by Sophia Stone, TMJA contributing author
In this study, 113 Japanese dentists were surveyed about their experience treating TMD. The majority (84%) of dentists surveyed were male, which is not all that unusual, but a striking contrast from the predominately female TMD patient population. Just over half (57%) were aware that TMD practice guidelines existed, and even fewer (42%) had actually read them. It’s not clear from this study why so few dentists were familiar with these guidelines, nor is it clear why a fraction hadn’t read them when they know they exist, but this seems like a pretty important oversight if you’re going to be treating TMD patients. Given that education on TMD orofacial pain is not required of US dental schools, and postgraduate programs on orofacial pain are few and far between, it is not all that surprising that this knowledge gap might exist among dental providers in other nations.
To better understand dentists’ feelings of distress regarding TMD treatment, the researchers classified this self-reported distress according to six major themes.
Now for the interesting part. Researchers then investigated the relationships between sources of dentist distress and the characteristics of their TMD patients. Specifically, they found that dentists distressing over whether to use occlusal adjustments in treatment and those challenged with patient communication were more likely to have patients with shoulder stiffness and headache. Only four TMD symptoms (inability to eat, fear of locked jaw, shoulder stiffness, and headache) were surveyed in this study, but shoulder stiffness and headache were previously reported to be the most frequent TMD-related symptoms in Japanese patients . An explanation for these associations might be that dentists with more symptomatic patients may have been more willing to consider occlusal therapy to be able to offer something to their patients. They may also have perceived their patient encounters as more difficult due to the pain their patients were experiencing.
The study also revealed that awareness of TMD guidelines was associated with lower prognostic distress. Due to the self-reported nature of this study, it’s hard to say whether knowledge of these guidelines leads to the enhanced ability to predict therapeutic responses, or simply the belief in one’s ability to do so. Furthermore, this study does not weigh in on whether such knowledge actually leads to better patient outcomes, although one would certainly hope so.
One of the challenges with interpreting this study is the difficulty in extracting causative relationships from associative data. Do dentists perceive more symptomatic patients as more “difficult” to communicate with? Or are symptomatic patients more likely to seek out certain providers, or to work or live in more in stressful environments? Does knowledge of TMD guidelines lead to prognostic confidence, or are successful dentists generally more well-read on current practices? Nonetheless, despite the possibility of confounding factors, significant relationships were still found between sources of dentist distress and characteristics of their patients. Thus, such disparities in provider distress and knowledge could have profound consequences for patients, particularly given the lack of educational standards for orofacial pain.
TMD pain is distressing to the patient, and it’s not exactly comforting to think that the prospects of treating TMD brings distress to dental providers. The results of this study suggest that dental education, particularly focused on TMD care directives and whether occlusal adjustments hold therapeutic merit, is one possible remedy.
This study also indicates that some dentists have a hard time talking to and educating their patients. It’s natural that communication difficulties may be more pronounced when faced with more complicated and severe cases. However, patient care may be compromised when patients are labeled as “difficult” or “uncooperative,” their condition is overly contributed to psychological factors, or they are wrongly perceived as noncompliant or exaggerating their pain. Given the historical dismissal of women with unexplained medical conditions as “hysterical,” these concerns are heightened for female TMD patients by the fact that TMD is more than twice as prevalent in women than in men, yet more than 80% of dentists in this study were men. This is consistent with the gender gap among US dentists, nearly 70% of whom are men . Thus, educational tools that help dentists understand not only the pathology, prognosis, and treatment options for TMD pain, but also the experience of the TMD patient, may alleviate such difficulties, thereby reducing distress among dental providers.
* There are scientific statements and parameters of care, but no formal guidelines for TMD treatment formulated by professional groups for the management of TMD. This was gleaned from reviewing 24 professional organizations that profess to diagnose and manage TMD, by researching their websites to obtain information about their organizations’ theories and practices.
1 Yokoyama, Y., Kakudate, N., Sumida, F., Matsumoto, Y., Gordan, V. V., and Gilbert, G. H. (2018). Dentist’s distress in the management of chronic pain control: The example of TMD pain in a dental practice-based research network. Medicine 97(1), e9553.
2 Lindfors, E., Tegelberg, Å., Magnusson, T., and Ernberg, M. (2016). Treatment of temporomandibular disorders—knowledge, attitudes and clinical experience among general practising dentists in Sweden. Acta Odontologica Scandinavica 74(6), 460-5.
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