The goal of this randomized clinical trial is to evaluate whether complementing usual treatment with: 1) a brief intervention that focuses on educating patients in self management of TMD and, {{2) then adding a stepped care component for patients whose TMD pain persists after a trial of usual care, will be more effective than usual treatment alone. The essential concept involved in stepped care is the introduction of planned increments in health care matched to patient progress in response to regular medical treatment. Stepped care regimens matching incremental increases in treatment in patient progress using nurses, for example, have been shown to be effective in enhancing the self-management of chronic medical problems, including hypertension and diabetes.}} The rationale for the proposed study is that most conservative treatments for TMD involve some degree of self care, yet patients do not generally receive sufficient education, training and support for such self care activities. Two levels of intervention are proposed as complements to usual TMD care: 1) Education in Self Care + Usual Treatment {{(n=90)}} provides education in self care delivered in small groups of TMD patients by a registered dental hygienist (RDH) before the onset of usual clinical TMD care; 2) Education in Self-Care + {{Stepped Care}} + Usual Treatment {{n=90}} uses the same self management education intervention, further supplemented by the availability and support of an RDH Case Manager, {{assigned only to TMD cases who have progressed satisfactorily as defined by a Graded Chronic Pain chore of II or higher after two months of usual treatment}}; and 3) those receiving usual treatment alone {{(n=90)}}. Treatment outcomes among groups will be compared for changes in: 1) self reported characteristic pain, jaw function/dysfunction; 2) clinical TMD measures of vertical jaw opening, muscle and joint palpation pain scores, joint sound assessment; 3) self-report measures of health care utilization and psychosocial functioning. Subjects in each of the groups will be compared to each other at baseline, 6-, 12- and 24- month follow ups. {{The overall goals of this research are to determine if management of TMD can be enhanced by complementing usual TMD treatment delivered by dentists with less costly interventions appropriate to the status of the patient that emphasize self-care for the chronic pain condition}}.
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