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

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.