PATTERNS OF CARE AND COSTS AMONG TMD PATIENTS IN HMO

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Temporomandibular joint disorders (TMD) comprise conditions characterized by pain in the temporomandibular joint,(TMJ) and/or mastication muscles. Individuals with these symptoms often present with clicking or popping in the TMJ and may have limited opening and decreased functional capacity as a consequence. Efforts to more fully understand and characterize these conditions have been hindered by lack of clear diagnostic criteria, although such criteria have been proposed in recent years. Further, little information has been reported on the diagnostic yield associated with clinical examinations and/or radiological procedures, on the effectiveness of nonsurgical versus surgical therapies for managing these conditions, on the use of medical, dental, and pharmaceutical services, or on cost. This project will examine the services members with a TMD clinic visit or TMD-related procedure use within a prepaid health maintenance organization. Using multiple administrative, clinical, and research databases, this project will describe and compare the use of services and associated costs for members who had at least one TMD clinic visit or TMD- related procedure with a similar population who did not have a TMD visit or TMD-related procedure. The comparison group is included to: 1) estimate the increase in use of services and costs that may be attributable to TMD and 2) to explore potential differences in care- seeking behavior between the two groups. Study variables include: use of all dental services and type and number of TMD clinic visits, pharmaceutical therapies, radiological procedures, inpatient surgical and nonsurgical procedures, and ambulatory surgical procedures. In addition, we will estimate the cost of TMD clinic visits, dental visits, pharmaceutical dispensings, and radiological services. This proposal is significant in that databases available for this type of study are uncommon in the United States. The medical and dental treatment records for a large population can be linked within the HMO to yield much more detailed information about TMD diagnosis, treatment, and costs. Information collected in this study will aid in the development of hypotheses to assess the utilization of health care services, effectiveness of surgical and nonsurgical therapies, the yield of diagnostic tests, and the costs associated with TMD care.