Treatment effectiveness of an early intervention for patients with acute TMD-related pain: A one-year outcome study

Department of Psychology, College of Science, University of Texas at Arlington, 313 Life Science Building, 501 S. Nedderman Drive, Arlington, Texas 76019-0528, USA.
Journal of the American Dental Association (1939) (Impact Factor: 2.01). 04/2006; 137(3):339-47. DOI: 10.14219/jada.archive.2006.0183
Source: PubMed


The authors conducted a randomized clinical trial to evaluate the efficacy of a biopsychosocial intervention for patients who were at high risk (HR) of progressing from acute to chronic temporomandibular disorder (TMD)-related pain.
The authors classified subjects' risk using a predictive algorithm and randomized them into an early-intervention (EI) or a nonintervention (NI) group. The EI included cognitive behavioral skills training and biofeedback. The authors assessed pain and psychosocial measures at intake and at a one-year follow-up. Subjects' self-reported pain levels were measured on an analog scale and as a response to palpation.
At one year, EI-group subjects had significantly lower levels of self-reported pain and depression. At one year, more NI-group subjects than EI-group subjects had utilized health care for jaw-related pain. NI-group subjects were 12.5 times as likely to have a somatoform disorder, more than seven times as likely to have an anxiety disorder, and 2.7 times more likely to have an affective disorder at one year, compared with EI-group subjects.
EI-group subjects had reduced pain levels, improved coping abilities and reduced emotional distress at one year.
The TMD-related pain experience is complex and requires early identification with a biopsychosocial EI to achieve maximal, sustainable results.

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    • "Oral appliance studies: Greene & Laskin 1972 (86) Rubinoff 1987 (87) Dao 1994 (88) Ekberg 1998 (89), 2003 (90), 2004 (91) Jokstad 2005 (92) Wassell 2006 (93) Conti 2006 (94) Truelove 2006 (95) Real oral appliances vs. placebo versions Clinical studies Usually a tie between active vs. placebo, but Ekberg group finds that OA> placebo Biopsychosocial TX: Olson & Malow 1987 (96) Gatchel 2006 (97) Stovell 2007 (98) Early intervention in acute phase vs. None Clinical studies (1) Reduces cost and reduces chronicity (2) Less psych outcomes, better symptom relief Physical medicine: "
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    ABSTRACT: The defining characteristic of a profession - and especially a health-care profession - is that the behaviour of its members is proscribed by a formal code of ethics. The main purpose of such codes is to guide practitioners' interactions with patients, assuring that patient interests are protected. In other words, the ethical code requires practitioners to place their patients' needs for proper diagnosis and appropriate treatment ahead of their own needs for income and advancement. The dental profession has a code of ethics that was developed by the American Dental Association many years ago; in most clinical situations, determination of proper behaviour is self-evident. However, the field of temporoman-dibular disorders (TMDs) has been the subject of considerable controversy for over half a century, and many people have argued that this makes it impossible to evaluate various approaches to treatment of TMDs within an ethical framework. In this article, the authors argue that the large volume of scientific evidence in the contemporary TMD literature provides an ethical framework for the diagnosis and treatment of patients with TMDs within a biopsychosocial medical model. They present a summary of the research with contemporary scientific integrity, which has produced that information over a period of many years. Based on that research, they conclude that dentists may provide conservative and reversible treatments that will be successful for most TMDs and in doing so will comply with the profession's code of ethics. Conversely, the authors claim that those dentists who continue to follow the older mechanistic models of TMD aetiology and treatment are not only out of step scientifically, but are placing their patients' welfare at risk by providing unnecessary irreversible bite-changing and jaw-repositioning interventions. Therefore, debate of these issues should not be solely focused on scientific merit, but also upon the compelling ethical obligations that dentists have as a result of the contemporary scientific literature regarding TMDs.
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