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 采取综合办法管理 颞下颌关节紊乱病（TMD）。 这些方法包括 生物医学治疗和适当的认知行为技术， 管理慢性疼痛。 研究1：志愿普通牙医将被随机分配接受： a）为期一天的密集技能型牙科继续教育 TMD综合管理课程，{{B）和8节学习俱乐部 课程涵盖相同的内容，但包括多种机会 复习、练习和强化这些技能，或者c）相同的材料 以函授课程的形式呈现。 影响 干预措施将通过牙医问卷调查， 案例小插曲，并分析牙医的磁带记录， 与标准化患者的互动。 在{{基线，1 将评估干预措施的有效性 目的：1）提高牙科医生对TMD病理生理学的认识， 慢性疼痛管理的认知行为方法及其 治疗TMD患者的舒适度; 2）增加 牙医应用生物心理社会学，而不是纯粹的生物医学， 在评估和计划TMD病例治疗时的解释模型; 改变医护人员与慢性TMD患者的互动方式 增加患者在会面中的参与， 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班的牙科课程 学生;控制班将只接受标准课程。 学生将完成问卷调查，并将与 训练前后的标准化病人;学生及其颞下颌关节紊乱病 诊所的病人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， 慢性疼痛模型和治疗TMD的舒适度 （2）提高学生的学习能力; 标准化患者反映了对疼痛的认知行为方法 管理;和3）增加学生的认知建议- 行为策略，改善患者 参与护理，患者和学生对护理过程的评分 和病人对疼痛的控制感。 我们还将评估 男性和女性牙科学生在他们的 与TMD患者的互动反映了以患者为中心的参与式 风格，并使用认知行为的方法来管理疼痛。

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.