New curriculum standards for teaching temporomandibular disorders in dental schools

Current status of temporomandibular disorders education in U.S. predoctoral dental curricula: A nationwide survey

OBJECTIVE

Studies have highlighted variability and deficiencies in temporomandibular disorders (TMD) predoctoral education, with limited student clinical exposure. However, no research has examined changes following CODA inclusion of TMD instruction in predoctoral curricula. We investigated current scope, instructional modalities, and extent of TMD curricula in U.S. predoctoral dental programs.

METHODS

A 17-item REDCapTM survey was distributed in September-October 2024 to deans/associate deans of academic affairs at 72 CODA-accredited U.S. predoctoral dental schools, investigating TMD curricula, modalities, and extent.

RESULTS

All 33 responding programs (53.2% response rate) included TMD instruction. Formal teaching accounted for 70.6±24.9% of instruction, while patient exposure constituted 22.5±21.0%. Programs dedicated 15.7±7.1 h on average (range 4-34) to TMD instruction . About 25.0% of programs had no board-certified orofacial pain (OFP) specialist on faculty. Instruction was mostly provided by OFP (75.8%), oral medicine specialists (36.4%), prosthodontists (30.3%), and oral surgeons (27.3%). Most programs (87.9%) treated TMD patients, yet 9.1% reported no student clinical exposure to these patients. In programs offering clinical exposure, patient interactions included direct evaluation and treatment (60.6%), rotations in OFP clinics (42.4%), observation (36.4%), or elective courses (3.0%). Management of OFP patients expanded to neuropathic pain (54.5%) and primary headache (33.3%), especially among programs with OFP specialists on faculty.

CONCLUSIONS

TMD instruction varies widely across responding programs, but recent curricula have expanded instructional hours, broadened scope, and increased opportunities for patient interaction compared to previous reports.

Testing an Educational Resource for Implementation in Temporomandibular Disorders Curriculum Through a Phase I Define and Refine Study

OBJECTIVES

This pilot study assessed the feasibility of a virtual patient-based learning (VPBL) platform as an educational tool to address insufficient clinical exposure to temporomandibular disorder (TMD) cases in predoctoral dental education.

METHODS

The VPBL platform, developed with Articulate Storyline, featured 15 virtual patients (VPs) based on Diagnostic Criteria for TMD. In a two-step study, 40 third- and fourth-year dental students rated the platform's feasibility, acceptability, appropriateness, burden, and usability using standardized Likert-based scales. In Cohort 1, 20 students (65.0% females; 26.9 ± 3.3 years old) evaluated the 15 VPs and provided feedback. Cohort 2-study consisted of adjusting the VPs based on feedback from Cohort 1 and re-piloting the cases on 20 randomly selected 4th-year students (68.4% females; 26.8 ± 1.9 years old). Scores from Cohort 1 and Cohort 2 were compared using independent t-tests; qualitative exit interviews were conducted on all participants.

RESULTS

The Cohort 1 study revealed high ratings in acceptability (4.4 ± 0.5, range 1-5), appropriateness (4.4 ± 0.6, range 1-5), feasibility (4.2 ± 0.5, range 1-5), and usability (73.8 ± 15.2, range 0-100), with a minimal burden (the greatest being the difficulty of use, 1.9 ± 0.6, range 0-4). In the Cohort 2 study, the VPBL was adjusted according to feedback, and five additional VPs were created. Compared to the Cohort 1-study, the modified-VPBL obtained significantly higher scores in acceptability (4.8 ± 0.3, p = 0.015), appropriateness (4.7 ± 0.4, p = 0.035), feasibility (4.7 ± 0.4, p = 0.004), usability (83.6 ± 12.9, p = 0.034), and lower scores in difficulty of use (1.5 ± 0.3, p = 0.022).

CONCLUSIONS

The VPBL platform demonstrated feasibility as an educational tool for integration into the TMD curriculum for third- and fourth-year dental students. These Phase I data provide scientific validation for more rigorous testing on a broader scale.

Confidence in diagnosing and treating temporomandibular disorders among dental students and faculty following implementation of the revised standards 2-24k: A cross-sectional study

OBJECTIVE

Following recognition of orofacial pain as specialty in 2020, US dental schools are now mandated to incorporate temporomandibular disorder (TMD) education into their predoctoral curricula. However, the perception of dental students regarding their TMD knowledge is unclear. This study assessed confidence in diagnosing and treating TMD among dental students at a predoctoral dental school where TMD instruction has been integrated across the dental curriculum.

METHODS

A 10-item REDCap-survey was distributed to all dental students and faculty, assessing self-perceived confidence in TMD (0-100, 100="Extremely confident"). Between-group differences were analyzed with independent t-tests and within-group differences across academic years and grade-point average (GPA) with ANOVA.

RESULTS

Among the 145 participants (108 = dental students), overall confidence in TMD was 52.7 ± 25.8 (49.3 ± 24.5 among students, 63.5 ± 26.8 among faculty). All participants reported the highest confidence in distinguishing between TMD/dental pain (59.5 ± 23.9) and the least confidence in adjusting occlusal appliances (43.8 ± 32.4). Students felt less confident than faculty in differentiating between TMD/dental pain (p = .005), establishing TMD diagnoses (p = .003), explaining TMD to patients (p = .010), understanding necessity for treatment (p = .003), adjusting occlusal appliances (p < .0001), and communicating with other providers (p < .001). Fourth-year students exhibited significantly higher confidence in establishing TMD diagnoses (p = .023), adjusting appliances (p < .001), and communicating with other providers than students in other academic years (p = .033). Students with higher GPA were more confident in differentiating between TMD/dental pain than those with lower GPA (p = .015).

CONCLUSION

TMD-perceived confidence can improve with training. The current TMD curricula may be lacking in specific areas, emphasizing the importance of structured TMD education within all dental curricula.

Enhancing Temporomandibular Disorders Education for Initial Care Clinicians Through Interprofessional Education

Introduction

Temporomandibular disorders (TMDs) are common musculoskeletal pain conditions that can significantly impact daily activities such as eating, talking, breathing, intimacy, and expressing emotion. TMDs are often complex and multifactorial, and many patients experience overlapping pain conditions, sleep difficulties, and mental health challenges. The National Academies of Sciences, Engineering and Medicine (NASEM) has called for improved TMD education and training for health professionals, as current training opportunities are limited.

Methods

To prepare health professionals to care for patients who have a TMD, we designed a 5-hour, interactive, module-based curriculum aligned with the 2020 NASEM recommendations. The four-part module set addresses TMD physiology and pathophysiology, assessment, diagnosis, and management. Instructional methods are founded on the Cognitive Theory of Multimedia Learning and include engaging videos, clinical evaluation and education tools, and interactive digital simulation scenarios.

Results

Thirty learners from diverse health professional backgrounds (medicine, dentistry, physician assistant, nursing, physical therapy) participated. Multiple-choice question assessments and pre/post retrospective survey scores demonstrated enhanced knowledge (M = 2.9 vs. M = 4.2, p < .001) and perceived competence (M = 1.9 vs. M = 3.4, p < .001), respectively. Encouragingly, all participants indicated applicability to their clinical practice.

Discussion

Our modules offer educators and clinicians a valuable resource to improve TMD knowledge and facilitate best practices. Supplementary resources included in the curriculum are conducive to clinical implementation, fostering improved clinician assessment and patient education.