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Original Research

Open Access

A Randomized Clinical Trial of a Tailored Comprehensive Care Treatment Program for Temporomandibular Disorders

  • Samuel F. Dworkin1,*,
  • Judith A. Turner2
  • Lloyd Mancl3
  • Leanne Wilson
  • Donna Massoth4
  • Kimberly H. Huggins4
  • Linda LeResche4
  • Edmond Truelove4

1Departments of Oral Medicine and Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington

2Department of Psychiatry and Behavioral Sciences and Department of Rehabilitation Medicine, University of Washington, Seattle, Washington

3Department of Dental Public Health Sciences, University of Washington, Seattle, Washington

4Department of Oral Medicine, University of Washington, Seattle, Washington

DOI: 10.11607/jofph.16401 Vol.16,Issue 4,December 2002 pp.259-276

Published: 30 December 2002

*Corresponding Author(s): Samuel F. Dworkin E-mail: dworkin@u.washington.edu

Abstract

Aims: To test the usefulness of tailoring cognitive-behavioral therapy (CBT) for patients with temporomandibular disorders (TMD) who demonstrated poor psychosocial adaptation to their TMD condition, independent of physical diagnosis. Methods: A randomized clinical trial compared a 6-session CBT intervention delivered in conjunction with the usual TMD treatment to the usual conservative treatment by TMD specialist dentists. For study inclusion, Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), Axis II criteria, were used to target patients with elevated levels of TMD pain-related interference with daily activities, independent of physical diagnosis (ie, Axis I). Results: At the post-treatment assessment, about 4 months after the baseline evaluations, the comprehensive care group, when compared to the usual treatment group, showed significantly lower levels of characteristic pain intensity, significantly higher self-reported ability to control their TMD pain, and a strong trend (P = .07) toward lower pain-related interference in daily activities. From post-intervention to 1-year follow-up, all subjects showed improvement. At the 1-year follow-up, the comprehensive care group, while not losing any of its early gains, was not significantly different from the usual care group with regard to reported levels of pain, ability to control pain, and levels of interference in activities. For many of these psychosocially disabled TMD patients, pain and interference 1 year after treatment remained at the same or higher levels than those observed at baseline among a group of patients selected for a separate randomized clinical trial on the basis of better psychosocial adaptation. Conclusion: The 6-session CBT intervention for patients with heightened psychologic and psychosocial disability was effective in improving pain-related variables over the course of the CBT in conjunction with usual treatment, but was too brief an intervention to result in further improvement after the sessions ended. Patient ratings of treatment satisfaction and helpfulness were high for both groups, but they were significantly higher for the comprehensive care group.

Keywords

temporomandibular disorders; cognitive-behavioral therapy; RDC/TMD

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Samuel F. Dworkin,Judith A. Turner,Lloyd Mancl,Leanne Wilson,Donna Massoth,Kimberly H. Huggins,Linda LeResche,Edmond Truelove. A Randomized Clinical Trial of a Tailored Comprehensive Care Treatment Program for Temporomandibular Disorders. Journal of Oral & Facial Pain and Headache. 2002. 16(4);259-276.

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