Temporomandibular disorders (TMD) are characterized by pain and tenderness in the muscles of
mastication and/or the temporomandibular joint (TMJ), limitations of jaw opening often
accompanied by deviations in mandibular path, and clicking, popping or grating TMJ sounds.
TMD is often found in association with other problems: depression, anxiety, sleep
disturbances, gastrointestinal symptoms, frequent infections, etc. This project proposes to
holistically address patient symptoms through three different approaches, Naturopathic
Medicine (NM), Traditional Chinese Medicine (TCM), and usual care at KPNW. We will conduct
a pilot test and Phase II trial to evaluate the two alternative healing approaches, TCM
(n=50) and NM (n=50) delivered by TCM and NM practitioners, are as effective as usual TMD
care (n=50) provided by dental clinicians in the KPNW TMD Clinic. Subjects will be females
25-55 years of age with multiple health problems (defined as patients who have had at least
4 organ system-grouped diagnoses in the past year, not including TMD). Subjects will be
evaluated at baseline, 6 and 12 months after start of treatment. The primary endpoint is
change from baseline in the Axis II Pain Related Disability and Psychological Status Scale.
Clinical examinations, saliva samples to assess salivary cortisol levels, and responses to a
series of questionnaires to assess pain, chronic pain, psychosocial functioning, and other
physical symptoms will be used to assess outcomes. We will passively monitor health care
utilization within KPNW using clinical, research, and administrative databases to determine
whether the interventions have an impact on overall health care utilization. If either of
these alternative interventions is shown to merit Phase III trial, our goal is to design and
implement such a clinical trial to further evaluate the health consequences and costs of
these alternative healing paradigms.
- Patients who have had at least 4 organ system-grouped diagnoses in the past year, not