Synopsis. The Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) study, from 2005 to the present, has gathered data regarding various aspects of temporomandibular disorders (TMD) under multiple study protocols. A wide range of variables, including those from clinical, health, psychological, autonomic, health, and genetics domains, characterize individuals with chronic TMD; many of those same variables predict the first life-time episode of TMD. Notably, while no characteristic measured before TMD onset is a particularly strong predictor by itself, a small set of variables can be used to predict who is at risk for developing TMD. In addition, subsequently reported stress and changes in sleep but clearly preceding TMD onset are interesting predictors due to their change over time. Overall, the evidence indicates that TMD is seldom an isolated condition, and multiple variables from each of clinical, health, and psychosocial domains are not only strong predictors of TMD onset but are also associated, based on available evidence, with transition to chronicity and maintaining chronicity. Consequently, and consistent with emerging clinical treatment studies, best practices for treatment of TMD may benefit from recognizing TMD as a largely non-local condition and thereby not only amenable to many therapies beyond a condition-specific disease orientation but perhaps best managed with those therapies given the nature of the risk factors. In particular, therapies that incorporate mechanisms relevant to both condition-specific aspects of TMD and to behavior and psychological status would be expected to have greater therapeutic efficacy and be more efficient.
Selected reprint. Slade, G.D., Ohrbach, R., Greenspan, J.D., Fillingim, R.B., Bair, E., Sanders, A.E., Dubner, R., Diatchenko, L., Meloto, C.B., Smith, S. and Maixner, W. (2016). Painful Temporomandibular Disorder: Decade of Discovery from OPPERA Studies. Journal of Dental Research 95:1084-1092.
Question. What should the role of the dentist be in managing TMD, given the OPPERA findings?