Temporomandibular Disorders Priorities for Research and Care (2020) / Chapter Skim
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TMDs have a range of causes and often co-occur with a number of overlapping medical conditions, including headaches, fibromyalgia, back pain, and irritable bowel syndrome. TMDs can be transient or long lasting and may be associated with problems that range from an occasional click of the jaw to severe chronic pain involving the entire orofacial region.
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The committee received input from more than 110 individuals through in-person and online opportunities to testify at the committee's public workshop (see Appendix A) and through written submissions to the study's public access file.1 Among the many i ssues raised in these testimonies, several focused on the health care system and the care of individuals with a TMD: • Lack of coordinated care and abandonment -- Individuals reported that they were often shuffled back and forth between clinicians in the medical and dental fields with little to no attention paid to 1 The study's public access file is available through the National Academies Public Access Records Office (paro@nas.edu)
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• Identifying qualified health care professionals -- Individuals with a TMD and their families often expressed their frustration at not knowing where to turn for quality care. Primary care and internal medicine clinicians and general dentists often did not know how to help them locate qualified specialists.
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with a specific diagnosis is not yet fully developed so that in some cases, particularly for chronic conditions, much remains to be learned. While a small number of abnormalities of the TMJ require specific surgical operations to correct, the majority of TMDs have diffuse symptoms and may not respond predictably to one specific intervention.
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The recommendations below 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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Build and Sustain Collaborative and Multidisciplinary Research Despite investment in research directly and indirectly related to TMDs -- most significantly in the field of orofacial pain -- researchers have yet to unravel the etiologies and pathophysiologies of TMDs or to translate, in a meaningful way, research findings into improved clinical care practices. Over the past decade, research on TMDs has centered on the biological mechanisms underlying the development and persistence of orofacial pain and on the structure and function of the joint and its tissues, while more recent research has begun to examine the molecular genetics, biomarkers, and biopsychosocial risk factors of TMDs and common comorbidities.
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Recommendation 1: Create and Sustain a National Collaborative R esearch Consortium for Temporomandibular Disorders (TMDs) 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)
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The National Collaborative Research Consortium for TMDs, led by the National Institutes of Health (NIH) along with other funders, should fund and strengthen: • Basic research efforts and the translation of that research as part of a patient-focused, multidisciplinary research agenda on TMDs to address evidence gaps, generate clinically meaningful knowledge, identify effective treatments, and improve quality of care; • The collection, assessment, 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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Recommendation 5: Improve the Assessment and Risk Stratification of Temporomandibular Disorders (TMDs) to Advance Patient Care The International Network for Orofacial Pain and Related Disorders Methodology, American Dental Association, American Academy of Orofacial Pain, and The TMJ Association, in collaboration with the American Academy of Family Physicians, Society of General Internal Medicine, American College of Rheumatology, and other relevant pro fessional organizations and stakeholders, should develop diagnostic, screening, and risk stratification tools, including a list of high-risk/ red-flag symptoms for health care professionals (primary care and dentists)
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and health professional associations should convene a working group across public and private health and dental insurers and health care systems to develop mechanisms for providing access to con sistent, fair, equitable, and appropriate insurance coverage for safe and effective treatments for TMDs. The Center for Medicare & Medicaid Innovation should also conduct demonstration projects that would ex plore new delivery and payment models for Medicare, Medicaid, and the Children's Health Insurance Program to improve access, quality, and coverage for TMD care.
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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 under graduate, 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. • Deans of health professional schools (across medicine, dentistry, nursing, physical therapy, and all relevant areas of health)
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• The Commission on Dental Accreditation should work with oral and maxillofacial surgery programs to ensure that participants receive comprehensive training on the surgical and non-surgical manage ment of TMDs, including referral to other health care professionals when appropriate. • Relevant professional associations should expand and improve op portunities for all health professionals to pursue clinical rotations
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Recommendation 11: Raise Awareness, Improve Education, and Re duce Stigma The TMJ Association, American Dental Education Association, TMJ atient-Led RoundTable, American Chronic Pain Association, and P American Academy of Orofacial Pain should lead efforts in collaboration with other relevant stakeholders to develop, update, and widely dissemi nate evidence-based communications and patient-focused tools related to temporomandibular disorders (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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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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