Future of TMD Education

The Future of TMD Education

The Future of TMD Education

By Dr. Bradley Eli and Ann McCulloch

There’s a pressing need to improve TMD education for frontline healthcare practitioners.

This article will cover the state of the problem and provide recommendations for the future.

In 2020, the National Academies of Sciences, Engineering, and Medicine (NASEM) published a landmark study on the current state of temporomandibular disorder (TMD) research, education, care, and its public health significance. This consensus report revealed a picture of a TMD care system that is broken and fragmented, in part because of the way that frontline providers receive education about TMDs.

Let’s explore what is broken in the TMD education system and some practical steps we can take to improve the situation.

Table of Contents

The Medical-Dental Divide and TMDs

The plight of those who suffer from TMDs (painful disorders of the temporomandibular joint and associated muscles, tissues, and nerves) is in part due to a historical accident. The medical-dental divide, stemming from a pivotal moment in 1840 when physicians at the University of Maryland College of Medicine rejected the inclusion of dental instruction in their curriculum, marks the historical separation between medicine and dentistry.

This refusal established a distinct College of Dentistry, exacerbating the schism between the two fields. Subsequent events, such as dentistry’s rejection of Medicare in the 1960s, widened this gap, in resulting in significant differences in medical and dental care reimbursement structures [1].

The medical-dental divide significantly hampers the management of TMDs, as neither doctors nor dentists typically claim this condition as a primary field of expertise. This lack of specialized knowledge and training results in delayed diagnosis and inadequate treatment for TMD patients. However, by integrating expertise from both medical and dental fields, we have the potential to significantly improve TMD management and alleviate patient suffering.

Consequently, patients may suffer from chronic pain and limited jaw function without access to appropriate care. Integrating expertise from both medical and dental fields is crucial for improving the management of TMDs and alleviating patient suffering.

The Importance of Acute TMD Care

Improved TMD education is particularly important for acute TMD injuries, as the clinical decisions of frontline providers may be able to prevent the development of chronic pain. Appropriate early intervention in temporomandibular joint injuries can prevent the progression of acute symptoms into chronic conditions, such as jaw and muscle sprain/strain (JAMSS) injuries. By improving education for frontline providers, patients can receive appropriate treatment and management strategies early, potentially averting long-term disability associated with chronic TMD.

Critical Assessment of the State of TMD Care

When evaluating the state of TMD care, the NASEM report noted that training frontline providers is key to improving the system. In the report, they provided this vision for vision for a patient-centered care pathway [2].

In an ideal world, a patient who is experiencing symptoms of a TMD would visit a primary health care professional who would be knowledgeable about the basics of TMD just as other health conditions, including what patients can do with self-care and when a referral to a specialist is indicated. Unless there was unusual severity or complexity to the symptoms or examination findings, the initial starting point for many patients would be treatments such as self-management and physical therapy.”

The report also recommends that these providers be proficient in managing referrals. If initial treatments are ineffective within a set timeframe, patients might be directed to specialists with advanced TMD training. Ideally, these referrals should entail coordinated collaboration across different disciplines, allowing referring practitioners to collectively identify appropriate treatments.

Barriers to Effective TMD Education

The NASEM report highlighted the lack of standardized TMD training for frontline healthcare professionals, including general dentists, primary care physicians, nurse practitioners, and physician assistants. These frontline practitioners often handle initial complaints and manage TMD patients.

Some identified barriers in the NASEM report:

  • Medical-Dental Divide: One reason the report noted for this lack of standardized care is the medical-dental divide. As a solution, the authors proposed incorporating interprofessional education into graduate programs to promote collaboration between dentists and physicians and provide interprofessional continuing education for practicing professionals to enhance collaboration further.
  • Fragmented Educational System: Regarding dental education on TMDs, the report characterized the educational system approach as fragmented, with conflicting viewpoints in the curriculum or provided no response. The authors concluded that predoctoral dental education on TMDs is often outdated, minimal, and narrowly focused. Similar findings were noted with medical education on TMDs.
  • Lack of Standardized Content in Continuing Education: The report noted that while continuing dental education in TMDs is available through various formats, the content varies widely. Many available courses lack an adequate evidence basis, and not all diagnosis and treatment recommendations are evidence-based.

Addressing these barriers will require collaborative efforts across disciplines, incorporating interprofessional education, and ensuring that educational programs are evidence-based and comprehensive. By enhancing TMD education for frontline providers, we can improve patient outcomes and mitigate the burden of TMD on individuals and healthcare systems.

Evidence-based medicine in TMD care

Evidence-based medicine (EBM) is an approach to clinical practice that integrates the best available evidence from scientific research with clinical expertise and patient values and preferences. EBM aims to optimize patient care by using the most up-to-date evidence to inform clinical decisions.

What is Evidence-Based Medicine?

Key components of evidence-based medicine include:

  • Evidence Synthesis: Systematic reviews and meta-analyses are conducted to summarize the findings of multiple studies on a particular topic, providing a comprehensive overview of the available evidence.
  • Clinical Guidelines: Organizations such as professional medical associations or government agencies develop clinical practice guidelines based on the best available evidence. These guidelines offer recommendations for healthcare providers on the diagnosis, treatment, and management of specific conditions.
  • Shared Decision-Making: EBM encourages shared decision-making between healthcare providers and patients, considering the best available evidence, the clinician’s expertise, and the patient’s values and preferences.

Why is EBM Hard to Implement in TMD Care?

Multifaceted challenge presenting while endeavoring to implement EBM in TMD care:

  1. Complex Nature of TMD: TMD encompasses a spectrum of conditions affecting the temporomandibular joint and associated structures, characterized by diverse symptoms and etiologies. The complexity of TMD subtypes and individual symptom presentation variability makes it difficult to develop standardized treatment protocols based on high-quality evidence.
  2. Diverse Array of Treatment Modalities: TMD management involves various treatment approaches, including pharmacotherapy, physical therapy, occlusal splints, and surgical interventions. The wide range of available treatments and the lack of comparative effectiveness data complicate decision-making and impede the implementation of evidence-based practices.
  3. Evolution of Research Landscape: While there is a growing body of research on TMD, including randomized controlled trials and systematic reviews, gaps in the evidence base persist. Emerging treatment modalities and less common subtypes of TMD may have limited research evidence, making it challenging to develop evidence-based recommendations for clinical practice.
  4. Variability in Diagnostic Criteria: The lack of universally accepted diagnostic criteria for TMD contributes to diagnostic uncertainty and variability in clinical practice. Differences in diagnostic criteria across studies hinder the synthesis of research evidence and complicate the development of evidence-based guidelines for TMD diagnosis and management.

Addressing these challenges requires collaborative efforts to bridge the gap between research evidence and clinical practice, enhance clinician awareness and training in EBM principles, and promote patient-centered care models that prioritize shared decision-making and individualized treatment approaches.

How can the Field of Orofacial Pain Help Solve the TMD Education Problem?

In 2020, Orofacial Pain became the 12th officially recognized subspecialty in dentistry. The creation of Orofacial Pain as a recognized subspecialty of dentistry has the potential to address several challenges in TMD education by providing a dedicated field that can generate authority and consensus [3].

How TMD education can resolve challenges:

  • Specialized Expertise: Orofacial pain specialists have advanced training and expertise specifically focused on diagnosing and managing orofacial pain conditions, including TMD. As a result, they can serve as authoritative sources of information and guidance for other healthcare professionals, including general dentists, primary care physicians, and nurse practitioners, who may encounter TMD patients in their practice.
  • Standardized Training: With orofacial pain recognized as a distinct subspecialty, there is an opportunity to establish standardized training programs for dentists interested in specializing in this field. These programs can ensure that future practitioners receive comprehensive education on TMD diagnosis, management, and treatment based on evidence-based practices.
  • Consensus Building: As a dedicated field, orofacial pain specialists can contribute to consensus-building efforts within the healthcare community. By collaborating with other experts in the field, they can develop guidelines, protocols, and best practices for TMD diagnosis and management. This consensus can help to address variations in TMD education and ensure that frontline providers receive consistent and up-to-date information.
  • Research and Innovation: Orofacial pain specialists are uniquely positioned to drive research and innovation in the field of TMD. By conducting studies, clinical trials, and outcome assessments, they can contribute to the evidence base supporting TMD diagnosis and treatment. This research can inform educational initiatives and improve patient care outcomes over time.

Pathway to enhanced TMD Education

Overall, recognizing orofacial pain as a subspecialty of dentistry offers a pathway to enhance TMD education by providing specialized expertise, standardized training programs, consensus-building efforts, and opportunities for research and innovation. By leveraging the authority and expertise of orofacial pain specialists, the healthcare community can work towards addressing the challenges associated with TMD education and improving patient care for individuals with TMD-related conditions.

Solutions for the Future of TMD Education

Addressing the problem of TMD education for frontline providers requires a multifaceted approach.

Some potential solutions for a better future include:

  1. Comprehensive Training Programs: Develop comprehensive educational programs on TMD diagnosis and management for frontline providers, including general dentists, primary care physicians, nurse practitioners, and physician assistants. These programs should cover the latest evidence-based practices, diagnostic criteria, treatment modalities, and referral guidelines.
  2. Interprofessional Collaboration: Foster collaboration between dental and medical professionals to enhance TMD education and patient care. Interprofessional education initiatives during graduate programs and continuing education opportunities can promote interdisciplinary teamwork and improve provider communication.
  3. Clinical Guidelines and Protocols: Develop and disseminate clinical guidelines and protocols for TMD diagnosis and management based on the best available evidence. These guidelines should be accessible to frontline providers and provide clear screening, assessment, treatment, and referral recommendations.
  4. Continuing Education: Offer continuing education opportunities for frontline providers to stay updated on advancements in TMD care. These educational activities can include workshops, seminars, webinars, and online courses focused on evidence-based practices and emerging treatment modalities.
  5. Integration of Behavioral Health: Incorporate behavioral health components into TMD education and training programs to address the biopsychosocial aspects of TMD. Providers should be trained in techniques such as cognitive-behavioral therapy, stress management, and relaxation techniques to manage TMD-related pain and improve patient outcomes effectively.
  6. Patient Education and Empowerment: Educate patients about TMD, including its causes, symptoms, treatment options, and self-management strategies. Empowering patients to participate in their care and make informed decisions can improve treatment adherence and outcomes.
  7. Research and Innovation: Encourage research and innovation in TMD education and care delivery to identify best practices, fill knowledge gaps, and develop novel approaches to diagnosis and management. Collaboration between academia, healthcare organizations, and professional societies can facilitate the translation of research findings into clinical practice.

By implementing these solutions, healthcare systems can improve TMD education for frontline providers. It will also enhance patient care, and ultimately alleviate the burden of TMD on individuals and healthcare systems.

The future of TMD education demands a comprehensive and collaborative approach to overcome existing barriers and improve patient care. The complexities of TMD, coupled with the historical divide between medical and dental care, have contributed to a fragmented healthcare system that often fails to adequately address the needs of TMD patients.

Conclusion: Improving TMD Education

We can work towards bridging the gap between research evidence and clinical practice by implementing solutions such as comprehensive training programs, interprofessional collaboration, development of clinical guidelines, continuing education initiatives, integration of behavioral health, patient education, and research innovation.

By empowering frontline providers with the knowledge and resources necessary to deliver evidence-based care, we can enhance patient outcomes and alleviate the burden of TMD on individuals and healthcare systems alike. It is imperative that stakeholders across the healthcare continuum come together to prioritize TMD education and pave the way for a brighter future in TMD care.

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Author bio:

Author Dr. Brad EliDr. Brad Eli, DMD, MS graduated from UCLA’s postdoctoral Orofacial Pain program. He specializes in the field of orofacial pain, temporomandibular disorders, and headache treatment and is a member of the Academy of Sport Dentistry (ASD). Dr. Eli has also been on the educational staff at university hospitals, pain centers, and the clinical staff of Southern California hospitals. He will be presenting at the 2024 annual meeting of ASD.

Author bio

AAnn McCullochAnn McCulloch, MBA is co-founder and president of Orofacial Therapeutics, this site, and oversees the company’s expanding portfolio of resources and tools for jaw and headache pain diagnosis and treatment. Her chronic jaw pain issues continue to inspire her to investigate the needs and challenges of patients suffering from orofacial pain.

 

 

References

[1] C. M. Rasmussen, et al., “Education Solutions to the Medical-Dental Divide,” Jan 2022, https://pubmed.ncbi.nlm.nih.gov/35133725/

[2] E. National Academies of Sciences, et al., “Caring for Individuals with a TMD. National Academies Press (US),” December 2020, https://www.ncbi.nlm.nih.gov/books/NBK557986/

[3] J. R. Fricton, and Jeffrey A Crandall, “Orofacial pain as a new dental specialty,” March 2020, https://pubmed.ncbi.nlm.nih.gov/32063226/

[3] R. L. Talley, J. R. Fricton, and J. P. Okeson, “Broad support evident for the emerging specialty of orofacial pain,” J. – Okla. Dent. Assoc., vol. 91, no. 1, pp. 14–17, 2000.

By Bradley Eli

Bradley A. Eli, DMD, MS: Orofacial Pain Specialist and Sleep Disordered Breathing Expert Dr. Brad Eli is nationally recognized by colleagues in both medicine and dentistry as a leader in pain management and the treatment of sleep disordered breathing. He is one of an elite group of board-certified Orofacial Pain Specialists in the nation with the advanced training and experience to diagnose and manage complex orofacial pain conditions. In over 25 years of dedication to the advancement of orofacial pain medicine, Dr. Eli has helped thousands of patients find pain relief and manage their chronic pain conditions. His patient-centered method matches each patient with the best treatment for their symptoms and lifestyle. He advances the field of orofacial pain medicine by developing treatment protocols and specialized products that improve care and provide better outcomes for patients with life-changing orofacial pain disorders and conditions. He actively collaborates with peers across the profession and has been a contributing author to the Journal of the American Dental Association, Pain Medicine and Management, Oral Health Journal, and Dental Economics. He has provided educational courses, webinars, and other orofacial pain and obstructive sleep apnea instruction to dental associations, study clubs, and medical groups.