Dentist's distress in the management of chronic pain control

Abstract

We aimed to obtain greater understanding of dentists’ distress when they diagnose and treat patients with temporomandibular disorders (TMD), and to explore ways in which TMD can be better treated.We conducted a cross-sectional study based on a questionnaire survey of dentists (n = 148). Dentists were queried using an open-ended questionnaire about distress they experienced when treating patients with TMD. Survey responses were analyzed using mixed methods. Associations between specific dentist and patient characteristics and types of distress were analyzed by one way analysis of variance and residual analysis.One hundred thirteen clinicians responded to the questionnaire, giving a 76% response rate. Thematic analysis identified 6 major themes: difficulty in predicting therapeutic effect and prognosis; difficulty in diagnosis; difficulty in the decision about whether to do occlusal adjustment; difficulty in specifying a cause; difficulty in communicating with patients and mental factors; and health insurance system barriers. Clinicians who reported difficulty in deciding whether to do occlusal adjustment saw significantly more patients who experienced shoulder stiffness and headache (P = .008 and P = .022, respectively). Dentists’ knowledge of TMD guidelines was associated with a lower percentage of difficulty in predicting therapeutic effect and prognosis (residual analysis; P = .010).These findings provide important insights into clinician's perception of difficulties with patients experiencing TMD-related pain. Knowledge of the existence of TMD clinical practice guidelines may lower dentist distress, particularly with regard to prognosis. Further studies are needed to decrease dentist's distress and to overcome the evidence-practice gap in TMD treatment.

Prevalence of Temporomandibular Disorders (TMD) in Dental Patients at a Specialized Regional Medical Center in Italy

“…Simmons discussed the insufficient training of dentists in diagnosing temporomandibular disorders [16]. Similarly, dentists' distress in diagnosing and managing TMD pain was shown in a study by Yokoyama et al [17]. Other studies reported similar conclusions, not only with the lack of standardized physical evaluation [18] but also with the lack of psychological assessment [19].…”

Building the foundation for a modern patient-partnered infrastructure to study temporomandibular disorders

“…This translates to a “hidden” cost to employers of £584 and £1,225 in lost productivity for each 6-month period among individuals living with TMD ( 9 , 10 ). The natural history and etiology of the disorder are poorly understood and thus, appropriate treatment options are difficult to determine, limited, and complex ( 11 ).…”

Reduction of headache intensity and frequency with maxillary stabilization splint therapy in patients with temporomandibular disorders-headache comorbidity: a systematic review and meta-analysis

“…Several research groups have reported that treating TMD can reduce HAs [ 6 33 42 43 44 45 46 ]. However, many dentists are uncomfortable diagnosing or treating TMD [ 47 48 49 ]; one study of recent dental graduates attributed their lack of confidence in TMD diagnosis and treatment to insufficient TMD training in the dental school curricula [ 48 ]. TMD management generally focuses on conservative reversible therapy, including counseling, physical therapy, pharmacotherapy, behavior modification following self-care instructions, and intraoral occlusal appliances [ 19 ].…”