First, the AUTOPP website will be posting three newsletters each year so that the membership will be kept better informed about events taking place within the organization. We invite members to take advantage of this type of communication so that an active interaction with the members of the Executive Council can be established and new ideas discussed.

Second, more formal communication between the AUTOPP and other organizations and groups with similar interests has been initiated. This will help facilitate collaboration and, equally important, strengthen our organization.

Third, the AUTOPP website will be further developed in ways that will become increasingly a resource that we will all find useful.

I might mention that an important milestone is the proposed active participation of the AUTOPP membership with a large scale diagnostic study being conducted by several of our members and under the aegis of NIDCR (see the minutes from our Annual Meeting). Also, NIDCR researchers expressing their interest for active collaboration with AUTOPP members is noteworthy. Such exciting proposals will open the opportunity for active membership participation in shaping the direction of clinical research like never before.

I hope that all AUTOPP members will enthusiastically embrace these opportunities so that the organization will become an increasingly useful forum within which to discuss and promote new ideas for research, teaching activities, and clinical direction. One topic proposed for the next Annual meeting in San Diego, California is related to whiplash and cervical spine injuries as they relate to TMD/orofacial pain. I invite members who would be interested in speaking on this topic, or any other, to let me know in advance so we can successfully plan our next Annual meeting. I can be reached at oplesh@itsa.ucsf.edu. I look forward to hearing from the membership about any of our exciting new goals.

In the program, Glaros described how evidence-based dentistry (EBD) is an approach to clinical practice that involves the ability to locate, critique, summarize and apply the best available information to patients, including the best available external evidence and individual clinical expertise, or the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The evidence could be in the form of manufacturers' claims, personal clinical experience, CE programs, study clubs and, best of all, published papers and research reports. One reason why EBD is needed is that reinforcement of unsound practice can occur with single patient "successes" in a private practice environment. Furthermore, new evidence is constantly being generated which will significantly change the way we care for patients, but many clinicians fail to become aware of this information. Both our up-to-date knowledge and clinical performance can therefore deteriorate with time. In addition, traditional CE programs do not seem to adequately improve clinical performance, whereas EBD approaches to clinical learning may better keep practitioners up-to-date.

There are four tasks required in order to practice EBD. First, we must ask a well-built clinical question. This could involve identifying the patient or the problem, the intervention, cause or prognostic factor, comparing interventions, and assessing the outcome(s).

Second, we must search for the best evidence. In order to do this, we must select the resource(s) and design a search strategy. There are several sources of evidence, including databases (e.g., Medline, Grateful Med), journals and reference libraries, CD-ROMs, the Internet, journal clubs, and colleagues.

Third, once the evidence has been gathered pertinent to the pointed clinical question, it must be critically appraised. Two key questions must be asked at this point: "Is the evidence valid?" "And is the evidence useful?" Regarding validity, students should be able to evaluate the scientific quality of evidence. As far as usefulness, we must assess, for instance, whether the intervention is appropriate for our specific patient and his/her circumstances and attitudes and whether the costs, both financial and clinical, are acceptable to the patient and the clinician.

The last task is for us to apply the results and evaluate. This can involve various methods of outcome assessment. Glaros suggested that EBD may not provide answers applicable to all the problems facing all of our orofacial pain patients and that EBD must be tempered with clinical expertise related to patient assessment, characteristics, and preferences. He also described how EBD is taught at UMKC, both in the classroom and clinic settings, and presented a variety of tips that could make this type of teaching easier for those of us in TMD and orofacial pain educational settings. Lastly, he provided the following web sites that can provide valuable information in the area of EBD: www.cochrane.org, www.cche.net, and www.ihs.ox.ac.uk/cebd/index.html.

In summary, as teachers in orofacial programs, we are aware of the controversies in the field of TMD and orofacial pain. We also know that classroom teaching can be contradicted by continued exposure to alternative points of view in the clinic or in practicum sites. Students hear many differing points of view, but they may not have a way to sort through conflicting claims and arrive at an appropriate, scientifically sound conclusion. Our challenge as educators is to construct an educational environment in which students value scientific knowledge, know how to identify and evaluate the scientific literature, and use their knowledge effectively in the treatment of their patients. The incorporation of EBD into the curriculum is one method for accomplishing these goals.

The slides from this talk were placed on the AUTOPP web site, as part of the plan to make available the educational materials generated each year from the AUTOPP meetings. We thank Dr. Glaros for his permission to do so.

If you have a current e-mail address, please let us know if your e-mail address changes! We want to be sure you're receiving the latest information about AUTOPP affairs. We still do not have e-mail addresses for some of our members, and we will continue to send out printed versions to them. If you are receiving this newsletter via post, let the Secretary know if you have an e-mail address, allowing your $15 dues to go further.

We agreed to create three editions of the newsletter each year. One edition will come out shortly after the IADR/AADR meeting (this issue). The second and third editions will come out in the fall and early winter, respectively. The purpose of the post-meeting newsletter is to summarize the business meeting, report on the education program, provide an agenda for the coming year, and send out a general call for next year's education program. The intent of the fall newsletter is to announce the plans for the education program and update members briefly on any major activities. The intent of the mid-winter newsletter is to present the final plans for the upcoming annual AUTOPP meeting, and to summarize any major activities of the year.

Starting with this newsletter, the post-meeting newsletter will be created by the previous secretary, facilitated by the current Executive Board. The newly elected secretary will begin newsletter duties with the fall newsletter. This change was instituted due to the typical lag in pulling this newsletter together. All prior officers of the organization know that the Secretary position is the most difficult, and this change is intended to make the transition into that office somewhat easier.

A number of proposed content areas for the web site were discussed and unanimously approved by the members. These areas included the following: (1) scientifically solid education links regarding TMD and orofacial pain, for patients to access; (2) listing of clinical services provided by AUTOPP members; (3) listing of member graduate training programs; (4) listing of member predoctoral programs; and (5) listing of member research programs. These links will potentially improve the visibility of our educational, research, and service activities to a wide range of possible users. Members agreed that we should try as well to ask other sites to link us to their site.

To assist with the task of adding the above information to our site, members authorized the expenditure from our Treasury of up to $1,000 to pay a student to carry out the clerical task of contacting programs, coordinating information, and so forth. Each member will receive a request for specifically formatted information within the above categories. If you have information within the above categories, please consider submitting it to AUTOPP. This formatted information will then be sent to the webmaster for site inclusion.

Richard Ohrbach announced that a multi-center grant focusing on TMD diagnosis has been designated for funding by the National Institute of Dental and Craniofacial Research (NIDCR). The grant, a collaborative effort among the University of Minnesota (Eric Schiffman, overall project PI), University at Buffalo (Richard Ohrbach, PI), and the University of Washington (Ed Truelove, PI), will examine the validity of the Research Diagnostic Criteria for TMD. The studies proposed in the application ranged from molecular biology studies to psychiatric issues.

Sam Dworkin, the primary consultant to the project, summarized the current status of the funding. An unusual aspect of this grant was the request by the NIDCR for a Cooperative Agreement (designated as a U01) between the grantees and NIDCR. National Institutes of Health (NIH) agencies set up Cooperative Agreements to maintain some control over aspects of the grant. The use of a cooperative agreement is a relatively new process for NIDCR but more commonly used in other agencies, particularly in clinical trials in which NIH has an interest in the outcome.

One aspect the Cooperative Agreement is the requirement that investigators for this TMD study create an external advisory panel that will include representatives not only from appropriate scientific and clinical research areas (e.g., surgery, medicine, radiology) but also from professional groups. The project PIs have designated AUTOPP as one organization that should be represented on this panel. Alan Glaros was nominated by the members to represent the educational community on this advisory panel. In the very near future, the grant investigators will send an open request to the AUTOPP membership, for commentary and recommendations for this very large grant; this information will be conveyed to Alan Glaros, who will then represent the membership on the panel. The current executive board believes that this is a unique opportunity for the values and perspectives of the pain educators within dental education to have a voice regarding how the field can advance at least in terms of formal clinical research designed to demonstrate empirically which variables are important in patient assessment, thus providing evidence for what we will be teaching over the next decade. We hope the membership will contribute fully.

Ray Dionne from NIDCR made a formal address to the membership. He asked whether AUTOPP members would consider collaborating with NIDCR researchers. More information is available in this newsletter. Dr. Dionne noted that NIDCR does not have much experience with development of nation-wide research support networks, but he noted that its development would make NIDCR more willing to consider such approaches in the future.

Speaking of dues, have you paid yours? We have a considerable number of people on our mailing and membership list who have not paid dues in the past few years. The membership agreed that such individuals should continue to be listed as members at least until we receive information to the contrary. If you are among that group who has not recently paid their dues, you can expect to receive a separate notice reminding you of your back dues. AUTOPP would be delighted to receive your back dues; alternately, at least let us know whether we should still send you the newsletters. If we do not hear from you, we will assume that you are no longer interested and drop your name from our membership and mailing list.

In the past year, we have received $200 in fees for the use of our mailing list. In each case, AUTOPP officers reviewed the request for its suitability with our membership. We have also allowed a graduate student to use the list to carry out an IRB-approved research project. The members were in agreement that such use of our mailing list was acceptable, but requested that all such requests be reviewed by at least two members of the Executive Board in terms of granting approval.

One of the clinical trials is evaluating the analgesic activity and adverse effects of celecoxib (Celebrex), the prototype of the selective COX-2 inhibitor class in comparison to naproxen, a traditional COX-1/COX-2 inhibitor. Potential subjects for this study include patients with early stages of TMD (disc displacement, synovitis, or capsulitis) who are experiencing pain of at least one-month duration. Pain, dysfunction and quality of life are assessed at baseline and after a six-week blinded trial of the celecoxib, naproxen, or placebo. Subjects for this trial must satisfy inclusion and exclusion criteria related to the diagnosis, their suitability for taking NSAIDs, and the duration of their symptoms. Patients will be evaluated at the NIH Clinical Center prior to enrollment in the study, provided with informed consent, instructed in the use of the pain diaries, and given a six-week supply of study medication. The investigators, to assure compliance with the protocol and to evaluate the occurrence of any adverse effects, will contact patients weekly. A return visit at the completion of the six weeks will permit assessment of the study outcomes and patients will be provided with therapeutic suggestions based on the MRI findings, results of lab tests, and clinical exam findings. This study has enrolled 50 percent of the projected sample and will continue to recruit subjects for approximately an additional year.

A second study is evaluating etanercept (Enbrel), a biologic modifier of tumor necrosis factor alpha (TNF) that is approved for the treatment of rheumatoid arthritis. We are evaluating the short-term effect of etanercept in comparison to placebo for patients with TMJ osteoarthritis of at least three months duration who have pain and tenderness to palpation over the TMJ. At baseline and six-week follow-up, outcomes such as pain, mandibular range of motion and biomarkers for TNF activity will be assessed. The inclusion/exclusion criteria for this study attempt to confirm the diagnosis while ruling out other processes that can mimic arthritic changes to the TMJ. Use of medications that might interfere with the use of etanercept or the conduct of the study will also be evaluated prior to patient enrollment. This study will also be open for enrollment for approximately one more year.

If you have any patients who you feel might qualify for either of these studies, please contact the principal investigator (Dr. Lauren Ta) or send a message via fax or e-mail providing the patient's name, address, phone numbers, your clinical impression, and any clinical signs and symptoms that will help characterize their disorder. We will contact the patient to determine their suitability for the study, make arrangements for an initial visit, pay for travel to Bethesda, and arrange for lodging at a hotel in the NIH vicinity. If patients are within easy travel distance of the NIH, they could probably complete their initial visit and return home on the same day.

A secondary objective of this announcement is to explore the feasibility of conducting collaborative, multi-site studies of temporomandibular disorders that would not otherwise be done due to limited enrollment at any one site. Previous studies of investigational treatments for other chronic pain disorders (e.g., diabetic neuropathy, post-herpetic neuralgia) in the Pain Research Clinic have demonstrated the strength of this approach. A recently completed case series of patients with failed TMJ surgery also provides evidence that patients can be referred from multiple investigators and sites for studies being conducted at NIH. A national referral base for studies of TMD will provide an initial first step towards the eventual development of a collaborative clinical trials network to advance treatment of chronic orofacial pain.

In discussion with Alan Glaros and Octavia Plesh, it has become clear that the upward migration of the AUTOPP officers is awkward; at least, it has been for those of us currently on the Executive Council. As such, we have decided that the Spring Newsletter, the new one approved at the last meeting and which you are reading, will be published immediately following the meeting; you might notice that we have not been very successful in the "immediate" part of the goal, but, nevertheless, at least we now have a third, and important, newsletter. In constructing this newsletter, we recognized that the President at the Annual meeting should preside over the completion of the newsletter which reflects the recent activity under that President, and that the current Secretary is best able to handle the task. Consequently, we have established the transition of the new officers to coincide with the completion of the Spring Newsletter, benefiting all. Hopefully, this will facilitate the forward movement of the organization, as the new President, Octavia Plesh, has been involved in the newly established goals for the organization and will, of course, contribute over the next several months with her own plans; we can expect to hear more about that in the Fall Newsletter.

In becoming the Immediate Past-President, I have specific goals of working with Scott McCall on the evolution of our web site, helping Alan with the compilation of information for the various directories to be established on the web site, and, perhaps most important, recruiting new members. I have already contacted four excellent colleagues who agreed to submit an application. I did not have to look very hard for colleagues I interact with frequently but who were not members. I suspect that almost every member knows someone who is involved in the teaching of temporomandibular disorders or orofacial pain but who is not a member. Please contact them, and ask them to consider joining. If we can build a stronger and more representative organization, then perhaps we can have a greater impact on the teaching of our discipline and its transmission into clinical care. The application resides on our web site.