Multilevel Determinants of Predoctoral TMD Education: A CFIR-Guided National Survey Highlighting Opportunities for...

Variability exists in how US dental schools integrate predoctoral temporomandibular disorder (TMD) training, yet multilevel determinants influencing implementation are underexplored. This study applied the Consolidated Framework for Implementation Research (CFIR) to examine differences in predoctoral TMD training and challenges in implementing CODA standards from leadership perspectives.

A CFIR-guided REDCap survey was distributed to deans/associate deans of academic affairs across all 75 dental schools (September, 2025 to October, 2025), assessing TMD screening, management, student exposure, and implementation challenges. Schools were classified into TMD-educational models based on orofacial pain (OFP) postgraduate affiliation (Model 1), presence of OFP specialists managing TMD patients (Model 2), OFP specialists providing didactic instruction only (Model 3), and absence thereof (Model 4). Outcomes were compared across models using chi-square tests; thematic analysis summarized implementation challenges via CFIR constructs.

Of 38 responses, 84.2% provided both didactic and clinical TMD instruction and routine screening. Overall, 97.4% managed TMD patients, with modalities varying by models (p < 0.001). Model 4 schools were significantly less likely to provide TMD management (p = 0.033). Confidence in meeting CODA standards was moderate-to-high for didactic (84.0 ± 18.2 on 0-100 scale, 100 = "high confidence") and clinical (77.3 ± 21.0) components. Perceived challenges differed across models (p = 0.006), including lack of specialists (Model 4), limited general faculty trained in TMD (Models 2 and 3) and patient availability, curricular constraints (Models 1, 2, and 4), and institutional barriers.

Variability in TMD education reflects multilevel implementation determinants. Embedding TMD competencies in a primary-care framework, strengthening OFP faculty recruitment, and enhancing curricular integration could improve consistency and implementation fidelity nationwide.