CRANIOMANDIBULAR DISORDERS: LONG TERM OUTCOME STUDY

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Treatment for craniomandibular disorders varies between conservative and surgical interventions. Longitudinal studies have shown positive outcomes with either intervention. However, due to the lack of controlled epidemiological research in the field, the relative long-term efficacy of the different treatments has not been fully established. Also, prior studies especially with conservative intervention have been composed of heterogenous diagnostic groups, so conclusions about specific diagnostic groups is not possible. The aims of this study are to complete a 3-year longitudinal outcome study of 150 consecutive female patients to 1) determine if the progression of TMJ ID without reduction can be halted or reversed wiith standardized conservative treatment versus surgical treatment, 2) deterinine what demographic, occlusal, behavioral or psychosocial factors affect outcome with different treatments. Pre-treatment data to be collected includes data to calculate the Cranio-mandibular Index (CMI), Symptom Severity Index (SSI), Helkimo's Clinical Dysfunction (Di) and Anamnestic Indices (Ai) indices that measure the objective and subjective severity of pain and dysfunction. Also, the Oral Habit Index (OHI), the Occlusal Dysharmony Index (ODI), the Illness Impact Index (III) and the West Haven-Yale Multidimensional Pain Inventory (MPI) will be utilized to assess the objective and subjective indicators of parafunctional habits, occlusal stability and the impact the disorder has on the patients' life. In addition, subjects will have specific TM joint diagnosis by using MRI and tomography. Subject selection is standardized with specific inclusion criteria. Blue Cross Blue Shield and other third part carriers have agreed to underwrite the cost of the imaging and interventions used in this study. The progression or regression of signs and symptoms of TMJ ID without reduction will be determined by the change in CMI, Di, Ai and SSI. Post-treatment radiographic status will be detemined by the change in the MRIs and tomograms. The relationship that oral parafunctional habits, occlusal disharmony, illness impact and psychosocial factors or a combination of these factors have wlth this progression or regression will be determined. The results will be used to help predict the consequences of nonsurgical treatment versus surgical treatment and determining what factors influence this process.