MODIFYING DENTISTS APPROACHES TO PATIENT CARE FOR TEMPOROMANDIBULAR DISORDERS

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The proposed research will assess the effectiveness of training dental practitioners in comprehensive approaches to the management of temporomandibular disorders (TMD). These approaches include both biomedical treatments and appropriate cognitive-behavioral techniques for management of chronic pain. Study 1: Volunteer general dentists will be randomly assigned to receive: a) an intensive one-day skills-oriented Continuing Dental Education course in comprehensive management of TMD, {{b) and 8-session Study Club course covering the same content, but including multiple opportunities to review, practice and reinforce these skills, or c) the same material presented in a correspondence course format.}} Effects of the interventions will be assessed through dentist questionnaires, responses to case vignettes, and analysis of tape recording of dentists' interactions with standardized patients. Measurement at {{baseline, 1 year and 2 years}} will assess the effectiveness of the interventions for: 1) increasing dentist's knowledge of TMD pathophysiology and cognitive-behavioral approaches to chronic pain management and their comfort in treating TMD patients; 2) increasing the degree to which dentists apply a biopsychosocial, as opposed to a purely biomedical, explanatory model when assessing and planning treatment for cases of TMD; and, 3) changing providers' interaction styles with chronic TMD patients to increase patients participation in the encounter and foster patient responsibility. Study 2: A training program in cognitive-behavioral approaches to chronic TMD pain will be added to the curriculum for one class of dental students; a control class will receive only the standard curriculum. Students will complete questionnaire measures and will be videotaped with standardized patients before and after training; students and their TMD clinic patients will also rate the process of care. We will assess whether the training program: 1) increases students' knowledge of cognitive-behavioral principles, their acceptance of a biopsychosocial model of chronic pain, and their level of comfort in treating TMD patients; 2) increases the degrees to which students; interactions with standardized patients reflect a cognitive-behavioral approach to pain management; and 3) increases student recommendations of cognitive- behavioral strategies for their clinic patients, improves patients participation in care, patient and student ratings of the process of care and patients' sense of control over pain. We will also assess whether male and female dental students differ in the extent to which their interactions with TMD patients reflect a patient-centered participatory style, and the use of a cognitive-behavioral approach to pain management.