Internet-Based Behavioural Therapy for Adolescents With Temporomandibular Disorder Pain: A Feasibility Multicenter Randomised Controlled Trial

Abstract

Background: Temporomandibular disorder (TMD) pain in adolescents is common, has a negative impact on quality of life, and is a predictor of pain in young adulthood. A common and symptomatic treatment is occlusal appliance therapy (OAT). Internet-based behavioural therapy (IBT) is a novel, multimodal, and patient-centred self-management therapy for adolescents with TMD pain. Objective: To evaluate the adherence and effect of IBT compared to OAT in adolescents with TMD pain. Methods: Participants were recruited from public dental care and specialist clinics in orofacial pain in Sweden between January 2016 and March 2020. Screening of adolescents, 13–19 years, was performed using three questions for TMD (3Q/TMD). Eligible subjects were examined according to the DC/TMD and randomly allocated to IBT or OAT. The IBT group performed the 7-week programme online with individualised feedback through phone after each section. The OAT group used a stabilisation splint night time for 3 months. A 3-month questionnaire follow-up on pain intensity, pain disability, and psychosocial outcomes was conducted. Results: In total, 52 patients were randomised to IBT and 48 to OAT. There was a low adherence to IBT with a 75% drop-out. Positive expectations of treatment were significantly (p = 0.001) greater in the OAT group. OAT was related to better outcomes for characteristic pain intensity (p = 0.047) and pain-related disability (p = 0.049) when compared to IBT. No significant difference within or between the groups regarding the psychosocial outcomes was observed. Conclusions: The current version of IBT was overly comprehensive for adolescents with TMD pain and needs to be revised.