MODIFYING DENTISTS APPROACHES TO PATIENT CARE FOR TEMPOROMANDIBULAR DISORDERS

拟议的研究将评估培训牙科的有效性 综合管理方法的实践者 颞颌关节紊乱(TMD)。这些方法包括 生物医学治疗和适当的认知行为技术 慢性疼痛的管理。 研究1：志愿普通牙科医生将被随机分配接受： A)为期一天、以技能为导向的强化牙科继续教育 战区导弹防御系统综合管理课程、{{b)和8节学习会 课程内容相同，但包含多个机会 复习、练习和强化这些技能，或c)相同的材料 以函授课程的形式呈现。}} 干预措施将通过牙医问卷、答复 以小插曲为例，对牙医的录音进行分析 与标准化患者的互动。在{{基线，1}处测量 将评估干预措施的有效性 用于：1)增加牙医对TMD病理生理学和 慢性疼痛管理的认知-行为方法及其应用 治疗TMD患者的舒适度；2)增加到 牙医应用生物心理社会，而不是纯粹的生物医学， 评估和计划TMD病例治疗时的解释模型； 3)改变提供者与慢性TMD患者的互动方式 提高患者参与会诊和寄养患者的积极性 责任。 研究2：认知-行为方法的培训计划 慢性TMD疼痛将被添加到一个牙科课程中 学生；对照班将只接受标准课程。 学生将完成问卷调查，并将被录制成视频 培训前后患者标准化；学员及其TMD 临床患者也将对护理过程进行评分。我们将评估 培训计划是否：1)增加学生的知识 认知-行为原则，他们对生物心理社会的接受 慢性疼痛模型及其治疗TMD的舒适度 患者；2)增加学生的程度；与 标准化患者反映了一种对疼痛的认知行为方法 管理；以及3)增加学生对认知- 为临床患者提供行为策略，改善患者 护理参与度、患者和学生对护理过程的评分 以及患者对疼痛的控制感。我们还将评估是否 男女牙科学生在多大程度上存在差异 与TMD患者的互动体现了以患者为中心的参与式 风格，以及使用认知行为方法来控制疼痛。

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.