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Conceptualizing the clinical decision-making process in managing temporomandibular disorders: a qualitative study
Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.ORCID iD: 0000-0003-1053-7170
Umeå University, Faculty of Medicine, Department of Odontology.ORCID iD: 0000-0003-2920-6654
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.ORCID iD: 0000-0002-3334-1376
Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
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2021 (English)In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 129, no 5, article id e12811Article in journal (Refereed) Published
Abstract [en]

Management of patients with temporomandibular disorders (TMD) appears to be more challenging than for other dental conditions. This study aimed to explore the decision-making process in TMD management, and thereby to conceptualize the decision-making process in dentistry. Individual semi-structured interviews were conducted during 2018 and 2019 with a purposive sample of 22 general dental practitioners from the Public Dental Healthcare Services and private practices in the Region of Västerbotten, Northern Sweden. The interviews were analysed using the Grounded Theory approach of Charmaz. Data analysis resulted in the core category 'Combining own competence and others' expectations in the desire to do the right thing'. The dentists showed interest in and a desire to apply professional knowledge, but also reflected on challenges and complexity in the decision-making process forTMD. The challenges were primarily related to organisational factors and lack of self-confidence. This identifies a need for re-organisation of daily clinical management in dentistry, and a need for more postgraduate training to improve self-confidence. The complexity of the decision-making process for TMD makes the study findings applicable in other dental situations.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021. Vol. 129, no 5, article id e12811
Keywords [en]
decision-making, dental health services, evidence-based dentistry, qualitative research, temporomandibular joint disorders
National Category
Dentistry Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Odontology
Identifiers
URN: urn:nbn:se:umu:diva-184795DOI: 10.1111/eos.12811ISI: 000662824700001PubMedID: 34145628Scopus ID: 2-s2.0-85107969782OAI: oai:DiVA.org:umu-184795DiVA, id: diva2:1569234
Projects
ujlAvailable from: 2021-06-18 Created: 2021-06-18 Last updated: 2023-12-14Bibliographically approved
In thesis
1. Exploring temporomandibular disorders: longitudinal and qualitative perspectives
Open this publication in new window or tab >>Exploring temporomandibular disorders: longitudinal and qualitative perspectives
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Smärta och funktionsstörning i käksystemet : longitudinellt och kvalitativt perspektiv
Abstract [en]

Background: Ideally, all clinical decision-making should enable care provision on the best available scientific evidence, clinical experience, and evaluated risks and benefits. Even though there are validated and evaluated decision tools for identification, diagnostics and treatment of temporomandibular disorders (TMD), patients with TMD still seem to go undetected, undiagnosed and undertreated in dentistry. Reasons for this discrepancy are unclear, but this clearly is a disadvantage for patients with TMD. Therefore, this project aimed to explore TMD in relation to the longitudinal course of the symptoms, dentists’ decision-making, and patients’ experiences.

Methods: The project was conducted at the Public Dental Health Services in the Region of Västerbotten, Northern Sweden. Data in the longitudinal studies were based on the screening instrument for TMD, the 3Q/TMD, and included self-reported orofacial pain and jaw dysfunction, specifically jaw catching/locking, from 2010 to 2017 (n=180,308; age 5-104). Descriptive statistics, generalized estimating equation models, and Poisson regression were used for analyses. Data included in the qualitative studies were the transcribed individual interviews with dentists (n=22, age 25-64) and patients (n=16, age 20-65). Analyses were based on the Grounded Theory and the Qualitative Context Analysis.

Results: The prevalence of orofacial pain increased over time (p<.01), but the prevalence of jaw catching/locking remained similar. The incidence, prevalence, and persistence of orofacial pain and jaw catching/locking were significantly higher in women than in men (p<.01). Women were at a higher risk for reporting both the first onset and the persistent orofacial pain (IRR 2.37; 95% CI, 2.25-2.50 and IRR 2.56; 95% CI, 2.28-2.87, respectively), and jaw catching/locking (IRR 2.29; 95% CI, 2.11-2.49 and IRR 2.32; 95% CI, 2.04-2.63, respectively) when compared to men. The onset of pain or jaw catching/locking was mostly independent and exclusive, i.e. without the other symptom (84.1%), and was higher for orofacial pain (64.9%) than for jaw catching/locking (19.2%). The decision-making process in the management of TMD was illustrated as an interplay between internal and external elements, where the dentists wished to apply professional knowledge but identified organizational obstacles and lack of self-confidence in their clinical decision-making for TMD. The patients expressed worry and social discomfort as a consequence of TMD. However, they strived to deal with the symptoms on their own as long as possible before seeking help. The challenges to access dental care and to receive suitable management were acknowledged. The right care at the right time was identified more like a wish than a current state of perceived TMD management.

Conclusions: The observed longitudinal patterns of orofacial pain and jaw dysfunction indicate increasing prevalence of orofacial pain together with substantial gender differences in TMD. The finding of independent onset of jawcatching/locking and orofacial pain reinforces that these two differ in the pathophysiology. The challenges in decision-making for patients with TMD and perceived suboptimal management of TMD symptoms are partly related to the structural organization of the Public Dental Health Services. Thus, careful review of the current organization is warranted since the treatment-need related to orofacial pain will probably increase.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2023. p. 74
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 148
Keywords
cohort studies, decision-making, dental health services, dentistry, epidemiology, evidence-based dentistry, facial pain, population health, qualitative studies, temporomandibular joint disorders, women
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-202148 (URN)978-91-7855-950-3 (ISBN)978-91-7855-951-0 (ISBN)
Public defence
2023-02-03, Sal B, byggnad 1D, Norrlands universitetssjukhus, Umeå, 13:00 (English)
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Supervisors
Available from: 2023-01-13 Created: 2023-01-09 Last updated: 2023-01-10Bibliographically approved

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Ilgunas, AurelijaLövgren, AnnaFjellman-Wiklund, AnncristineHäggman-Henrikson, BirgittaKarlsson Wirebring, Linnea

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