The Detection and Management of Temporomandibular Disorders in Primary Dental Care
Course Number: 395
Dental Professional Directed Patient Self-management Approach
Once it has been determined that a patient needs TMD treatment, the dental professional can work with the patient to primarily implement self-management, because few treatment strategies require in office hands-on procedures. Self-management of TMD can be very successful in decreasing TMD related pain and symptoms.11The dental professional establishes a self-management plan of care that focuses on areas of treatment that is specific to each patient. Many patients benefit from a written plan of care, such as the sample Patient Self-management Checklist, shown in Table 6. In addition to providing a checklist for self-management strategies, it is helpful to check with the patient after a few weeks to determine if they are using the checklist, any concerns, and ensure symptoms are improving. Patients can be seen in the dental office for follow-up and in some cases telephone check-in will be sufficient.
Table 6. Sample Patient Self-management Checklist.
____ Monitor Habits and Behaviors: Check Frequently/at Least 4 times/day
____ Clenching and grinding
____ Jaw posture
____ Other habits (chewing on pencils, pens, other)
____ Diet Modification:
____ Small bites/cut food up
____ Soft diet
____ Avoid crunchy, chewy and hard foods
____ Stretching:
Open as wide as possible without pain hold ____ sec, close halfway, rest 5 sec ( ____ repetitions, ____ times/day)
____ Thermal Pack:
Apply [ ] cold pack or [ ] heat pack to areas of pain ( ___ minutes 2/day)
____ NSAIDS: ____ mg ____ times/day
____ Splint Use: [ ] nightly [ ] ____ hours/daytime
____ Identify and Reduce Stressors
____ Breathing/Relaxation Exercises: [ ] Abdominal Breathing [ ] PMR
It must be recognized that for some TMD patients, the self-management strategies provided above may not be sufficient, especially when there is a high pain intensity. In such cases, the dentist may consider a referral to a hospital or university-based TMD pain clinic–most dental schools have such a clinic and are well-suited to manage resistant cases of TMD, whether the resistance to treatment is associated with biologic and structural factors or behavioral and emotional factors.