Liaison treatment between dentists and psychiatrists for patients with TMD

Abstract

This article describes liaison treatment between dentists and psychiatrists for patients with temporomandibular disorders (TMD). Psychosomatic disease is considered to lie on the border between physical and mental diseases. Although TMD is considered to be a "dental psychosomatic disease", no clear definition of such disease has been established. In the clinical setting, this term is used in both the narrow and broad senses, with the narrow sense indicating a specific dental disease according to the definition of psychosomatic disease established by the Japanese Society of Psychosomatic Medicine (1991). On the other hand, in the broad sense, the term is used for patients who have a clinically unexplainable symptom and require both psychological and somatic assessment/management. In liaison psychiatric clinics, somatoform disorders are seen in more than 70% of patients with dental psychosomatic disease. TMD is a multi-factorial disorder with psychosocial factors that include the patient's psychological status (such as anxiety and/or depression), personality traits, emotional stress, and psychiatric diseases. It is important to consider each factor in the diagnosis and treatment of TMD. Dentists should make a bio-psychosocial evaluation of patients with TMD and use an interview-based treatment strategy that incorporates listening, acceptance, sympathy, support and reassurance. Medical interviews including psychosocial contents are important for patients with TMD who require liaison treatment with psychiatrists. Caution is required for patients whose dentists cannot find an objective finding following a physical examination or who exhibit a divergence between subjective symptoms and objective findings. Therefore, it is important to distinguish patients who are only able to be treated by a dentist from those who require liaison treatment with a psychiatrist.