Temporomandibular Disorders Priorities for Research and Care (2020) / Chapter Skim
Currently Skimming:
8 Next Steps and Recommendations
8 Next Steps and Recommendations
Pages 321-340
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From page 321... ...
Individuals with TMD symptoms often encounter health professionals (across medicine, dentistry, and beyond) that are unfamiliar with TMDs and do not know where best to refer patients for further diagnosis and treatment.
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From page 322... ...
The recommendations in this chapter focus on the actions that many organizations and agencies should take to improve TMD research and care. The committee also emphasizes the critical role that individuals with a TMD and their family members have played -- and hopefully will continue to play -- in bringing TMD issues to the attention of policy makers and health professionals and moving the research and care agenda forward on multiple levels in the public and private sectors.
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From page 323... ...
The committee recommends that a research consortium be established to bring together relevant National Institutes of Health (NIH) institutes and centers and other stakeholders from the public and private sectors to focus future research efforts on filling key evidence gaps in TMD research and care and to ensure that clinically meaningful, patient-centered outcomes are prioritized.
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From page 324... ...
A National Collaborative Research Consortium for TMDs should be established and sustained to coordinate, fund, and translate basic and clinical research (including behavioral, population-based, and imple mentation research) to address evidence gaps, generate clinically mean ingful knowledge, identify safe and effective treatments, and improve the quality of TMD care.
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From page 325... ...
and strategic plan; o Design and implement a national research framework for TMDs that would establish short- and long-term research priorities and cultivate multidisciplinary research focused on the needs of the patient; and o Conduct an annual symposium to explore promising research directions, methods, and tools for TMD research and to foster multidisciplinary, and possibly international, collaborations. Medium- to long-term implementation actions: • Once established, the National Collaborative Research Consortium for TMDs should implement the research framework by synchro nizing and guiding research efforts across stakeholders and research areas; • Encourage and incentivize multidisciplinary collaborations; • Leverage funding resources to address research priorities that may overlap with and be part of larger research initiatives (e.g., HEAL initiative)
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Recommendation 3: Strengthen Population-Based Research on the P ublic Health Burden of Temporomandibular Disorders (TMDs) The National Collaborative Research Consortium for TMDs along with other funders should expand and strengthen the collection, assess ment, and dissemination of population-based data on the burden and costs of TMDs and the effects of TMDs on patient outcomes in order to improve the prevention (primary, secondary, and tertiary)
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From page 327... ...
Recommendation 4: Bolster Clinical Research Efforts to Build the Evi dence Base for Patient-Centered Care and Public Health Interventions for Temporomandibular Disorders (TMDs) The National Collaborative Research Consortium for TMDs along with other funders should fund clinical and implementation research to clearly define effective treatments and continuously improve the quality of care for patients with a TMD.
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From page 328... ...
that foster the translation of theory and basic science to improve TMD care; and • Explore and support the development and implementation of a n ational TMD patient registry: o National Institute of Dental and Craniofacial Research, The TMJ Association, TMJ Patient-Led RoundTable, and Medical Device Epidemiology Network Initiative (MDEpiNet) , in col laboration with professional associations and TMD centers of excellence (see Recommendation 8)
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Innovative approaches and interprofessional efforts will be needed. Specialized TMD centers, e specially for individuals that need multiple types of care, would be vital and could contribute significantly to telehealth options for improving access to specialty care as well as to innovative approaches to health professional education, clinical research, and data collection and analysis.
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Once clinical practice guidelines are developed, clinical performance measures should be deployed in quality improve ment initiatives. Near-term implementation actions: • The International Association for the Study of Pain, American Academy of Pain Medicine, American Academy of Orofacial Pain, International Network for Orofacial Pain and Related Disorders Methodology, and the American Chronic Pain Association should
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From page 331... ...
to develop evidence-based consensus clinical practice guidelines for dentists and primary care clinicians to guide diagnosis, initial treatment, and referral strategies for patients with TMD symptoms. Medium- to long-term implementation actions: • ADA, in conjunction with the American Association for Dental Research and the International Association for Dental Research, the American Academy of Family Physicians, Society of General Internal Medicine, the Agency for Healthcare Research and Quality, the National Committee for Quality Assurance, The TMJ Association, and other professional organizations involved in quality metrics and in the care of TMDs should: o Develop a national quality measurement and improvement strat egy for TMD care.
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From page 332... ...
and Orofacial Pain Centers of Excellence for TMDs and Orofacial Pain should be estab lished to provide comprehensive evaluations and treatment of indi viduals with TMDs; to serve as a resource for clinicians (including interprofessional consultations and telehealth opportunities) ; to contrib ute to the research base for TMDs; and to provide onsite and virtual education and training, particularly continuing education, for a range of health care professionals.
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Medium- to long-term implementation actions: • The network of Centers of Excellence for TMDs and Orofacial Pain should: o Develop the metrics and processes to publicly report on a stan dard set of quality, outcome, and health services data; o Serve as a pilot site for novel insurance approaches; o actively involved in basic, translational, and clinical research; Be o Expand and continually improve the quality of care offered in house and via online resources; o Expand and continually improve the interprofessional educa tion and training offered on TMD care to a range of health and uman services professionals; and h o actively engaged in the dissemination of information about Be TMDs to the public. IMPROVE HEALTH CARE PROFESSIONAL EDUCATION ABOUT TMDs A critically important component of improving care for TMD patients is ensuring that health care professionals (across medicine and dentistry)
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for Health Care Professionals Health professional schools and relevant professional associations and organizations across medicine, dentistry, nursing, physical therapy, and all other relevant areas of health care should strengthen undergraduate, graduate, pre- and postdoctoral, residency, and continuing education curricula in pain management, orofacial pain, and TMD care for health professionals and work to ensure interprofessional and interdisciplinary training opportunities. Near-term implementation actions: • Deans of health professional schools (across medicine, dentistry, nurs ing, physical therapy, and all relevant areas of health)
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Medium- to long-term implementation actions: • The American Dental Association, in conjunction with relevant pro fessional associations and patient advocacy groups, should develop innovative approaches to interprofessional continuing education on TMDs that convey evidence-based information on the treatment and management of TMDs, disseminate guidelines for appropriate refer ral to other health care professionals, and encourage and facilitate interprofessional collaboration for patient care. Recommendation 10: Establish and Strengthen Advanced/Specialized Training in Care of Orofacial Pain and Temporomandibular Disorders (TMDs)
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should be strengthened, pro moted, and widely disseminated through multiple avenues for adults and youth of all health literacy levels and in multiple languages to raise public awareness about TMDs, improve the resources available to patients and families, and reduce the stigma related to TMDs. Specific implementation steps should include: Near-term implementation actions: • The TMJ Association, American Dental Education Association, TMJ Patient-Led RoundTable, American Chronic Pain Association, and American Academy of Orofacial Pain should lead efforts in col laboration with other relevant stakeholders to: o Develop, update, and widely disseminate evidence-based informa tion and resources to patients and family members (in multiple languages and health literacy levels)
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. o Conduct a baseline survey of health care professionals to assess their biases, attitudes, beliefs, knowledge, and behavior regard ing people with TMDs.
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: • ontinue to be involved in efforts across the spectrum of TMD research C and care to promote patient-centered care • rovide input on research planning, patient registry development, and P standards of care • ork with researchers and developers on improving communication ave W nues regarding TMD awareness and care Health care professionals (including general dentists, primary care and internal medicine clinicians, pain specialists, and oral and maxillofacial surgeons) : • tay current on the evidence base on TMDs and TMD care S • rovide evidence-based information on TMDs to patients and help them P navigate care pathways • ork to establish relationships with colleagues across professions and W provide coordinated interprofessional TMD care Research funders and researchers (including relevant National Institutes of Health institutes and centers, Department of Veterans Affairs, Centers for Disease Control and Prevention, Department of Defense, private-sector research funders, academic research centers, research foundations, and professional associations)
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From page 339... ...
and health professional licensing boards and organizations (including but not limited to the American Dental Association, Ameri can Dental Education Association, American Academy of Orofacial Pain, organi zations administering the National Board Dental Examinations, the United States Medical Licensing Examination, and the National Physical Therapy Examination) : • ecognize orofacial pain as a dental specialty R • xpand and improve licensing exam questions about pain management E and TMDs • nsure that continuing education programs on TMD care are evidence E based • evelop and disseminate evidence-based information and resources on D TMDs for patients and families and explore the feasibility of a public aware ness campaign in collaboration with patient advocacy organizations • ork with academic health centers to establish Centers of Excellence for W TMDs and Orofacial Pain • mprove TMD diagnostic and risk stratification tools I Health care professional schools (including schools of dentistry, medicine, nursing, and physical therapy)
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340 TEMPOROMANDIBULAR DISORDERS REFERENCES IOM (Institute of Medicine)
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