A survey on German dentists regarding the management of craniomandibular disorders

Abstract

The purpose of the present investigation was to identify the most frequent therapies and, in particular, the prescription patterns for occlusal splints for the management of craniomandibular disorders (CMDs) used by German general dentists and specialists. Additionally, the knowledge and opinion of the practising dentists were examined. All active members of the statutory dental insurance providers of the German North Rhine (n = 5,500) and the Westphalia-Lippe area (n = 4,984) were surveyed with a questionnaire by mail. Results indicated that occlusal splints were the first-choice therapy followed by physiotherapy and occlusal equilibration. In the preceding year, both general dentists and specialists made 30 occlusal splints on average. With regard to high-quality evidence-based recommendations, some statistically significant discrepancies between general dentists and specialists were detected. On the basis of the present data, it seems useful to consider intensifying the topic of CMDs and orofacial pain in future undergraduate dental curricula and in postgraduate training.

Impact of dentists’ years since graduation on management of temporomandibular disorders

“…Our response rate (56 %) is a further strength of our study and was comparable to other studies in this area [23], with reported response rates of 7.6 to 9.0 % in studies in South Korea [17] and Germany [14] and 83 to 87 % reported in studies in Sweden and the USA [20,21,25]. A separate nonresponder analyses revealed no substantial differences between respondents and nonrespondents in gender distribution and proportion of practitioners performing TMD diagnostics.…”

“…Consequently, we had expected to find a higher proportion of practitioners making use of behavioral therapy. However, our findings support the results of previous studies reporting low experiences and rare recommendations of those treatment modalities by general dental practitioners [14,19,20]. This lack of utilization of behavioral therapy may be caused by a lack of training in psychosocial competence and understanding in undergraduate curricula.…”

“…Although definite occlusal changes are not a recommended option for initial TMD treatment or prevention [29,30], about 44 % of our participants indicated performing such procedures. This might be an indicator for the still prevalent belief about the importance of occlusion in the etiology and treatment of TMD, which has also been observed in other studies [19-21, 23, 55], even though there seems to be a shift in thinking by dentists toward less occlusal therapy as observed in more recent studies [14,56]. Only 40 % of our participants mentioned relaxation training as an example of behavioral therapy as an option in their treatment spectrum.…”

“…However, general dental practitioners' experiences with cognitive behavioral therapy, stress management, and relaxation training as additional treatment modalities are generally low, and these treatments are rarely performed or recommended to their TMD patients [14,19,20]. Nonetheless, the increasing evidence has resulted in several recommendations and guidelines for TMD diagnostics and treatment being published or updated during recent years [33][34][35][36][37].…”

“…During the past decades, a large number of studies in several countries such as Germany [14,15], Iran [16], Korea [17], Sweden [18][19][20][21], UK [22], and the USA [23][24][25] have been conducted which investigated dentists' knowledge and performance of diagnostic and treatment procedures. It has been shown that dentists have gaps in their knowledge regarding the management of TMD patients [22] and that many dentists lacked sufficient experience and skills regarding TMD diagnostic and treatment procedures [20].…”