Traditionally, patients with temporomandibular disorders (TMD) have been diagnosed on the basis of a diversity of oral dysfunction and structural abnormalities (OD/SA). Several attempts to subdivide TMD based on physical parameters have been developed and used as the basis for treatment. There is growing consensus, however, that like other groups of chronic pain patients, subgroups of TMD patients are most appropriate characterized by psychosocial and behavioral as well as physiological features. Progress in assessment methods available. To date, there are no agreed upon quantitatively sound measures of OD/SA. More over, there have been no attempts to integrate physical and psychological measures to develop a taxonomy of TMD or to treat patients differentially on the basis of empirically-derived classifications. This competing continuation application has four primary objectives: (1) development of reliable measures of both subjective oral/dental examination data and objective OD/SA findings (i.e., MRI and EMG activity) and the integration of these measures into quantitatively sound general indices of OD/SA; (2) integration of OD/SA index(es) with psychosocial and behavioral assessment findings in order to identify homogeneous subgroups of TMD patients; (3) assessment of EMG differences in subgroups of TMD patients in response to psychological and physical stressors, and how these response patterns are associated with OD/SA index(es); and (4) evaluation of the differential utility of combined dental (interocclusal appliance) and psychological treatments (biofeedback-assisted relaxation, cognitive- behavioral therapy for depression, and interpersonal problem solving training) to empirically-derived subtypes of TMD. During the current project, we identified 3 subgroups of TMD patients based on an empirical taxometric approach. We labeled these groups: """"""""Dysfunctional"""""""" (high psychological distress), """"""""Interpersonally Distressed"""""""" (inadequate or maladaptive social support), and """"""""Adaptive Copers"""""""" (low levels of psychological distress). Differential treatment response and maintenance of change were found for these subgroups. Thus, we hypothesize that tailoring interventions to patient characteristics will be more effective than providing patients with generic treatments. The primary objectives of the proposed studies will be accomplished over a 5 year period by (a) testing advanced psychometric approaches to the integration of comprehensive radiographic, oral/dental, electromyographic, and psychological evaluations of 500 TMD study candidates; and (b) conducting generic and tailored treatment interventions and comprehensive follow-up assessments to 369 TMD subjects to evaluate if tailored treatments are more effective, particularly in maintenance of effects, than a commonly used, generic therapeutic approach. This is a revision competing continuation application of 2 R01 DE07514-05.
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