A randomized clinical trial using research diagnostic criteria for temporomandibular disorders-axis II to target clinic cases for a tailored self-care TMD treatment program.
OBJECTIVE
To carry out a randomized clinical trial (RCT) contrasting usual conservative treatment of TMD by clinical TMD specialists with a structured self-care intervention, targeted to clinic cases independent of TMD physical diagnosis, who were reporting minimal levels of psychosocial dysfunction; the intervention was delivered by dental hygienists in lieu of usual treatment.


METHODS
The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used to target subjects who exhibited minimal TMD-related psychosocial interference. Criteria for study inclusion were: (1) self-report of facial and/or masticatory muscle pain discomfort for which usual care was prescribed by the clinic TMD specialist; (2) RDC/TMD Axis II graded scale of chronic pain (GCP) score of 0, I, or II-Low. (3) Age 18 to 70 years.


RESULTS
On 1-year follow-up, while both groups showed improvement in all clinical and self-report categories measured, patients in the tailored self-care treatment program compared to usual TMD treatment showed significantly; (a) decreased TMD pain, (b) decreased pain-related interference in activity; (c) reduced number of masticatory muscles painful; (d) fewer additional visits for TMD treatment. Groups were comparable with regard to measures of vertical range of motion. The self-care program was associated with consistent, but non-statistically significant, trends towards lower levels of depression and somatization. Ability to cope with TMD, knowledge concerning TMD and patient satisfaction was significantly enhanced for the self-care group. No participating patients experienced physical or personal adverse effects during the 1-year post-treatment follow-up period.


CONCLUSIONS
Use of RDC/TMD psychosocial assessment criteria can contribute to successful clinical decision-making for the management of TMD.
Dworkin
Samuel F
SF
Washington State Dental Foundation, University of Washington, Departments of Oral Medicine and Psychiatry and Behavioral Sciences, Box 356370, Seattle, WA 98195, USA. dworkin@u.washington.edu
Huggins
Kimberly H
KH
Wilson
Leanne
L
Mancl
Lloyd
L
Turner
Judith
J
Massoth
Donna
D
LeResche
Linda
L
Truelove
Edmond
E
D000328:Adult; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy; D003756:Dental Hygienists / Q000193:education; D003863:Depression / Q000175:diagnosis; D004522:Educational Status; D005157:Facial Pain / Q000523:psychology / Q000628:therapy*; D005260:Female; D006267:Health Education, Dental; D006801:Humans; D008297:Male; D008410:Masticatory Muscles / Q000503:physiopathology; D017090:Occlusal Splints; D010147:Pain Measurement; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D012064:Relaxation Therapy; D012648:Self Care; D013001:Somatoform Disorders / Q000175:diagnosis; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*