1. What is the decision or change (e.g., clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
Current treatment guidelines for temporomandibular disorders (TMDs) lack sufficient science-based evidence. This gap in evidence leads to multiple healthcare visits, sometimes contradictory advice to patients, and ineffective treatments, with sometimes harmful outcomes. Patients suffer continued oral and facial dysfunction, financial difficulties, social stigma, and an increasingly poor quality of life because guidelines for quality care are not available.
The past decade has seen an increase in research on TMDs and new data has shown that this is not simply a disorder of the temporomandibular joint and its surrounding tissues. Rather, it is a complex condition involving neurological, immune, cardiovascular, and endocrine systems. TMDs should be approached using a biopsychosocial model of disease. Women are more likely to develop TMD and individuals with multiple comorbid conditions are more likely to transition to complex, intractable TMD. Current treatments for TMDs range from conservative, non-invasive management of pain and dysfunction to highly invasive total joint replacement in the most severe cases.
A summary of the current research supporting comprehensive, interdisciplinary, clinical management of TMDs is needed in light of recent advancements in our understanding of the disease process, its many risk factors, and underlying etiology. A clinical practice guideline supported by high quality research is sorely needed.
2. Why are you struggling with this issue?
Science-based (evidence-based) guidelines do not exist. It seems as if each TMD health care provider has their own guidelines. Referrals to additional specialists seem haphazard and without scientific merit. Additionally, medical and dental practitioners lack sufficient professional school training and uneven residency and specialty education in TMD management and treatment. Patients also are unsure of best approaches to treatments since professional sources of credible information are lacking.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
There is a need for clinical treatment guidelines for treating TMDs that are patient-centered, interdisciplinary, team oriented, and above all, based on high quality basic, translational, and clinical research results. Current guidelines do not meet these standards.
If evidence-based Guidelines are introduced, then metrics involving standards of care will improve. Patient-reported outcomes will improve. Fewer patients will progress to more invasive treatments, and the numbers and costs of treatments will decrease.
4. When do you need the evidence report?
Tuesday, 04/30/2024
5. What will you do with the evidence report?
The evidence report will be used to develop and implement a science-based guideline for treatment of TMDs. We will encourage professional organizations to use these new guidelines and/or to incorporate them into their existing documentation. We also will encourage individual clinical specialists and others who treat TMD patients to apply these new guidelines in their daily practice. Through our advocacy on behalf of TMD patients, we will provide them with the new guidelines and thus empower them to make informed decisions regarding their treatment in a meaningful dialog with their health care providers. We will do this just as we have been and continue to promote the results of the 2020 National Academies of Sciences, Engineering and Medicine report on TMD through our information materials, social media, publications and meetings.
Sufficient time will be needed to implement the results of the report and establish metrics for evaluation of the impact of new guidelines on patient well-being. One to two years will be sufficient for this to occur.
Supporting Documentation
NAM Report on TMD (PDF, 177KB)
Optional Information About You
If you are you making a suggestion on behalf of an organization, please state the name of the organization. The TMJ Association www.tmj.org
May we contact you if we have questions about your nomination? Yes
