By: Beth Walsh for Dental1
Patients with temporomandibular disorder (TMD, which is sometimes simply called TMJ) that underwent cognitive behavioral training and biofeedback reduced their overall and jaw-related care costs, according to a study published in the Journal of the American Dental Association.
The temporomandibular joint is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is in front of the ear on each side of the head. The flexible joints allow the jaw to move up and down and from side to side for activities such as talking and chewing. Muscles attached to and surrounding the jaw control the position and movement of the jaw.
Causes of TMD: Dentists are unsure of the cause but believe that symptoms are the result of problems with the jaw muscles or with parts of the joint. Injury to the jaw, temporomandibular joint, or muscles of the head and neck can cause TMD. Grinding or clenching teeth, osteoarthritis, rheumatoid arthritis and stress are other possible causes.
Symptoms of TMD: Severe pain and discomfort can be temporary or last for years. The jaw may lock or not open very wide. More women than men experience TMD and TMD is seen most commonly in people between the ages of 20 and 40. Some people experience toothaches, headaches, dizziness, earaches and hearing problems.
Anna Stowell, PhD, of the McDermott Center for Pain Management of the University of Texas Southwestern Medical Center in Dallas, headed up a team that compared two groups of patients with acute TMD. The intervention group had significantly lower jaw-related costs during a year of follow-up than the non-intervention group ($131.67 versus $433.75) despite greater associated costs from pain onset to baseline ($768.27 versus $471.35).
The cost-effectiveness analysis did not include the cost of treatment, which Stowell estimated to be about $600 for a similar six-visit treatment course if performed outside the study. She said that even factoring in the cost of the bio-psychosocial treatment, it could be well worth it if it prevents patients from progressing to the need for chronic pain management.
“This is new ‘uncharted’ territory of dental care where the cost parameters have never been clearly delineated, and have always been uncertain for patients undergoing treatment for diagnoses such as TMD,” she said.
Stowell said TMD is one of the disorders that gets jockeyed between medical and dental insurance carriers and often ends up being fully paid for by the patient. TMD has been estimated as second only to chronic low back pain as the most common musculoskeletal condition resulting in pain and disability. It affects an estimated 10 to 15 percent of the U.S. population, with an annual cost of about $4 billion.
At baseline, 96 patients were in the acute phase of TMD (less than six months since onset) and were classified as high risk for progression to chronic TMD. The majority were women (76 versus 20 men) with an average age of 37.54 (range 18 to 60.88).
The bio-psychosocial treatment included six weekly sessions teaching patients about the body's reaction to stress. There was also training on relaxation and how to control muscle tension, respiration, and body temperature during stress. Both groups were followed for a year and were allowed to seek other medical, dental or complimentary care.
The intervention group used more healthcare services between the onset of pain and the start of the study, but had fewer total visits to healthcare providers during the year of follow-up (14 versus 18). The researchers concluded that cognitive-behavioral interventions are successful and cost effective treatments for TMD.