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Fig 1: Stepped Care Model

than 30% of patients with MSK disorders were referred to physical LIFESTYLE MODIFICATIONS AND SELF- CARE PRACTICES
therapists within 3 months of their initial diagnosis (George 2020). In Simple yet impactful lifestyle modifications form a solid foundation
this same cohort, it was also found that this delay in seeing a physical when managing TMDs. By decreasing stress tissue sensitivity,
therapist was associated with an increased risk for receiving opioids improving restoration periods, and encouraging return to activities
(George 2020). Clearly, delayed care is a driver towards sensitization of daily living, will help improve patient outcomes. Stress reduction
and nociplastic pain. When conservative care is indicated, promptly techniques including yoga, meditation apps, mindfulness training,
offering these options to your patients fosters better patient outcomes cognitive behavioural therapy, and aerobic exercise can significantly
and ensures a patient-centred approach. diminish TMD-related symptoms.
In patients with chronic MSK pain, aerobic exercise at 50-70%
MANAGEMENT of their max heart rate for 150 minutes per week is proven to have
TMD management can best be approached through patient (1) an analgesic effect (Tan et al., 2022). Additionally, addressing sleep
education, (2) lifestyle modification and selfcare practices, as well as disorders, sleep hygiene practices, and promoting quality sleep can
(3) manual therapy and exercise regimes. significantly impact the management of TMDs. We can optimize
our sleep by having fixed sleep and wake-up times, a consistent bed-
EDUCATION time routine, and reducing screen time 1-2 hours before bed. Self-
Patient expectations are a powerful prognostic variable and as management strategies like self-massage to affected areas can also
healthcare professionals we can set these expectations through simple be useful by desensitizing tissues with exposure to non-threatening
education. Empowering patients with comprehensive education about mechanical stimuli (Bishop et al., 2015).
their bodies, conditions, treatment choices, and preventive measures Educating patients on lifestyle modifications and utilizing self-
enables them to make informed health decisions, fostering success in management strategies is a low cost and low risk way of addressing
their health journey. Aguiar et al. (2022) found that integrating pain a patient’s pain or dysfunction, following the stepped care model. It
science education alongside manual therapy and exercise improved is also a well-rounded and patient-centered approach to managing
disability among chronic TMD patients, with a sustained effect their pain. The biopsychosocial model highlights the interconnection
observed over time. Patients are often anxious when they experience between our biology, psychology, and socio-environmental status,
pain in the orofacial region. Dedicating the time to explain the origin of all coming together to form our pain (or pain-free) experience. We
the clicking sound, reassuring them that it’s possible to have muscular cannot simply treat pain by targeting one aspect.
pain in your head/face, and informing them that conservative care is
first-line treatment has proven to relieve patient anxiety. Education MANUAL THERAPY AND EXERCISE REGIMES
regarding reasonable timelines for recovery is also essential in keeping When indicated, manual therapy can be an excellent tool for treating
a patient optimistic about their rehabilitation process. MSK disorders, including TMDs. Manual therapy can be performed

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Dental Practice I July-August 2024 I Vol 20 No 4 45