An Implementation and Biobehavioral Study of Temporomandibular Joint and Muscle Disorder (TMJMD)

With the great economic costs and traditionally poor outcomes among chronic
temporomandibular joint and muscle disorder (TMJMD) patients, it has become important to
treat patients in the acute state, in order to prevent these more chronic disability
problems. This has been the goal of two past funded grant projects. Results of the initial
project isolated risk factors that successfully predicted the development of chronicity with
a 91% accuracy rate. A statistical algorithm was developed which was used in the second
project to screen out "high-risk" patients. These patients were then randomly assigned an
early intervention or non-intervention group. One-year follow-up evaluations documented the
treatment efficacy and cost effectiveness of early intervention. These results have major
implications for effective early intervention and significant health care cost savings for
this prevalent pain and disability problem. For the present proposed project, we plan to
implement this treatment program in order to evaluate its effectiveness in more
community-based dental practices. This is in response to NIH's request for the
implementation of evidence-based treatment approaches, developed in controlled clinical
settings, to the "real world" of diverse practices in the community. Acute TMJMD patients
will be recruited from two community-based clinics. Based upon our "risk" screening
algorithm, high-risk patients will be randomly assigned to one of two groups (n=225/group):
an early biobehavioral intervention or an attention-control group. It is hypothesized that
the attention control "high-risk" patients will display more chronic TMJMD problems,
relative to the "high-risk" early intervention patients, at one- and two-year follow-ups. A
number of biopsychosocial measures will be evaluated, including chewing performance, the
RDC/TMD, self-reported pain and stress, etc. Such a multi-level, multi-systems approach has
not been applied to better understand the biopsychosocial underpinnings of TMJMD. Results
from this component of the project will greatly aid in stimulating future research leading
to the better understanding of TMJMD, as well as better tailoring of prescribed treatment
regimens.