Objectives: Minimal literature exists to describe the effectiveness of TMD treatments in community dental practices. One objective of this National Dental Practice-Based Research Network (http://nationaldentalpbrn.org) prospective, observational study regarding the management of TMD pain patients was to describe the observed change-from-baseline at 1-, 3-, and 6-month follow-ups in pain intensity and jaw function.
Methods: Beginning in July 2016, consecutive consenting TMD pain patients were recruited by Network practitioners who provided treatments they believed appropriate for their patients. Patients completed baseline and follow-up questionnaires for Characteristic Pain Index (CPI) and the Jaw Functional Limitation Score (JFLS). A mixed-model GEE procedure compared least squares mean change-from-baseline for CPI and JFLS at 1, 3 and 6 months, accounting for clustering within practitioner, and four observations per patient per follow-up period. Clinically important improvements were defined as minimal (10% to <30%), moderate ( ≥ 30% to <50%), and substantial ( ≥ 50%).
Results: 185 Network practitioners recruited 1,904 patients with the mean number of patients per practitioner of 10.3 (SD=6.4, median=9). Patient mean age was 44.1 years (SD: 15.6); 1,584 (83.4%) were female, and 1,398 (73.9%) reported chronic TMD pain (present ≥ 6 months). Least squares mean changes indicated statistically significant improvements from baseline CPI (SE) of 49.7 (0.6) to 34.2 (0.7) at 1 month (p<0.0001) (31% improvement), to 28.3 (0.7) at 3 months (p<0.0001) (43% improvement), to 23.9 (0.7) at 6 months (p<0.0001) (52% improvement). For JFLS, the baseline mean of 2.0 (0.06) improved to 1.7 (0.06) at 1 month (p<0.0001) (15% improvement), to 1.4 (0.05) at 3 months (p<0.0001) (30% improvement), to 1.2 (0.05) at 6 months (p<0.0001) (40% improvement).
Conclusions: The large sample size of practitioners and patients supports reliable estimation of patient outcomes associated with current management of painful TMD. Clinically important improvement was observed to be substantial for TMD pain and moderate for jaw function at the 6-month follow-up.