMJDs, the level of understanding 
about them has evolved over time. For example, since the 1996 
Technology Assessment Conference, it has become apparent that 
individuals with TMJDs often experience other chronic and painful 
disorders, such as chronic fatigue syndrome, fibromyalgia, and 
irritable bowel syndrome.[Footnote 10] In addition, subsequent research 
has found that women in their childbearing years are more likely than 
men or than younger or older women to seek care for TMJDs, suggesting a 
possible role of female sex hormones in TMJDs.[Footnote 11] 

NIH's Structure and Processes for Supporting Research: 

NIH institutes and centers accomplish their mission chiefly by funding 
extramural research. NIH states that it seeks to fund high-caliber, 
unique, and investigator-initiated research that is relevant to public 
health needs. NIH funds research primarily by providing support for 
investigator-initiated applications that are submitted independently or 
in response to targeted funding announcements, with funding decisions 
made according to NIH priority areas, including TMJDs. Approximately 84 
percent of NIH's budget--a total of about $29 billion in fiscal year 
2007--supports extramural research. This extramural research is 
supported primarily by grants, but also through cooperative agreements 
and contracts.[Footnote 12] NIH also supports intramural research, 
conducted by scientists working in its own laboratories and clinical 
center. Approximately 10 percent of NIH's budget supports intramural 
research.[Footnote 13] 

NIH awards a variety of types of grants to support extramural research, 
and each type of grant supports a specific type of research activity. 
For example: 

* Some grants support discrete research efforts by specific 
investigators. The most common type of grant--a research project grant-
-is used to support a specified, circumscribed project, traditionally 
under the direction of a single principal investigator.[Footnote 14] 
The research project grant is typically awarded for a period of 3 to 5 
years to support research in an area representing the investigator's 
specific interest and competencies.[Footnote 15] Small research grants 
support research that can be carried out in a short period of time with 
limited resources. Exploratory or developmental grants are designed to 
encourage the development of new research activities in the early and 
conceptual stages. 

* Other NIH grants, including center and research program project 
grants, support multiple research efforts. For example, a research 
program project grant is designed to support a broadly based, 
multidisciplinary program that has a specific major objective or basic 
theme. This type of grant is used to support research that generally 
involves the organized efforts of several investigators conducting 
related research projects. Similarly, a general clinical research 
center grant is designed to support a research unit within a hospital, 
for example, where scientists conduct studies on a wide range of 
issues.[Footnote 16] Another type of grant--a specialized center grant-
-is designed to support multidisciplinary research, both basic and 
clinical, on a specific disorder or biomedical issue. 

* NIH also provides fellowships and research career development grants 
to help individuals obtain research training or pursue their research 
careers. One such grant helps individuals who have completed doctoral 
training obtain additional research training to broaden their 
scientific background and increase their potential for research. 

* NIH also has conference grants to support organized meetings where 
people exchange information. 

(See table 1 for examples of NIH's grants and the types of research 
activities they support.) 

Table 1: Examples of Extramural Research Grants: 

Type of grant: Research Projects: Research project grant; 
Supported research activities: A discrete, circumscribed project, 
usually under the direction of a single principal investigator and 
typically awarded for a period of 3 to 5 years. 

Type of grant: Research Projects: Small research grant; 
Supported research activities: Research that can be carried out in a 
short period of time with limited resources. 

Type of grant: Research Projects: Exploratory/developmental grant; 
Supported research activities: New research activities in the early and 
conceptual stage. 

Type of grant: Centers and programs: Research program project grant; 
Supported research activities: A broadly based, multidisiciplinary 
program that typically has a specific major objective and generally 
involves several investigators conducting related research. 

Type of grant: Centers and programs: General clinical research center 
grant; 
Supported research activities: A research unit within a hospital or 
other inpatient care facility where scientists conduct studies on a 
wide range of issues. 

Type of grant: Centers and programs: Specialized center grant; 
Supported research activities: Multidisciplinary research, both basic 
and clinical, on a specific disorder or biomedical issue. 

Type of grant: Fellowships and research career development: 
Postdoctoral individual National Research Service award; 
Supported research activities: Research training for individuals who 
have completed a doctoral degree. 

Type of grant: Fellowships and research career development: Mentored 
patient-oriented research career development award; 
Supported research activities: Supervised study and research for 
clinically trained professionals who have the potential to develop into 
productive, clinical investigators focusing on patient-oriented 
research. 

Source: GAO analysis of information from NIH. 

[End of table] 

Although most extramural grant applications submitted to NIH for 
funding are unsolicited--that is, submitted in the absence of a 
targeted announcement--NIH can signal particular interest in specific 
areas by issuing targeted funding announcements on specific topics of 
high priority. Targeted funding announcements include, for example, 
program announcements and requests for applications.[Footnote 17] 
Program announcements describe areas of research that NIH is interested 
in funding, but for which it has generally not set funds aside. 
Requests for applications describe areas of research for which NIH has 
set funds aside. 

NIH evaluates grant applications for extramural research support using 
a two-tiered system of peer review that reflects assessment of key 
factors, such as scientific merit and NIH priorities. First, 
applications are reviewed for scientific and technical merit by review 
groups composed primarily of nongovernment scientists who are experts 
in relevant fields of research. Based on this review, each application 
is given a "priority score" that becomes the main determinant in 
whether an applicant will eventually receive funding for the research 
proposal. A second level of peer review is conducted by the relevant 
institute's or center's National Advisory Council or Board, which 
includes both scientific and lay representatives. The council or board 
reviews applications not only for scientific and technical merit, but 
also for their relevance to the institute's or center's programs and 
priorities. Institute and center directors make the final funding 
decisions among the top priority applications. According to NIH 
officials, institute and center directors may decide to fund certain 
applications that fall just outside the normal priority score 
percentile cutoff if the research is of particular interest to the 
institute or center--for example, if the research falls within one of 
the high-priority areas described in one of the institute's or center's 
targeted funding announcements[Footnote 18].: 

NIH's Structure for Supporting Research on TMJDs: 

Within NIH, NIDCR has primary responsibility for research on 
TMJDs.[Footnote 19] Other institutes and centers may fund TMJD-related 
research to the extent that the research is consistent with their 
programs and priorities.[Footnote 20] For example, the National 
Institute of Arthritis and Musculoskeletal and Skin Diseases may fund 
research on those TMJDs associated with arthritis, and the Office of 
Research on Women's Health (ORWH), within the Office of the Director, 
may contribute funding toward research on gender differences in TMJDs. 

Two NIH committees facilitate coordination among institutes and centers 
on issues related to TMJDs. First, the Temporomandibular Muscle and 
Joint Disorders Interagency Working Group is a committee that meets 
annually to facilitate cooperation, communication, and collaboration 
among NIH institutes and centers and other federal agencies that 
conduct or support TMJD-related activities[Footnote 21]. Second, NIH's 
Pain Consortium seeks to enhance pain research across NIH and to 
promote collaboration among institutes and centers with programs and 
activities addressing pain, including the pain associated with TMJDs. 
These committees provide a forum for the exchange and dissemination of 
information and can facilitate the coordination of activities, 
including the development of targeted funding announcements, across 
institutes and centers. 

NIH Supported a Wide Range of TMJD-Related Research: 

NIH has supported a range of different types of research addressing a 
variety of questions related to TMJDs. We identified 170 TMJD-related 
projects supported by NIH during fiscal years 2002 through 
2006.[Footnote 22] These projects varied in the types of research 
activities involved, the institutes and centers that supported them, 
and the questions the research was designed to investigate. 

NIH supported a variety of research activities related to TMJDs. Of the 
170 projects we identified, 55 were extramural research project grants. 
In addition, we found that NIH supported extramural centers and 
research program projects (2 specialized centers, 1 comprehensive 
center, 1 research program project, and 56 subprojects of other 
research program projects or centers),[Footnote 23] extramural 
fellowships and research career programs, including career development 
awards[Footnote 24] (17 projects), extramural conferences (6 projects), 
other types of extramural research (such as small research grants and 
grants for exploratory or developmental research--27 projects, 
including 1 research and development contract and 3 cooperative 
agreements), and intramural research (5 projects). See enclosure II for 
a list of the 170 NIH-supported projects related to TMJDs funded from 
fiscal years 2002 through 2006. 

Most of the TMJD-related projects supported by NIH from fiscal years 
2002 through 2006 were funded through NIDCR. Nine other NIH institutes 
and centers and the Office of the Director also funded TMJD-related 
projects. Specifically, NIDCR was the primary sponsor of 103 of the 170 
projects we identified--that is, NIDCR had administrative 
responsibility for these projects. Other institutes and centers that 
were primary sponsors of TMJD-related research included the National 
Center for Research Resources (48 projects), National Institute of 
Biomedical Imaging and Bioengineering (6 projects), National Institute 
of Neurological Disorders and Stroke (4 projects), National Center for 
Complementary and Alternative Medicine (3 projects), National Institute 
of Arthritis and Musculoskeletal and Skin Diseases (2 projects), 
National Institute of Mental Health (2 projects), National Institute of 
Child Health and Human Development (1 project), and National Institute 
on Drug Abuse (1 project). Some of these institutes and centers, along 
with the National Institute on Deafness and Other Communication 
Disorders and two offices within the Office of the Director--ORWH and 
the Office of Rare Diseases--also provided additional support for TMJD- 
related research by cofunding one or more of these projects. 

NIH supported research that addressed a wide range of questions related 
to TMJDs, including topics identified by the panel from the 1996 
Technology Assessment Conference as research needs. NIH supported 
projects to address such questions as the prevalence of TMJD signs and 
symptoms, predisposing and precipitating conditions, treatment 
outcomes, and gender differences in TMJDs and related comorbid 
conditions. NIH also supported basic research on questions about such 
issues as pain and biomechanics. These projects included multiple 
studies on each of several topics that NIDCR officials identified as 
most critical to advancing a scientific understanding of TMJDs--risk 
factors, pathophysiology,[Footnote 25] pain mechanisms, the structure 
and function of the temporomandibular joint, comorbidities, treatments 
(including early intervention), sex and gender differences in TMJDs, 
and animal models of TMJDs. Although a few examples cannot illustrate 
the full range of TMJD-related research supported by NIH from fiscal 
years 2002 through 2006, the following examples illustrate some aspects 
of NIH's support for research on questions related to TMJDs: 

* NIDCR began funding a research project entitled "Orofacial Pain: 
Prospective Evaluation and Risk Assessment," or OPPERA in fiscal year 
2005. This project, the first large-scale prospective study of TMJDs, 
is a clinical study intended to identify risk factors that contribute 
to the development of TMJDs by collecting a wide range of biological 
and behavioral data from people before they develop these disorders. 
Researchers plan to evaluate and monitor 3,200 volunteers--people who 
are initially free from TMJDs--for 3 to 5 years. This project is 
expected to provide important data about genetic, biological, and 
psychological factors associated with the development of TMJDs. It is 
also expected to provide information about the signs, symptoms, and 
course of these disorders once they do develop. Funded through a 
cooperative agreement, the research will be conducted at four 
universities. 

* NIH funded a research project entitled "Brief Focused Treatment for 
TMD: Mechanisms of Action" to obtain information about certain 
treatments for TMJDs. Specifically, this project was designed to 
compare the effectiveness of a standard treatment for TMJDs--use of an 
intraoral splint[Footnote 26] and anti-inflammatory drugs--with and 
without cognitive-behavioral therapy, as well as to obtain information 
about predictors of treatment effectiveness. This project was funded by 
NIDCR and cofunded by ORWH from fiscal years 2003 through 2006. 
Additional support was provided through a general clinical research 
center grant from the National Center for Research Resources. 

* NIH awarded a grant for a specialized center of research to support 
interdisciplinary studies, including both clinical and basic research. 
These studies were designed to address gender-related factors (such as 
hormones) that influence pain and the development of TMJDs and other 
pain-related conditions (such as irritable bowel syndrome). This 
project, entitled "ORWH: SCOR[Footnote 27] on Sex and Gender Factors 
Affecting Women's Health," was managed through the National Institute 
of Arthritis and Musculoskeletal and Skin Diseases, which also provided 
some funds for the project; the majority of funds were from ORWH. The 
project was funded from fiscal years 2002 through 2006. 

* A career development award entitled "Spatial and Temporal 
Characteristics of Central Sensitization in Chronic Pain Diseases" 
supported research designed to illuminate certain pain mechanisms 
involved in chronic pain disorders. Specifically, research supported 
through this award was intended to clarify the conditions under which 
chronic pain causes an increase in sensitivity to pain, so that painful 
stimuli are perceived as even more painful, or previously nonpainful 
stimuli become painful. Funding for this project was awarded by the 
National Institute of Neurological Disorders and Stroke from fiscal 
years 2002 through 2006. 

* A research project grant entitled "The Role of Tooth Mechanoreceptors 
in Jaw Movement" provides an example of NIH's support for research on 
the biomechanics of the temporomandibular joint. This project was 
designed to obtain information about the nerves that carry information 
from deep orofacial regions to the central nervous system, the normal 
processes involved in sensory feedback from craniofacial nerves, and 
how those processes are altered in disorders such as TMJDs. This 
project was supported by NIDCR from fiscal years 2002 through 2006. 

* A career transition award entitled "Accelerated Osteoarthritis in the 
TMJ of Biglycan/Fibromodilin DKO Mice" supported research designed to 
identify ways of preventing osteoarthritis of the temporomandibular 
joint by detecting it and treating it at an early stage. This research 
on the pathophysiology of TMJDs was designed to be conducted with mice 
that provide a model of osteoarthritic-like TMJD. It was intended to 
assess the role of mechanical loading on the progression of 
osteoarthritis of the temporomandibular joint[Footnote 28] and the 
biomarkers of osteoarthritis in this joint. It was also designed to 
examine proteins that are involved in the proliferation and death of 
cells in the cartilaginous portion of the temporomandibular joint. 
Funding for this project was awarded by NIDCR in fiscal year 2006. 

NIH officials noted that, in addition to supporting research that is 
specifically related to TMJDs, NIH also supports a wide range of 
research that is not specifically related to TMJDs, but is nonetheless 
of potential relevance. For example, NIH supports research on related 
topics such as pain, gender differences in health, and conditions that 
are frequently comorbid with TMJDs. Information gained through such 
research has the potential to contribute to the scientific 
understanding of TMJDs, even though these projects were not 
specifically designed to do so. 

NIH Plans to Continue Supporting Research on TMJDs: 

NIH officials told us that they plan to support future research on 
TMJDs by continuing to fund research applications found to be 
meritorious, including those submitted in response to targeted funding 
announcements. Several funding announcements issued from December 2005 
through December 2007 signaled NIH's interest in supporting research in 
areas involving TMJDs, either by focusing directly on TMJDs or by 
addressing other areas, such as pain, that could include TMJDs. (See 
enc. III for a list of the areas of research addressed in the targeted 
funding announcements.) Specifically, NIH signaled interest in 
receiving applications in one research area that focused directly on 
TMJDs--the co-occurrence of TMJDs with other chronic conditions such as 
chronic fatigue syndrome and fibromyalgia. Three funding announcements 
on this topic, entitled "Temporomandibular Joint and Muscle Disorders: 
Pathophysiological Mechanisms Linking Comorbid Conditions," were 
identical in scientific scope; they differed in the type of research 
activity for which support could be made available. One of these 
funding announcements addressed research project grants, a second 
addressed small research grants, and the third addressed exploratory/ 
developmental grants.[Footnote 29] NIDCR issued these funding 
announcements in March and December of 2006, and other institutes 
indicated potential interest in funding some of this work. These three 
announcements will expire in May 2009.[Footnote 30] 

Other targeted funding announcements issued during this same 2-year 
time period signaled NIH's interest in supporting research in areas 
that could include--but are not required to include--TMJDs. From 
December 2005 through December 2007, NIH issued funding announcements 
addressing 15 other research areas that explicitly noted that TMJDs 
could be included as a research focus.[Footnote 31] The following 
examples illustrate areas of research addressed in these targeted 
funding announcements:[Footnote 32] 

* In August 2006 and January 2007, NIH's National Institute of Nursing 
Research, in collaboration with NIH's Pain Consortium, issued a set of 
funding announcements entitled "Mechanisms, Models, Measurement, & 
Management in Pain Research." These announcements indicated NIH's 
interest in receiving applications through early September 2009 to 
support a wide range of pain research, including basic and clinical 
pain studies. TMJDs were among several pain conditions--such as 
headaches, fibromyalgia, and spinal cord injury pain--that were 
identified as being of special interest. These funding announcements 
invited researchers to submit applications that could address TMJDs, 
but did not require them to do so. The funding announcements issued for 
this area of research were identical in scientific scope and also 
involved three separate types of research activities--research project 
grants, small research grants, and exploratory/developmental grants. 

* In December 2005, NIDCR issued a set of funding announcements 
entitled "Drug Delivery Systems for Orofacial Disease." These 
announcements expressed interest in receiving applications for small 
business innovation research grants and small business technology 
transfer grants, which support research and development projects that 
could result in commercial projects or services. The targeted funding 
announcements indicated NIH's interest in supporting research on the 
design and development of novel delivery systems for drugs to treat 
oral diseases (such as tooth decay and periodontal disease) or TMJDs. 
The announcements expire in May 2008. 

In addition to signaling interest in supporting research in these 
specific substantive areas, NIH has also encouraged institutions to 
submit applications to support training programs that could address 
TMJDs. NIH officials and representatives of advocacy groups told us 
that the scientific workforce has not always included as many qualified 
TMJD researchers as would be desirable. Although institutional training 
grants are not designed to guarantee that individuals obtain training 
as TMJD researchers, such grants can create opportunities to do so. NIH 
issued a funding announcement in January 2006 entitled "Institutional 
Grants for Research Training in Biomedical Informatics" that signaled 
its interest in receiving applications through mid-March 2006 to fund 
continuing-education training grants.[Footnote 33] These grants assist 
professional schools and other public and nonprofit institutions to 
establish, expand, or improve programs of continuing professional 
education. This announcement explicitly mentioned that training in 
TMJDs could be included as a specialized track offered through the 
proposed training programs. 

NIH officials also reported that they expect to issue additional 
targeted funding announcements involving TMJDs as the agency identifies 
appropriate areas for emphasis. In particular, agency officials told us 
that they are exploring the merits of encouraging research that adopts 
a systems approach to TMJDs. According to NIH officials, a systems 
approach involves interdisciplinary research that explicitly seeks to 
enhance the understanding of TMJDs by integrating information from 
multiple domains, such as genetics, physiology, biochemistry, and 
psychology. In September 2007, the Temporomandibular Muscle and Joint 
Disorders Interagency Working Group participated in a meeting of a 
Working Group of NIDCR's National Advisory Dental and Craniofacial 
Research Council to discuss the systems approach to TMJDs and provide 
guidance for the development of recommendations for the council's 
consideration. NIH officials told us that as of February 2008, no 
decisions had been reached about this issue. 

NIH officials stressed that targeted funding announcements are a way 
for NIH to signal interest in particular areas of research, and that 
they plan to continue to support research investigating a broad range 
of questions about TMJDs. They also emphasized that their future 
support for research on TMJDs will continue to be driven by factors in 
addition to their targeted funding announcements. In particular, most 
future research on TMJDs is likely to be investigator-initiated and 
will reflect the scientific developments that result from research that 
is currently underway. 

Agency Comments: 

We provided a draft of this report to HHS for comment. The department 
provided technical comments, which we incorporated as appropriate. 

We are sending copies of this report to the Secretary of HHS, the 
Director of NIH, relevant congressional committees, and interested 
parties. We will also make copies available to others upon request. In 
addition, this report will be available at no charge on GAO's Web site 
at [hyperlink, http://www.gao.gov]. 

If you or your staff have any questions concerning this report, please 
contact me at (202) 512-7114 or [email protected]. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this report. GAO staff who made major contributions to 
this report are listed in enclosure IV. 

Sincerely yours, 

Signed by: 

Marcia Crosse: 

Director, Health Care: 

[End of section] 

Enclosures I:  

Scope and Methodology: 

To identify the research activities related to temporomandibular joint 
and muscle disorders (TMJD) supported by the National Institutes of 
Health (NIH) from fiscal years 2002 through 2006, we reviewed a list of 
TMJD-related projects provided by NIH and interviewed NIH 
officials.[Footnote 34] NIH prepared this list when developing its 
estimate of funding for this set of disorders during these 
years.[Footnote 35] Because we learned that some NIH institutes and 
centers did not begin reporting TMJD-related projects until after 
fiscal year 2002[Footnote 36] and that institutes and centers differed 
in their methods for determining whether projects were TMJD-related, we 
validated the list of projects NIH provided. In addition, we took steps 
to determine whether NIH had sponsored other relevant projects that 
were not included on its list. 

To validate information on NIH's list and confirm that a project was 
TMJD-related, we reviewed an abstract or other documentation, such as a 
progress report, for each listed project. We also interviewed agency 
officials about how NIH's institutes and centers determined which 
projects were related to TMJDs. We did not develop independent criteria 
for what constitutes TMJD-related research; instead, we relied on NIH's 
scientific expertise. For example, research on pain mechanisms can be 
directly or indirectly relevant to TMJDs, and we relied on NIH 
officials to determine which of these projects to count. For each 
listed project, we confirmed that the abstract or other documentation 
either addressed TMJDs directly or addressed topics that we determined 
had been among NIH's research priorities for TMJDs from fiscal years 
2002 through 2006. These topics included the biomechanics of the jaw; 
conditions that are comorbid with TMJDs (including irritable bowel 
syndrome, chronic fatigue syndrome, fibromyalgia, multiple chemical 
sensitivity, and sleep disorders); craniofacial or orofacial pain; 
gender differences in TMJDs or pain; pain mechanisms and management; 
reconstruction technologies related to the temporomandibular joint and 
surrounding orofacial areas; risk factors for TMJDs; and the trigeminal 
system (which involves the motor and sensory nerves for the mandibular 
region). When our review of the abstracts or other documentation did 
not readily confirm that a project was TMJD-related, we sought 
clarification from NIH officials. In some of these cases, NIH officials 
agreed that projects had been mistakenly listed as TMJD-related, and we 
removed those projects from our list. As one example, a project that 
NIH had originally listed as TMJD-related was designed to study tibial 
muscular dystrophy. That project had been mistakenly included on NIH's 
list because the abstract referred to tibial muscular dystrophy by the 
acronym, TMD, which is also an acronym that can refer to 
temporomandibular joint and muscle disorders. 

In addition, we took steps to ensure that we identified relevant 
projects that were not included on NIH's list. Specifically, we 
compared its list to one that we developed through a keyword search of 
the Department of Health and Human Services' Computer Retrieval of 
Information on Scientific Projects (CRISP) database.[Footnote 37] We 
searched for the keywords "temporomandibular," "TMD," and "TMJ" (which 
would include TMJD).[Footnote 38] As we previously reported,[Footnote 
39] however, and NIH officials confirmed, there are limits to the 
reliability and validity of information derived from the CRISP 
database. For example, CRISP abstracts are based on grant applications, 
and not actual research activities. Researchers may revise their plans 
after submitting an application. Thus, if a researcher initially 
planned to include a study related to TMJDs as part of a broader 
proposal, but eliminated that study from the research plan before NIH 
funded it, the project could be incorrectly identified as TMJD-related 
through a search of CRISP. When our search of CRISP identified projects 
that were not on NIH's list of TMJD-related projects, we reviewed the 
abstract. If the abstract appeared to be TMJD-related, we sought 
clarification from NIH officials. In some of these cases, NIH officials 
agreed that projects were TMJD-related, and so we added them to our 
list. For example, one project had been omitted from the list because 
the institute that funded the project did not consider TMJDs to be a 
primary focus of the research. NIH officials agreed, however, that the 
project was relevant to TMJDs, and we included it in our list. 
Similarly, when NIH's list included a project that we had not 
identified through our search of CRISP--as could happen when a 
researcher who received funding to support research that was not 
expected to address TMJDs subsequently conducted studies that were TMJD-
related--we resolved the discrepancy with NIH officials. 

As another step to validate our list of TMJD-related projects, we 
identified specific research projects that appeared on NIH's list as 
TMJD-related during 1 or more fiscal years and, based on available 
project documentation, appeared to have been underway during 1 or more 
preceding fiscal years, but were not included on NIH's list as TMJD- 
related during those years. We sought clarification from NIH for these 
projects, and in some cases, NIH officials agreed that the project had 
been mistakenly omitted from their list for 1 or more fiscal years. We 
included those additional years of support in our list. As an example, 
NIH's National Center for Research Resources (NCRR) had not previously 
developed a list of TMJD-related projects for fiscal years 2003 or 
2004. In response to our request for clarification about projects that 
it listed for fiscal year 2005, but not for previous years, NCRR staff 
reviewed their files for fiscal years 2002 through 2006. They then 
provided us with a revised list of TMJD-related projects and supporting 
documentation for each of those years. We adjusted our list of projects 
accordingly. 

It is possible that NIH supported research projects related to TMJDs 
from fiscal years 2002 through 2006 that are not included in our final 
list. Our search of CRISP would not identify all TMJD-related research 
supported by NIH because the keywords we used to search CRISP would not 
necessarily appear in each abstract. For example, research on the 
biomechanics of the jaw could be of direct relevance to TMJDs, even if 
the abstract or other information in CRISP did not include the keywords 
"temporomandibular," "TMD," or "TMJ." If a TMJD-related project was not 
on NIH's list of TMJD-related projects and the CRISP entry for a TMJD- 
related project did not include the words "temporomandibular," "TMJ," 
or "TMD," then we would not have identified it. Based on these analyses 
and discussions, we determined that our final list of TMJD-related 
projects supported by NIH from fiscal years 2002 through 2006 was 
sufficiently reliable and valid for our purposes. 

To identify NIH's plans to support future research on TMJDs, we 
reviewed public announcements of NIH research funding opportunities 
issued from December 2005 through December 2007. We identified relevant 
targeted funding announcements by searching NIH's online Guide for 
Grants and Contracts[Footnote 40] for the keywords "temporomandibular," 
"TMD," "TMJ," and "TMJD."[Footnote 41] We asked NIH whether it had 
funded TMJD-related research applications submitted in response to the 
targeted funding announcements.[Footnote 42] We also interviewed NIH 
officials about their plans to support future research on TMJDs, 
including potential funding announcements. In addition, we interviewed 
representatives of three TMJD advocacy groups to help us understand 
their perspectives on TMJD-related research. These advocacy groups were 
the American Alliance of TMD Organizations, the Jaw Joints & Allied 
Musculo-Skeletal Disorders Foundation, and the TMJ Association. 

We conducted this performance audit from February 2007 through March 
2008 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. 

[End of section] 

Enclosure II: 

Research Projects Related to Temporomandibular Joint and Muscle 
Disorders Supported by the National Institutes of Health: 

We identified 170 projects related to temporomandibular joint and 
muscle disorders (TMJD) funded by the National Institutes of Health 
(NIH) from fiscal years 2002 through 2006. These projects were funded 
or cofunded by two offices within the Office of the Director--the 
Office of Research on Women's Health (ORWH) and the Office of Rare 
Diseases (ORD)--and by the following NIH institutes and centers: 

* National Center for Complementary and Alternative Medicine (NCCAM), 

* National Center for Research Resources (NCRR), 

* National Institute of Arthritis and Musculoskeletal and Skin Diseases 
(NIAMS), 

* National Institute of Biomedical Imaging and Bioengineering (NIBIB), 

* National Institute of Child Health and Human Development (NICHD), 

* National Institute of Dental and Craniofacial Research (NIDCR), 

* National Institute of Mental Health (NIMH), 

* National Institute of Neurological Disorders and Stroke (NINDS), 

* National Institute on Deafness and Other Communication Disorders 
(NIDCD), and: 

* National Institute on Drug Abuse (NIDA). 

These projects involved a variety of types of research activities. 
Specifically, these projects included the following: 

* extramural research projects, which are discrete, specified, 
circumscribed projects performed by a particular investigator(s) in an 
area representing the investigator's specific interest and competencies 
(table 2); 

* extramural centers and research program projects, which involve 
multiple research activities or subprojects (table 3);[Footnote 43] 

* extramural fellowships and research career program grants, which 
support individuals as they obtain research training or pursue research 
careers (table 4); 

* extramural conferences, which are organized meetings where people 
exchange information (table 5); 

* other extramural research activities (table 6); and: 

* intramural research projects (table 7). 

Table 2: NIH-Supported Extramural Research Projects Related to TMJDs, 
Fiscal Years 2002-2006: 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Fibromyalgia, Depression and Myofascial TMD. 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Four Treatment Strategies for TMJ Disk Displacement. 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Gonadal Steroid Hormonal Regulation of Persistent Pain. 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Menstrual Cycle Effects on TMD Pain and Other Symptoms. 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Nerve- Muscle Interactions during Jaw Muscle 
Development. 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Pain and Analgesic Response--Sex and Hormone Variations. 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Parafunctional Activity and Temporomandibular Disorders. 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Photopolymerization for Noninvasive Cartilage Tissue. 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Puberty and Gender Differences in Pain Responsivity. 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Regulation of Masticatory Muscle Fiber Phenotype. 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Gender Differences in Pain Sensation and Pain Report. 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NICHD; 
Cofunding institute, center, or office: None; 
Project title: Neuronal Control of CGRP Gene Expression. 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Sex vs Gender in Pain Perception. 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Tissue Engineering of the Temporomandibular Joint. 

Fiscal year(s): 2002-2004; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: An Evaluation and Treatment Study of TMD. 

Fiscal year(s): 2002-2004; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Engineering Skeletal Muscle with Biodegradable 
Hydrogels. 

Fiscal year(s): 2002-2004; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Interaction Affecting Craniofacial Muscle 
Differentiation and Morphogenesis. 

Fiscal year(s): 2002-2005; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Engineering Joint Scaffolds for Function/Regeneration. 

Fiscal year(s): 2002-2005; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Kinesthetic Mechanisms in the Trigeminal System. 

Fiscal year(s): 2002-2005; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Mechanisms of Persistent Temporomandibular Pain. 

Fiscal year(s): 2002-2005; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: ORWH; 
Project title: Pain Management in Temporomandibular Joint Disorders. 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Estrogen and Inflammation in TMD Pain. 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Mechanical Environment in Mandibular Distraction. 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Nanocrystalline Coatings for Dental TMJ Implants / 
Nanotechnology in Osseointegration of TMJ Implants. 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: The Role of Tooth Mechanoreceptors in Jaw Movement. 

Fiscal year(s): 2003-2005; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: ORWH; 
Project title: Genotype and TMJD Vulnerability Traits. 

Fiscal year(s): 2003-2005; 
Primary funding institute or center: NIBIB; 
Cofunding institute, center, or office: None; 
Project title: Novel Amino Acid-Based Glass-Ionomer Biomaterials. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIBIB; 
Cofunding institute, center, or office: None; 
Project title: Biomaterials (Mg/Zn/F-BCPs) for Osteoporosis Therapy. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Bone Growth, Periosteal Migration and Muscle Function. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Brainstem Mechanisms Controlling Jaw Movements. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: ORWH; 
Project title: Brief Focused Treatment for TMD: Mechanisms of Action. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: CGRP Control in Trigeminal Neurons in Vitro and in Vivo. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Cytokine Pathways and Orofacial Pain. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: ORWH; 
Project title: Estrogenic Regulation of Inflammation Related to TMJD. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Inflammation of TMJDs: Role of Biomechanical Signals. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NINDS; 
Cofunding institute, center, or office: None; 
Project title: Inflammation-Induced Plasticity in Sensory Neurons. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIBIB; 
Cofunding institute, center, or office: None; 
Project title: Injectable Osteoinductive Biodegradable Composities. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Integrins and Mechanoreception in the Inflamed TMJ. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: ORWH; 
Project title: Neuronal Plasticity Related to TMD and Fibromyalgia. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Peripheral NMDA Receptors and TMD Pain Mechanisms. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: RAGE, Inflammation and Temporomandibular Joint 
Disorders. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Regulation of Mandibular Condylar Cartilage Growth. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Stem Cell- Driven Regeneration of the Mandibular Joint. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Trigeminal Pain Pathways. 

Fiscal year(s): 2004-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: ORWH; 
Project title: Hormonal Cycles in Women: Effects on TMD Pain & 
Symptoms. 

Fiscal year(s): 2004-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: TMJ Disc Regeneration. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: COMT and AR Polymorphism and Development of Painful TMD. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Craniofacial Tissue Engineering. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIBIB; 
Cofunding institute, center, or office: None; 
Project title: Integrin- Specific Implant Surfaces for Bone Repair. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Optimizing Mandibular Scaffold Modulus/Porosity Balance. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Peripheral Receptor Mechanisms in Orofacial Muscle Pain. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Sex Steroids, and TMJ Pain. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: CGRP Regulation of iNOS and MAP Kinases/Phosphatases in 
Trigeminal Ganglia Glia. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Effects of Gender and TMD on Mandibular Mechanics. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Neuron- Glia Interactions in Trigeminal Ganglia as a 
Basis for Future Therapy. 

Source: GAO analysis of data from NIH. 

Note: The extramural research project grants listed in this table are 
known as R01 grants. (NIH identifies types of projects using a specific 
letter, generally followed by a two-digit number.) Each such grant is 
made to support a discrete, specified, circumscribed project to be 
performed by a particular investigator(s) in an area representing the 
investigator's specific interest and competencies. Some of these 
projects are scheduled to end after fiscal year 2006. 

[End of table] 

Table 3: NIH-Supported Extramural Centers and Research Program Projects 
Related to TMJDs, Fiscal Years 2002-2006: 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: EEG Studies of Vibrotactile Adaptation; 
Type of grant: Research program project[A] (subproject). 

Fiscal year(s): 2002; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Effects of Dextromethorphan, Naloxone and Fentanyl on 
Experimental Pain Stimuli; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: HPA Axis Dysregulation in Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Investigate the Safety & Efficacy of LY293558 in 
Patients with Chronic Neuropathic Pain; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Investigate the Safety / Efficacy of LY293558 in 
Patients with Chronic Neuropathic Pain; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Mechanisms of Action in TMD Treatment; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002; 
Primary funding institute or center: NIAMS; 
Cofunding institute, center, or office: None; 
Project title: Multipurpose Arthritis and Musculoskeletal Diseases 
Center; 
Type of grant: Comprehensive center[C]. 

Fiscal year(s): 2002; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Neuroendocrinology of Masticatory Muscle Disorders in 
Women; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Pain Sensitivity and the Development of 
Temporomandibular Disorders; 
Type of grant: Research program project[A] (subproject). 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Self Care Intervention for TMD; 
Type of grant: Research program project[A] (subproject). 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Somatosensory Channel Interactions in Trigeminal Nerve-
Injured Patients; 
Type of grant: Research program project[A] (subproject). 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Vibratory Analgesia in Normals and Persons with 
Temporomandibular Disorders; 
Type of grant: Research program project[A] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Chronic Pain Management in Primary Care; 
Type of grant: Research program project[A] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NCCAM; 
Cofunding institute, center, or office: None; 
Project title: Craniofacial Complementary & Alternative Medicine 
Center; 
Type of grant: Specialized center[D]. 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Influence of Belief and Coping on TMD Pain Problems; 
Type of grant: Research program project[A] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Interactions between the HPA Axis and ANS in Women with 
Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Mechanisms in Chronic Multisymptom Illnesses; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Modification of Tonic and Experimental Pain in 
Fibromyalgia Syndrome; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Pain in Adolescents: Biologic/Psychosocial Risk Factors; 
Type of grant: Research program project[A] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Pain Perception in Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Pilot Study of Acupuncture in Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Regulation of Adrenal Function in Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Role of Female Reproductive Hormones in TMJ Disease; 
Type of grant: Comprehensive center[C] (subproject). 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Stress, Adrenergic and Inflammatory Factors in 4 
Disorders; 
Type of grant: Comprehensive center[C] (subproject). 

Fiscal year(s): 2002-2004; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Genetic Fibromyalgia Study; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2004; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Immunoneuroendocrine Response to Tetanus Toxoid; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2004; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Mapping of Genes for Fibromyalgia Syndrome; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2005; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Factors in Arthritis, CFS, Fibromyalgia & 
Temporomandibular Disorders; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2005; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Physiological Benefits of Psychological Well-Being in 
Chronic Disease; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2005; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: The Role of Female Reproductive Hormones in the 
Etiopathogenesis of TMJ Diseases; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Fibromyalgia: Central Factors in Its Etiopathogenesis--
Second Cycle; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Neuroendocrine Alterations in Fibromyalgia and IBS; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NIAMS; 
Cofunding institute, center, or office: ORWH; 
Project title: ORWH: SCOR on Sex and Gender Factors Affecting Women's 
Health; 
Type of grant: Specialized center[D]. 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Sex- Related Determinants of Pain Responses in 
Fibromyalgia and Temporomandibular Disorders / Sex-Related Determinants 
of Pain Responses in Fibromyalgia-Family Study; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2003-2004; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Autonomic Arousal and Abnormal Pain Sensitivity in 
Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2003-2004; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Cerebrospinal Fluid Neuropeptides in Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2003-2004; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Effect of Analgesics on Experimental Pain; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2003-2004; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Optimizing Fibromyalgia Self Management; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2003-2005; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Mapping Genes for Fibromyalgia Syndrome; 
Type of grant: Biotechnology resource grant[E] (subproject). 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Pain Management in Temporomandibular Joint Disorders; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Sensory Testing in Patients with Chronic Musculoskeletal 
Pain Syndromes; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2004; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Real-Time fMRI Directed Modulation of Pain Perception 
and Brain Activation in Chronic Pain; 
Type of grant: Biotechnology resource grant[E] (subproject). 

Fiscal year(s): 2004-2005; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Beneficial Exercise and Diet Effects in Fibromyalgia 
with Pyridostigmine; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2004-2005; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Evaluation of Sleep Dysfunction in Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2004-2005; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Functional MRI Study of Cognition in Patients with Lupus 
and Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2004-2005; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Testing for Single Nucleotide Polymorphisms Associated 
with Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2004-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Brief Focused Treatment for TMD: Mechanisms of Action; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2004-2006; 
Primary funding institute or center: NINDS; 
Cofunding institute, center, or office: None; 
Project title: CNS Processes Underlying Pain Regulation and 
Persistence; 
Type of grant: Research program project[A]. 

Fiscal year(s): 2004-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Long-Term FMS Self-Management; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2004-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Subject Registry: Interdisciplinary Studies of Chronic 
Multi-Symptom Illnesses; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2005; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Cardiovascular Disease Risk in Young Rheumatoid 
Arthritis Patients; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2005; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: University of Kentucky Center of Biomedical Research 
Excellence: Pilot Projects; 
Type of grant: Exploratory grant[F] (subproject). 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Effectiveness of EEG Biofeedback in the Treatment of 
Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Pain Mechanisms in Chronic Multi-Symptom Illnesses; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Peripheral and Central Sensitization after Eccentric 
Muscle Exercise; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: GHRH Perturbations in Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Immunological and Genetic Analysis of Autoinflammatory 
Genes in Fibromyalgia; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Locus of Pain Control: Neural Substrates and 
Modifability; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Mechanisms of Acupuncture Analgesia: A (fMRI) and (PET) 
Study; 
Type of grant: General clinical research center[B] (subproject). 

Fiscal year(s): 2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Sleep Disturbance and Pain Sensitivity in Chronic Pain; 
Type of grant: General clinical research center[B] (subproject). 

Source: GAO analysis of data from NIH. 

Notes: Grants for general clinical research centers are known as M01 
grants; research program projects and centers are in NIH's category of 
P grants. (NIH identifies types of projects using a specific letter, 
generally followed by a two-digit number.) These grants support 
multiple research activities or subprojects. NCRR and NIDCR reported 
these grants at the subproject level; NCCAM, NIAMS, and NINDS reported 
them at the overall center level. Some of these projects are scheduled 
to end after fiscal year 2006. 

[A] A research program project grant is designed to support a broadly 
based, multidisiciplary program that has a specific major objective or 
basic theme and generally involves the organized efforts of several 
investigators conducting related research projects. 

[B] A general clinical research center grant is designed to support a 
discrete research unit within a hospital or other inpatient care 
facility where scientists conduct studies on a wide range of issues. 
Covered costs include operational costs, such as equipment, and 
supplies. 

[C] A comprehensive center grant is designed to bring together related 
facilities within a specific community to achieve such goals as 
fostering research and educating professionals about specific 
disorders. 

[D] A specialized center grant is designed to support multidisciplinary 
research, both basic and clinical, on a specific disorder or biomedical 
issue. 

[E] A biotechnology research grant is designed to make biotechnological 
resources available to multiple qualified investigators. 

[F] An exploratory grant for a research program project or center is 
designed to support planning for new programs, expansion or 
modification of existing resources, or studies of the feasibility of 
interdisciplinary programs. 

[End of table] 

Table 4: NIH-Supported Extramural Fellowships and Research Career 
Program Grants Related to TMJDs, Fiscal Years 2002-2006: 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Individual Predoctoral Dental Scientist Fellowship; 
Type of grant: NIDCR individual predoctoral dental scientist 
fellowship[A]. 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIMH; 
Cofunding institute, center, or office: None; 
Project title: Early Detection and Prevention of Chronic Pain 
Disability; 
Type of grant: Research scientist development award--Research[B]. 

Fiscal year(s): 2002-2004; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Individual Predoctoral Dental Scientist Fellowship; 
Type of grant: NIDCR individual predoctoral dental scientist 
fellowship[A]. 

Fiscal year(s): 2002-2004; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Modulation of TMJ Degradation by Relaxin and Estrogen; 
Type of grant: Research scientist development award--Research[B]. 

Fiscal year(s): 2002-2004; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Tissue Engineering of Temporomandibular Joint Cartilage; 
Type of grant: Career transition award[C]. 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NINDS; 
Cofunding institute, center, or office: None; 
Project title: Spatial and Temporal Characteristics of Central 
Sensitization in Chronic Pain Diseases; 
Type of grant: Mentored patient-oriented research career development 
award[D]. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Brainstem Mechanisms of Craniofacial Muscle Pain; 
Type of grant: Career transition award[C]. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Molecular Targeting of the Vanilloid-1 Receptor; 
Type of grant: Career transition award[C]. 

Fiscal year(s): 2004-2006; 
Primary funding institute or center: NIMH; 
Cofunding institute, center, or office: None; 
Project title: Comorbidity of Mental Disorders and Pain; 
Type of grant: Research scientist award[E]. 


Fiscal year(s): 2004-2006; 
Primary funding institute or center: NINDS; 
Cofunding institute, center, or office: None; 
Project title: Sleep Disturbance and Pain Sensitivity in Chronic Pain; 
Type of grant: Mentored patient-oriented research career development 
award[D]. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Individual Predoctoral Dental Scientist Fellowship; 
Type of grant: NIDCR individual predoctoral dental scientist 
fellowship[A]. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Innovative Minimal Contact Therapy for Reducing TMD 
Pain; 
Type of grant: Postdoctoral individual National Research Service 
award[F]. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Mechanical Stimulation of Cells in Photopolymerized 
Gels; 
Type of grant: Career transition award[C]. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Individual Predoctoral Dental Scientist Fellowship; 
Type of grant: NIDCR individual predoctoral dental scientist 
fellowship[A]. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Regulation of Genes in Mouse Temporomandibular Joint; 
Type of grant: Career transition award[C]. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Accelerated Osteoarthritis in the TMJ of 
Biglycan/Fibromodilin DKO Mice; 
Type of grant: Career transition award[C]. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Central Pain Processing in Chronic Face Pain: fMRI 
Study; 
Type of grant: Mentored patient-oriented research career development 
award[D]. 

Source: GAO analysis of data from NIH. 

Notes: Extramural fellowship and research career program grants are in 
NIH's F and K categories of grants. (NIH identifies types of projects 
using a specific letter, generally followed by a two-digit number.) 
Some of these projects are scheduled to end after fiscal year 2006. In 
addition to the grants listed in this table, NIDCR funded three dentist 
scientist award grants to institutions to support programs designed to 
allow newly trained dentists, who were appointed by the institution, to 
develop independent research skills. These grants could have supported 
TMJD-related research, but were not necessarily used for such research 
and therefore are not listed. 

[A] An NIDCR individual predoctoral dental scientist fellowship is 
designed to support integrated dental and graduate research training 
that leads to attainment of both a Doctor of Dental Surgery or Doctor 
of Dental Medicine degree and a Doctor of Philosophy degree. 

[B] A research scientist development award for research is designed to 
support a researcher who needs additional experience to pursue a 
commitment to research. 

[C] A career transition award is designed to support newly trained 
investigators by facilitating establishment of a record of independent 
research to sustain or promote a successful research career. 

[D] A mentored patient-oriented research career development award is 
designed to support supervised study and research for clinically 
trained professionals who have the potential to develop into 
productive, clinical investigators focusing on patient-oriented 
research. 

[E] A research scientist award is designed to support a research 
scientist who is qualified to pursue independent research that would 
extend the research program of that researcher's institution or direct 
an essential part of that research program. 

[F] A postdoctoral individual National Research Service award is 
designed to support individuals who have completed doctoral training as 
they broaden their scientific background and extend their potential for 
research. 

[End of table] 

Table 5: NIH-Supported Extramural Conferences Related to TMJDs, Fiscal 
Years 2002-2006: 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: NIAMS, NIBIB; 
Project title: Joint and Muscle Dysfunction of Temporomandibular Joint. 

Fiscal year(s): 2004; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: NIAMS, NIBIB, ORWH, ORD; 
Project title: Advancing Diagnostic Approaches for TMJ Disorders. 

Fiscal year(s): 2004, 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Craniofacial Skeletal Tissue Engineering Conference. 

Fiscal year(s): 2005; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: ECM in Structure & Function of the Craniofacial Complex. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: NIBIB; 
Project title: TMJ Bioengineering Conference. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: NIAMS, NIDA, NIDCD, NINDS, 
ORWH; 
Project title: A Systems Approach to the Understanding of TMJ as a 
Complex Disease. 

Source: GAO analysis of data from NIH. 

Note: Conferences are funded as R13 grants, which support organized 
meetings where people exchange information. (NIH identifies types of 
projects using a specific letter, generally followed by a two-digit 
number.) Some of these projects are scheduled to end after fiscal year 
2006. 

[End of table] 

Table 6: Other NIH-Supported Extramural Research Projects Related to 
TMJDs, Fiscal Years 2002-2006: 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Cellular and Molecular Targeting of TMJ Destruction; 
Type of grant or other support: Small research grant[A]. 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: K-Opioid Systems--Sex and Pregnancy Linked Differences; 
Type of grant or other support: First independent research support and 
transition award[B]. 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Animal Models for TMJ Research: Functional 3-D Loading; 
Type of grant or other support: Small research grant[A]. 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: DentoCAT: Dentomaxillofacial CT Scanner; 
Type of grant or other support: Small business innovation research 
grant--phase II[C]. 

Fiscal year(s): 2002-2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Mechanical Stimulation for TMJ Disc Tissue Engineering; 
Type of grant or other support: Small research grant[A]. 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NIDCR[D]; 
Cofunding institute, center, or office: NIBIB, ORWH; 
Project title: NIDCR TMJ Implant Registry and Repository; 
Type of grant or other support: Research and development contract[E]. 

Fiscal year(s): 2002-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Research Diagnostic Criteria--Reliability and Validity; 
Type of grant or other support: Research project (cooperative 
agreement)[F]. 

Fiscal year(s): 2003; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: A 3-D Interactive Atlas of the Human Mandible and TMJ; 
Type of grant or other support: Small business innovation research 
grant--phase I[G]. 

Fiscal year(s): 2003-2004; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: A New Nanocomposite Scaffold for TMJ Tissue Engineering; 
Type of grant or other support: Exploratory/developmental grant[H]. 

Fiscal year(s): 2003-2004; 
Primary funding institute or center: NIBIB; 
Cofunding institute, center, or office: None; 
Project title: Molecular Imprinting to Control Cell Responses; 
Type of grant or other support: Exploratory/developmental grant[H]. 

Fiscal year(s): 2003-2004; 
Primary funding institute or center: NIDA; 
Cofunding institute, center, or office: None; 
Project title: Recombinant Herpes Injection into Trigeminal Ganglia; 
Type of grant or other support: Exploratory/developmental grant[H]. 

Fiscal year(s): 2003-2004; 
Primary funding institute or center: NCCAM; 
Cofunding institute, center, or office: None; 
Project title: Shamanic Healing for Women with TMD; 
Type of grant or other support: Exploratory/developmental grant[H]. 

Fiscal year(s): 2004; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: Digitized Transmission Electron Microscope: 
Temporomandibular Disorders; 
Type of grant or other support: Biomedical research support shared 
instrumentation grant[I]. 

Fiscal year(s): 2004; 
Primary funding institute or center: NIBIB; 
Cofunding institute, center, or office: None; 
Project title: Incorporating Bone Minerals into Orthopaedic Surfaces; 
Type of grant or other support: Small business technology transfer 
grant--phase I[J]. 

Fiscal year(s): 2004; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Neural Substrates of Adaptive Jaw Movement; 
Type of grant or other support: Academic research enhancement award[K]. 

Fiscal year(s): 2004; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Polymer Gel to Treat TMJ Pain; 
Type of grant or other support: Small business innovation research 
grant--phase I[G]. 

Fiscal year(s): 2004-2005; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: ORWH; 
Project title: Mast Cell Role in Masseter Muscle Repair; 
Type of grant or other support: Exploratory/developmental grant[H]. 

Fiscal year(s): 2004-2005; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Temporomandibular Joint Syndrome in Females; 
Type of grant or other support: Exploratory/developmental grant[H]. 

Fiscal year(s): 2004-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: A 3-D Interactive Atlas of the Maxilla, Mandible & TMJ; 
Type of grant or other support: Small business innovation research 
grant--phase II[C]. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Mandibular Bone Transport Reconstruction Plate; 
Type of grant or other support: Small business technology transfer 
grant--phase II[L]. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Mechanotransduction in Mandibular Tissue Engineering; 
Type of grant or other support: Small research grant[A]. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Neural Mechanisms of Chronic Muscle Pain Disorders; 
Type of grant or other support: Small research grant[A]. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Orofacial Pain: Prospective Evaluation and Risk 
Assessment[M]; 
Type of grant or other support: Research project (cooperative 
agreement)[F]. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NCCAM; 
Cofunding institute, center, or office: None; 
Project title: TCM for TMD: A Multi-Site Whole Systems Trial; 
Type of grant or other support: Research project (cooperative 
agreement)[F]. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: A Novel Model of TMJ Osteoarthritis to Define Glial 
Reactivity in Chronic Pain; 
Type of grant or other support: Exploratory/developmental grant[H]. 

Fiscal year(s): 2006; 
Primary funding institute or center: NCRR; 
Cofunding institute, center, or office: None; 
Project title: ICP-MS Instrument for Baylor College of Dentistry; 
Type of grant or other support: Biomedical research support shared 
instrumentation grant[I]. 

Fiscal year(s): 2006; 
Primary funding institute or center: NIDCR; 
Cofunding institute, center, or office: None; 
Project title: Joint Degeneration: Somatic Mosaic Analysis in a 
Transgenic Mouse; 
Type of grant or other support: Exploratory/developmental grant[H]. 

Source: GAO analysis of data from NIH. 

Notes: Biomedical research support shared instrumentation grants are 
known as S10 grants, research and development contracts are designated 
by N01, and research projects (cooperative agreements) are designated 
by U01. The remaining projects listed in this table are funded under 
NIH's R grant programs. (NIH identifies types of projects--including 
grants, cooperative agreements, and contracts--using a specific letter, 
generally followed by a two-digit number.) Some of these projects are 
scheduled to end after fiscal year 2006. 

[A] Small research grants are designed to support research that can be 
carried out in a short period of time with limited resources. 

[B] First independent research support and transition awards were 
designed to support newly independent investigators as they initiated 
their own research and demonstrated the merit of their own research 
ideas. NIH stopped accepting applications for these awards in 1998. 

[C] Small business innovation research grants--phase II are designed to 
support in-depth development of research and development concepts that 
have been shown to be feasible in a prior phase of funding. 

[D] NIDCR did not provide funding for this project in fiscal year 2004. 

[E] Research and development contracts support research-related 
activities conducted under contract to NIH. 

[F] Research projects (cooperative agreements) support a discrete, 
specified, circumscribed project to be performed by a particular 
investigator(s) in an area representing the investigator's specific 
interest and competencies, with the anticipation that NIH staff will 
have a substantial programmatic involvement in the project. 

[G] Small business innovation research grants--phase I are designed to 
support time-and resource-limited research to establish the technical 
merit and feasibility of research and development concepts that could 
lead to commercial products or services. 

[H] Exploratory/developmental grants are designed to encourage the 
development of new research activities by supporting the early and 
conceptual stages of their development. 

[I] Biomedical research support shared instrumentation grants are 
designed to make research instruments available to multiple NIH- 
supported researchers at the same institution. 

[J] Small business technology transfer grants--phase I are designed to 
support time-and resource-limited research by small businesses in 
cooperation with research institutions to establish the technical merit 
and feasibility of ideas that have potential for commercialization. 

[K] Academic research enhancement awards are designed to support small- 
scale research projects conducted by faculty in institutions that grant 
primarily baccalaureate degrees. 

[L] Small business technology transfer grants--phase II are designed to 
support in-depth, time-and resource-limited research by small 
businesses in cooperation with research institutions on ideas that have 
potential for commercialization and have been shown to be feasible in a 
prior phase of funding. 

[M] This project was initially entitled "Risk Factors for Onset and 
Persistence of TMD." 

[End of table] 

Table 7: NIH-Supported Intramural Research Projects Related to TMJDs, 
Fiscal Years 2002-2006: 

Fiscal year(s): 2002; 
Primary funding institute or center: NIDCR; 
Project title: Clinical Investigations in Infectious & Autoimmune 
Diseases. 

Fiscal year(s): 2002-2004; 
Primary funding institute or center: NIDCR; 
Project title: Experimental Therapeutics for Chronic Orofacial Pain. 

Fiscal year(s): 2003-2006; 
Primary funding institute or center: NIDCR; 
Project title: Analgesic Mechanisms in Patients with Chronic Pain. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Project title: Function of Skeletal Matrix Genes. 

Fiscal year(s): 2005-2006; 
Primary funding institute or center: NIDCR; 
Project title: Genetic Studies of Human Craniofacial Diseases. 

Source: GAO analysis of data from NIH. 

Note: Scientists in NIH Intramural Research Programs are generally 
responsible for conducting original research consonant with the goals 
of their individual institute or center. Intramural research projects 
are coded as Z01 projects. (NIH identifies types of projects using a 
specific letter, generally followed by a two-digit number.) 

[End of table] 

[End of section] 

Enclosure III: 

Areas of Research Addressed in Targeted Funding Announcements Involving 
Temporomandibular Joint and Muscle Disorders Issued by the National 
Institutes of Health: 

From December 2005 through December 2007, the National Institutes of 
Health (NIH) released targeted funding announcements--public 
announcements that describe opportunities for NIH funding--for research 
in areas that either focused directly on temporomandibular joint and 
muscle disorders (TMJD) or addressed other areas, such as pain, that 
could include TMJDs. These targeted funding announcements were issued 
by the following NIH institutes and offices: 

* National Cancer Institute (NCI), 

* National Institute of Arthritis and Musculoskeletal and Skin Diseases 
(NIAMS), 

* National Institute of Biomedical Imaging and Bioengineering (NIBIB), 

* National Institute of Dental and Craniofacial Research (NIDCR), 

* National Institute of Neurological Disorders and Stroke (NINDS), 

* National Institute of Nursing Research (NINR), 

* National Institute on Deafness and Other Communication Disorders 
(NIDCD), and: 

* Office of Behavioral and Social Sciences Research (OBSSR) and the 
Office of Research on Women's Health (ORWH), both within NIH's Office 
of the Director. 

Specifically, NIH released targeted funding announcements from December 
2005 through December 2007 covering one area of research that was 
directly focused on TMJDs--the co-occurrence of TMJDs with other 
chronic conditions such as chronic fatigue syndrome. During the same 2- 
year time period, NIH issued targeted funding announcements addressing 
15 other areas of research, such as pain, that identified TMJDs as a 
possible--but not required--research topic.[Footnote 44] (See table 8 
for a list of the 16 areas of research addressed by these targeted 
funding announcements.) 

Table 8: Areas of Research Addressed in NIH's Targeted Funding 
Announcements Involving TMJDs: 

Area of research[A]: Temporomandibular Joint and Muscle Disorders: 
Pathophysiological Mechanisms Linking Comorbid Conditions; 
Issuing institute, center, or office[B]: NIDCR; 
Publication date(s): 3/24/2006; 
12/13/2006[D]; 
Expiration date: 5/8/2009; 
Type of grant(s)[C]: Research project grant;[E] small research grant;f 
exploratory/developmental grantg; 
Focus of proposed research: Must involve TMJDs. 

Area of research[A]: Developing Complex Models of Oral Health 
Behavior[H]; 
Issuing institute, center, or office[B]: NIDCR; 
Publication date(s): 12/26/2007; 
Expiration date: 11/15/2008; 
Type of grant(s)[C]: Exploratory/developmental grant[G]; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Collaborative Research on Tinnitus[H]; 
Issuing institute, center, or office[B]: NIDCD; 
Publication date(s): 8/24/2007; 
Expiration date: 10/23/2007; 
Type of grant(s)[C]: Research project grant[E]; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Application of Metabolomics for Translational and 
Biological Research; 
Issuing institute, center, or office[B]: NCI; 
Publication date(s): 1/17/2007; 
Expiration date: 1/8/2010; 
Type of grant(s)[C]: Research project grant;[E] 
exploratory/developmental grantg; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Mechanisms, Models, Measurement, & Management in 
Pain Research; 
Issuing institute, center, or office[B]: NINR; 
Publication date(s): 8/31/2006; 
1/8/2007[D]; 
Expiration date: 9/8/ 2009; 
Type of grant(s)[C]: Research project grant;[E] small research grant;f 
exploratory/developmental grantg; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Chronic Fatigue Syndrome: Pathophysiology and 
Treatment; 
Issuing institute, center, or office[B]: ORWH; 
Publication date(s): 12/22/2006; 
Expiration date: 11/6/2007; 
11/17/2007[I]; 
Type of grant(s)[C]: Research project grant;[E] small research grant;f 
exploratory/developmental grantg; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Epidemiological and Behavioral Research in Oral 
Health; 
Issuing institute, center, or office[B]: NIDCR; 
Publication date(s): 12/14/2006; 
Expiration date: 1/8/2010; 
Type of grant(s)[C]: Research project grant[E]; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Research on Mind-Body Interactions and Health; 
Issuing institute, center, or office[B]: OBSSR; 
Publication date(s): 11/21/2006; 
Expiration date: 1/8/2010; 
Type of grant(s)[C]: Research project grant[E]; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Enabling Technologies for Tissue Engineering and 
Regenerative Medicine; 
Issuing institute, center, or office[B]: NIBIB; 
Publication date(s): 8/1/2006; 
Expiration date: 5/21/2009; 
Type of grant(s)[C]: Research project grant[E]; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: New Models of Pain Relevant to the Trigeminal 
System[H]; 
Issuing institute, center, or office[B]: NIDCR; 
Publication date(s): 5/17/2006; 
7/14/2006[I]; 
Expiration date: 11/22/2006; 
Type of grant(s)[C]: Research project grant;[E] 
exploratory/developmental grantg; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Specialized Centers Of Interdisciplinary Research 
(SCOR) On Sex And Gender Factors Affecting Women's Health[H]; 
Issuing institute, center, or office[B]: NIAMS; 
Publication date(s): 6/12/2006; 
Expiration date: 9/15/2006; 
Type of grant(s)[C]: Specialized center grant[J]; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Joint Degeneration: Mouse Models; 
Issuing institute, center, or office[B]: NIAMS; 
Publication date(s): 6/9/2006; 
Expiration date: 1/8/2008; 
Type of grant(s)[C]: Exploratory/ developmental grant[G]; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: NIDCR Clinical Trial Planning Grant; 
Issuing institute, center, or office[B]: NIDCR; 
Publication date(s): 3/17/2006; 
Expiration date: 1/8/2009; 
Type of grant(s)[C]: Exploratory/ developmental grant[G]; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: International Collaborative Oral Health Research 
Planning Grant; 
Issuing institute, center, or office[B]: NIDCR; 
Publication date(s): 3/8/2006; 
Expiration date: 1/8/2009; 
Type of grant(s)[C]: Exploratory/developmental grant[G]; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Neurobiology Of Persistent Pain Mediated By The 
Trigeminal Nerve; 
Issuing institute, center, or office[B]: NINDS; 
Publication date(s): 3/3/2006; 
Expiration date: 7/1/2006; 
Type of grant(s)[C]: Exploratory/developmental grant[G]; 
Focus of proposed research: May involve TMJDs. 

Area of research[A]: Drug Delivery Systems for Orofacial Disease; 
Issuing institute, center, or office[B]: NIDCR; 
Publication date(s): 12/13/2005; 
Expiration date: 5/8/2008; 
Type of grant(s)[C]: Small business technology transfer grant--phase I 
and II;[K]; 
Small business innovation research grant--phase I and II[L]; 
Focus of proposed research: May involve TMJDs. 

Source: GAO analysis of NIH data. 

Notes: This table includes areas of research addressed in targeted 
funding announcements--program announcements or requests for 
applications--released from December 2005 through December 2007. 
Program announcements describe areas of research that NIH is interested 
in funding, but for which it has generally not set funds aside. 
Requests for applications describe areas of research for which NIH has 
set funds aside. No requests for proposals (solicitations for contract 
proposals) issued during this time frame involved TMJDs. If an 
announcement was reissued during this time period, we listed the most 
recent announcement. Expired announcements were included in recognition 
of the lag time between receipt of an application submitted to NIH in 
response to a funding announcement and funding decisions reached by 
NIH. 

[A] Funding announcements with the same title and scientific scope are 
grouped together as one area of research. We defined the area of 
research by the title of the funding announcement(s). 

[B] We have listed the issuing organization identified in NIH's online 
Guide for Grants and Contracts. 

[C] In general, NIH issued a separate funding announcement for each 
type of grant listed. 

[D] The later date applies to the funding announcement for the research 
project only. 

[E] Research project grants support discrete, specified, circumscribed 
projects to be performed by a particular investigator(s) in an area 
representing the investigator's specific interest and competencies. 

[F] Small research grants are designed to support research that can be 
carried out in a short period of time with limited resources. 

[G] Exploratory/developmental grants are designed to encourage the 
development of new research activities by supporting the early and 
conceptual stages of their development. 

[H] The funding announcements for this area of research were requests 
for applications. All other funding announcements listed in the table 
were program announcements. 

[I] The earlier date applies to the funding announcement for research 
project grants only. NIH officials told us that the announcement 
entitled "Chronic Fatigue Syndrome: Pathophysiology and Treatment" that 
had an expiration date of 11/17/2007 has remained active and will be 
replaced through an arrangement with the Office of Extramural Research. 

[J] A specialized center grant is designed to support multidisciplinary 
research, both basic and clinical, on a specific disorder or biomedical 
issue. 

[K] Small business technology transfer grants--phase I are designed to 
support time-and resource-limited research by small businesses in 
cooperation with research institutions to establish the technical merit 
and feasibility of ideas that have potential for commercialization. 
Phase II grants are designed to support in-depth, time-and resource- 
limited research by small businesses in cooperation with research 
institutions on ideas that have potential for commercialization and 
have been shown to be feasible in a prior phase of funding. 

[L] Small business innovation research grants--phase I are designed to 
support time-and resource-limited research to establish the technical 
merit and feasibility of research and development concepts that could 
lead to commercial products or services. Phase II grants are designed 
to support in-depth development of research and development concepts 
that have been shown to be feasible in a prior phase of funding. 

[End of table] 

[End of section] 

Enclosure IV: 

GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Marcia Crosse, (202) 512-7114 or [email protected]: 

Acknowledgments: 

In addition to the contact named above, Geraldine Redican-Bigott, 
Assistant Director; Kristen Joan Anderson; Laura Sutton Elsberg; 
Cathleen Hamann; and Julian Klazkin made key contributions to this 
report. 

[End of section] 

Footnotes: 

[1] In this report, we use the acronym TMJDs to be consistent with the 
terminology preferred for this set of conditions by the National 
Institutes of Health (NIH). Other common acronyms include TMJ and TMD. 

[2] Although NIH previously reported that TMJDs may affect as many as 
10 million Americans, this estimate is based on papers presented at the 
Technology Assessment Conference on TMJDs in 1996. NIH officials told 
us that additional epidemiological research is needed to validate the 
number of Americans affected by TMJDs. 

[3] Artificial temporomandibular joint implants have been used to 
replace the jaw joint in an effort to decrease pain and increase jaw 
function for some individuals in this latter group. Experts recommend 
that conservative treatments be used to relieve symptoms before 
irreversible treatments--such as implants--are used. Conservative 
treatments can include taking pain medications, using a splint or bite 
guard, applying ice packs, or eating soft food. See GAO, Medical 
Devices: FDA's Approval of Four Temporomandibular Joint Implants, GAO- 
07-996 (Washington, D.C.: Sept. 17, 2007). 

[4] Management of Temporomandibular Disorders: National Institutes of 
Health Technology Assessment Conference Statement April 29-May 1, 1996 
(Bethesda, Md.: U.S. Department of Health and Human Services, National 
Institutes of Health, 1996). 

[5] Applied research involves systematic study to gain the knowledge or 
understanding necessary to determine the means by which a recognized 
and specific need may be met. Applied research that addresses clinical 
issues (such as the diagnosis or treatment of disease) is often 
referred to as clinical research. Basic research involves systematic 
study directed toward fuller knowledge or understanding of the 
fundamental aspects of phenomena and of observable facts without 
specific applications towards processes or products in mind. Basic 
research may, however, include activities with the potential for broad 
applications. 

[6] Biomechanics refer to the mechanical bases of biological, 
especially muscular, activity and the study of the principles and 
relations involved. Research on the biomechanics of TMJDs could 
include, for example, research on jaw movement or jaw muscle 
development. 

[7] When we did our work, fiscal year 2006 was the most recent year for 
which NIH could provide full information about the TMJD-related 
projects it funded. 

[8] See [hyperlink, http://grants.nih.gov/grants/guide/index.html] 
(accessed on Jan. 16, 2008). 

[9] NIH's reported obligations are based on information provided by its 
institutes and centers. These institutes and centers currently use 
different procedures to determine whether a project is TMJD-related. 
The institutes and centers also estimate how much of the total 
obligation for the project to designate as TMJD-related based on 
scientific judgments about the project. These estimated obligations do 
not necessarily represent the exact obligations, nor do they 
necessarily represent actual spending or costs. For example, reported 
obligations may be greater than actual spending on TMJD-related 
research if institutes or centers designated a high proportion of the 
total amount obligated to a project as TMJD-related and only a small 
proportion of the project's actual costs were TMJD-related. Reported 
obligations may be lower than actual spending if institutes or centers 
did not identify all TMJD-related projects, or did not include projects 
of peripheral relevance to TMJDs. NIH officials stated that the process 
of determining which projects are sufficiently related to TMJDs and 
which are not is complex and involves scientific judgment. For example, 
much of NIH's extensive portfolio of basic research on pain is 
potentially relevant to TMJDs, and NIH did not classify all of its 
basic pain research as TMJD-related. NIH is developing a new process 
for classifying its research by disease or condition, including TMJDs, 
that is expected to be implemented in phases by all institutes and 
centers beginning with fiscal year 2008 data. NIH expects this system 
to result in greater consistency across institutes and centers in 
estimates of obligations, including TMJD-related estimates. 

[10] See, for example, L. A. Aaron, M. M. Burke, and D. Buchwald, 
"Overlapping Conditions Among Patients With Chronic Fatigue Syndrome, 
Fibromyalgia, and Temporomandibular Disorder," Archives of Internal 
Medicine, vol. 160 (2000). 

[11] See, for example, T. T. Dao, K. Knight, and V. Ton-That, 
"Modulation of Myofascial Pain by the Reproductive Hormones: A 
Preliminary Report," Journal of Prosthetic Dentistry, vol. 79, no. 6 
(1998); M. P. Warren and J. L. Fried, "Temporomandibular Disorders and 
Hormones in Women," Cells, Tissues, Organs, vol. 169, no. 3 (2001); and 
N. Landi, I. Lombardi, D. Manfredini, E. Casarosa, K. Biondi, M. 
Gabbanini, and M. Bosco, "Sexual Hormone Serum Levels and 
Temporomandibular Disorders: A Preliminary Study," Gynecological 
Endocrinology, vol. 20, no. 2 (2005). 

[12] NIH awards a cooperative agreement rather than a grant when it 
anticipates that there will be substantial scientific or programmatic 
involvement of NIH staff after funds are awarded. Substantial 
involvement means that, after the cooperative agreement is awarded, 
scientific or program staff will assist, guide, coordinate, or 
participate in project activities. In contrast to grants and 
cooperative agreements, which support research plans developed by 
extramural investigators, NIH research and development contracts are 
awarded to academic institutions and other nonprofit and commercial 
organizations to procure specific activities for scientific inquiries 
in particular areas of research and development needed by NIH. 

[13] The remaining 6 percent of NIH's budget is used for NIH buildings 
and facilities and the National Library of Medicine, among other 
things. 

[14] NIH began accepting applications that name multiple principal 
investigators in February 2007. 

[15] Typically, grantees develop proposals for multiyear projects for 
which the first year of funding is provided through competitive grants, 
with a recommended period of support that can be more than 1 year. For 
subsequent years, grantees may obtain funding through noncompetitive 
continuation grants. 

[16] NIH is currently transitioning from general clinical research 
center grants to a new type of similar grant called clinical and 
translational science awards. 

[17] NIH issues program announcements and requests for applications to 
signal interest in receiving applications for grants and cooperative 
agreements. NIH issues requests for proposals to solicit contract 
proposals. Funding announcements are issued by one or more institute(s) 
or center(s). Other institutes and centers with potential interest in 
funding some of the research may be listed on the funding announcement. 

[18] In some cases, research is cofunded by two or more institutes and 
centers after separate review by each of the funding institute's and 
center's council or board. In these cases, one institute or center--the 
primary funding institute or center--assumes administrative 
responsibility for the grant. Applications submitted in response to 
requests for applications--for which funds have been set aside--are 
reviewed as a group. 

[19] NIDCR's mission is to improve oral, dental, and craniofacial 
health through research, research training, and the dissemination of 
information. 

[20] Of the 27 institutes and centers, 24 have the authority to award 
grants. 

[21] In addition to members from NIH, this working group includes 
representatives from other federal agencies, including the Agency for 
Healthcare Research and Quality, the Food and Drug Administration, the 
Centers for Disease Control and Prevention, and the Department of 
Defense. Nonfederal representatives from patient advocacy groups and 
academia participate as nonvoting observers. 

[22] Some of these projects were scheduled to end after fiscal year 
2006. 

[23] Some institutes and centers reported which specific subprojects of 
research program projects or centers were TMJD-related; other 
institutes and centers reported which overall research program projects 
or centers included TMJD-related subprojects. In this report, we use 
the term "project" to refer to both overall projects and subprojects 
unless otherwise specified. 

[24] NIDCR officials identified career development awards as an 
important means of supporting TMJD-related research. 

[25] Pathophysiology refers to the functional changes that accompany a 
particular syndrome or disease. 

[26] Temporary use of an intraoral splint is a common, conservative 
dental treatment for TMJDs. There are different types of such splints. 
For example, one type is designed to help alter the jaw's posture to a 
more open, relaxed, resting position. Another type of intraoral splint 
attempts to decrease the compression load on the joint. 

[27] SCOR here refers to Specialized Center of Research. 

[28] Mechanical loading involves the exertion of force on the joint. 

[29] As of February 2008, NIH officials reported that they have not 
funded any TMJD-related research applications in response to these 
three funding announcements. NIDCR officials reported that they had 
received 9 such applications, but that none of them were considered to 
be of sufficient scientific merit to warrant funding. ORWH officials 
informed us that NIH had not completed its scientific review of 
applications received in response to these announcements, which have 
not expired. 

[30] Applications submitted in response to an expired program 
announcement may be delayed in the review process or returned without 
review. In contrast, NIH does not accept applications submitted in 
response to expired requests for applications. 

[31] The following institutes issued funding announcements for these 
areas of research: National Cancer Institute, National Institute of 
Arthritis and Musculoskeletal and Skin Diseases, National Institute of 
Biomedical Imaging and Bioengineering, NIDCR, National Institute of 
Neurological Disorders and Stroke, National Institute of Nursing 
Research, and National Institute on Deafness and Other Communication 
Disorders. NIH's ORWH and Office of Behavioral and Social Sciences 
Research--both within the Office of the Director--each issued one of 
these funding announcements. 

[32] As of February 2008, NIDCR officials reported that they funded 2 
of 3 TMJD-related research applications submitted in response to the 
targeted funding announcement "Neurobiology of Persistent Pain Mediated 
by the Trigeminal Nerve" and 10 of 43 TMJD-related applications 
submitted in response to "New Models of Pain Relevant to the Trigeminal 
System." For the other targeted funding announcements, NIH officials 
reported that they had either not received TMJD-related research 
applications in response, or had not received TMJD-related applications 
considered to be of sufficient scientific merit to warrant funding. NIH 
may also fund additional applications on these areas of research that 
are not submitted in response to these targeted funding announcements. 

[33] As of February 2008, NIH officials reported that one application 
was received and funded in response to this targeted funding 
announcement that could provide specialized training in issues of 
relevance to TMJDs. 

[34] When we did our work, fiscal year 2006 was the most recent year 
for which NIH could provide full information about the TMJD-related 
projects it funded. 

[35] Each year, NIH prepares an estimate of its funding for research on 
TMJDs and other disorders for public distribution. 

[36] For example, the National Institute of Neurological Disorders and 
Stroke began reporting TMJD-related research in fiscal year 2004. 

[37] CRISP is a publicly available database that includes information 
about, and abstracts for, projects funded by NIH. 

[38] In this report, we use the acronym TMJDs to refer to this set of 
disorders. Some experts use the acronyms TMJ or TMD instead. 

[39] GAO, Chronic Fatigue Syndrome: CDC and NIH Research Activities Are 
Diverse, but Agency Coordination Is Limited, GAO/HEHS-00-98 
(Washington, D.C.: June 2, 2000). 

[40] NIH's online Guide for Grants and Contracts is available through 
NIH's Office of Extramural Research Web site at [hyperlink, 
http://grants.nih.gov/grants/guide/index.html] (accessed on Jan. 16, 
2008). 

[41] We excluded two targeted funding announcements on TMJDs. One of 
these funding announcements notified applicants who have a currently 
active NIH grant of an option to obtain supplemental funding to support 
travel or workshop activities to support exchange, training, and 
research collaborations between scientists in the United States and 
Japan. The second excluded funding announcement was for institutional 
training grants, which are not designed to support specific research 
activities. 

[42] We did not ask NIH to provide this information for two targeted 
funding announcements--both requests for applications--with a peer 
review date in 2008, for which funding decisions were not made prior to 
the completion of our audit work. Applications submitted to NIH in 
response to requests for applications are reviewed as a group in a 
onetime competition. In contrast, applications submitted in response to 
program announcements are not reviewed in a onetime competition. 

[43] Some institutes and centers reported which specific subprojects of 
research program projects or centers were TMJD-related; other 
institutes and centers reported which overall research program projects 
or centers included TMJD-related subprojects. In this report, we use 
the term "project" to refer to both overall projects and subprojects 
unless otherwise specified. 

[44] We excluded two targeted funding announcements on TMJDs. One of 
these funding announcements notified applicants with an active NIH 
grant of an option to obtain supplemental funding to support travel or 
workshop activities to support exchange, training, and research 
collaborations between scientists in the United States and Japan. The 
other excluded funding announcement signaled interest in funding 
institutional training grants, which are not designed to support 
specific research activities. 

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