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Henien M, Zebic L, Mahendran K, Mellor A, Sproat C, Maciag A. The TMD management dilemma. Br Dent J 2024; 236:949-954. [PMID: 38942856 DOI: 10.1038/s41415-024-7506-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/21/2024] [Accepted: 03/02/2024] [Indexed: 06/30/2024]
Abstract
As temporomandibular disorders (TMDs) become ever more prevalent in both primary and secondary care settings, successful management is increasingly challenging in both sectors. The authors aim to explore the dilemma of TMD management as the patient journeys through from primary to secondary care and offer educational tools to support practitioners in managing this complex patient cohort, as well as outlining alternative solutions for the delivery of TMD management strategies.
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Affiliation(s)
- Marianne Henien
- Consultant Oral Surgeon, Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, UK.
| | - Lara Zebic
- Specialist Oral Surgeon, Department of Oral Surgery, Birmingham Dental Hospital, UK
| | - Krishantini Mahendran
- Academic Clinical Fellow in Oral Surgery, Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, UK
| | - Amy Mellor
- Speciality Dentist in Oral Surgery, Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, UK
| | - Chris Sproat
- Consultant Oral Surgeon, Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, UK
| | - Anna Maciag
- Consultant Oral Surgeon, Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, UK
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Penlington C, Durham J, O'Brien N, Green R. Filling in the Gaps. Making Sense of Living with Temporomandibular Disorders: A Reflexive Thematic Analysis. JDR Clin Trans Res 2024:23800844231216652. [PMID: 38166469 DOI: 10.1177/23800844231216652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Persistent, painful temporomandibular disorders (TMDs) are challenging to manage and usually require the active engagement of patients. To achieve this, it is necessary to understand the complex and multifactorial nature of persistent pain. Many dental professionals have little education about persistent pain and may prefer to offer structural management and advice. This research aims to explore how people understand their persistent TMD and how this understanding has been influenced by their treatment providers. METHODS Twenty-one people were recruited to represent a diversity of experience with persistent TMD. Interviews followed a semistructured topic guide. Themes were constructed through reflexive thematic analysis to represent how people made sense of their symptoms and the messages that they had picked up through their treatment journey. RESULTS Participants described examples of conflicting opinions and inconsistent management recommendations. They rarely recalled collaborative discussions about the nature and complexity of their symptoms and different options for treatment. This experience is represented by a single theme, "a medical merry-go-round." Subthemes of "a medical journey to nowhere-participants' frustrated attempts to find medical management that will end their pain" and "is it me?-participants' questioning their role in persisting pain" kept participants on the merry-go-round, while symptom resolution and participants' emerging development of a holistic understanding of their TMD pain provided exit points. Understanding pain holistically tended to be helpful and typically occurred despite rather than because of the advice given in routine treatment settings. CONCLUSION Participants in this study had not typically found their pain management within dental and medical settings to have helped them to construct meaning and understand their experiences of painful TMD. However, understanding symptoms holistically was experienced as beneficial. This study suggests that improved communication and signposting within services for persistent TMD may be beneficial to patients with TMD pain. KNOWLEDGE TRANSFER STATEMENT Results of this study confirm that being offered a series of anatomically based, singular-cause explanations for persisting pain symptoms had been experienced as unhelpful by the participants who had sought help for their TMD. Participants highlighted the importance of accurate and collaborative communication and of dental professionals explicitly adopting and communicating a biopsychosocial understanding of pain to their patients who have TMD. Results highlight that some people can struggle to manage persisting pain with minimal support. Signposting patients to appropriate services and resources may help them to understand more about the nature of persistent pain and methods of managing it.
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Affiliation(s)
- C Penlington
- Newcastle University Faculty of Medical Sciences, Newcastle, UK
| | - J Durham
- Newcastle University Faculty of Medical Sciences, Newcastle, UK
| | - N O'Brien
- Northumbria University Department of Psychology, Newcastle upon Tyne, Tyne and Wear, UK
| | - R Green
- Newcastle University Faculty of Medical Sciences, Newcastle, UK
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Taimeh D, Riordain RN, Fedele S, Leeson R. Healthcare priorities in patients with chronic facial pain of temporomandibular disorders. Oral Dis 2023; 29:2878-2887. [PMID: 36565449 DOI: 10.1111/odi.14483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the experiences of patients with temporomandibular disorders (TMDs) with the National Health Service and to discover their healthcare priorities when seeking treatment. METHODS Semi-structured interviews were used. They were directed using a topic guide covering subjects such as initial visits in primary care, referrals to secondary care, and the effect on symptoms. The discussions were audiotaped and transcribed verbatim. Thematic analysis was utilised to analyse the data. RESULTS In total, 15 participants took part in three focus groups. Six themes were identified: "access to appropriate care", "organised and coordinated care", "receiving a diagnosis and enough information", "interaction with the clinical staff", "treatment strategies and having an 'action plan'" and "support and social networks". CONCLUSIONS The participants gave accounts of the difficulties encountered in healthcare in general terms and specific to TMD. Most notable was the struggle to access appropriate care, receive a diagnosis and be understood. Our findings suggest that delays in delivering appointments with people of expertise may have caused the worsening of symptoms. However, when a pleasant experience was encountered, access to care was fast, the clinician was understanding and communication with the clinical team was good. These provided positive experiences and were appreciated by the patients.
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Affiliation(s)
- Dina Taimeh
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, University of Jordan, Amman, Jordan
| | - Richeal Ni Riordain
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Oral Medicine Unit, Cork University Dental School and Hospital, Cork, Ireland
| | - Stefano Fedele
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Oral Medicine Unit, Eastman Dental Hospital, University College London Hospitals Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Rachel Leeson
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
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Lövgren A, Ilgunas A, Häggman-Henrikson B, Elias B, ROUDINi OA, Visscher CM, Lobbezoo F, Wänman A, Liv P. ASSOCIATIONS BETWEEN SCREENING FOR FUNCTIONAL JAW DISTURBANCES AND PATIENT REPORTED OUTCOMES ON JAW LIMITATIONS AND ORAL BEHAVIORS. J Evid Based Dent Pract 2023; 23:101888. [PMID: 37689443 DOI: 10.1016/j.jebdp.2023.101888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/30/2023] [Accepted: 04/13/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES Temporomandibular disorders (TMDs) is a collective term for pain and functional disturbances related to the jaw muscles and the temporomandibular joint. In contrast to screening for orofacial pain, knowledge is limited on the association between patient-reported outcomes and screening for joint-related functional jaw disturbances. Therefore, our aim was to evaluate the association between a screening question for functional jaw disturbances, and disease-specific outcome measures for functional jaw limitations and oral behaviors. METHODS This study included 299 individuals (201 women; 20-69 years, median 37.0) in a general population sample from Västerbotten, Northern Sweden in 2014. A single screening question for functional jaw disturbances "Does your jaw lock or become stuck once a week or more?" was used to categorize individuals as cases or controls. Patient-reported outcomes on functional jaw disturbances were assessed with the 20-item jaw functional limitation scale (JFLS-20) and oral behaviors with the 21-item Oral Behaviors Checklist (OBC-21). RESULTS The strongest predictive probability to have a positive screening outcome was functional jaw limitations related to mobility (AUCboot=0.78, 95 CI:0.71-0.86, P < .001), followed by limitations related to communication (AUCboot = 0.74, 95 CI:0.63-0.80, P < .001) and mastication (AUCboot = 0.73, 95 CI:0.66-0.81, P < .001). The frequency of oral behaviors was not significantly associated with a positive screening outcome (AUCboot = 0.65, 95 CI:0.55-0.72, P = .223). CONCLUSIONS Self-reported functional limitations, but not oral behaviors, are strongly associated with a single screening question for frequent functional jaw disturbances. This finding provides support for incorporating a question on jaw catching/locking once a week or more in screening instruments for TMDs.
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Affiliation(s)
- A Lövgren
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden.
| | - A Ilgunas
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden; Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - B Häggman-Henrikson
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden; Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - B Elias
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - O Al ROUDINi
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - C M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A Wänman
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - P Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Corline A, Cole F, Trewern L, Penlington C. 'Power to the People, to the people': Training for social prescribers improves support of persistent pain. Br J Pain 2023; 17:281-292. [PMID: 37342392 PMCID: PMC10278448 DOI: 10.1177/20494637231152979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Introduction Supported self-management is an important aspect of managing pain, however widely held beliefs about the biomedical nature of pain and limited time availability can make it a tricky concept to introduce to patients. Social prescribers are in an ideal position to support self-management of pain if appropriate training is available to support them. This study aimed to evaluate training for social prescribers and to explore their opinions and experiences about providing self-management support. Methods This was a mixed methods study. Repeated measures t-tests were used to compare the reported confidence of attendees in supporting different facets of self-management before and after the training. Thematic analysis of interviews was used to develop a deeper understanding of how participants related the training to their work with patients. Results Average confidence improved in all aspects of supporting self-management, and particularly with regard to supporting understanding pain, acceptance, pacing, setting goals, sleep and managing setbacks. Challenges were identified around explaining pain in an accurate and accessible way in order to provide a meaningful rationale for self-management. Conclusion Training for social prescribers in self-management support is feasible and leads to improvements in self-reported confidence. Further research is needed to determine the impact on patients and over a longer period of time.
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Affiliation(s)
- Alex Corline
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | | | - Louise Trewern
- Lead Lived Experience Trainer, Live Well with Pain, NHS Pain Service Volunteer Torbay and South Devon
| | - Chris Penlington
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
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Bhattacharjee B, Bera RN, Verma A, Soni R, Bhatnagar A. Efficacy of Arthrocentesis and Stabilization Splints in Treatment of Temporomandibular Joint Disc Displacement Disorder Without Reduction: A Systematic Review and Meta-analysis. J Maxillofac Oral Surg 2023; 22:83-93. [PMID: 36703686 PMCID: PMC9871120 DOI: 10.1007/s12663-021-01675-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background Temporomandibular joint disc displacement disorders are a group of temporomandibular disorders beside from other inflammatory disorders and growth related disorders of joint. The purpose of this analysis was to evaluate the efficacy of arthrocentesis procedure in comparison with stabilization splints used for disc displacement disorders without reduction. Materials and Methods A systematic search was done in electronic databases (PubMed, Cochrane Central, Web of Science). In addition to this hand search of references and grey literatures was done. Qualities of randomized controlled clinical trials were assessed by Cochrane's tool for Systematic Reviews of Interventions and the Newcastle-Ottawa Scale was followed to assess the prospective and retrospective studies. Outcome variables pain (VAS) and maximum mouth opening were assessed by the software review manager 5.03. Results A total of five studies were included in the review. Three studies showed greater improvement of symptoms in patients of arthrocentesis group in terms of maximum mouth opening, pain (VAS) value. Two other studies found no significant advantage of arthrocentesis over the other treatment protocol. The meta-analysis resulted in statistically significant difference between outcome variables favouring arthrocentesis group (VAS 1-10) (Mean Difference: 3.10; 95% CI 1.74, 4.45; P ≤ .00001, Mean difference: 2.00; 95% CI 0.29, 3.71; P = 0.02). Conclusion Arthrocentesis showed effective result in terms of increase in mouth opening and reduction of pain level compared to stabilization splint and other non-invasive approaches in patients with disc displacement disorders without reduction. Overall, results supported the rationale of using arthrocentesis in patients with disc displacement disorders without reduction.
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Affiliation(s)
- Bappaditya Bhattacharjee
- Unit of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh 221005 India
| | - Rathindra Nath Bera
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh 221005 India
| | - Arju Verma
- Unit of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh 221005 India
| | - Romesh Soni
- Unit of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh 221005 India
| | - Atul Bhatnagar
- Unit of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh 221005 India
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De Medeiros Tormes AK, Lemos GA, Da Silva PLP, Forte FDS, De Sousa FB, Araujo DN, Batista AUD. Temporomandibular disorders: knowledge, competency, and attitudes of predoctoral dental students. Cranio 2023; 41:32-40. [PMID: 32866058 DOI: 10.1080/08869634.2020.1812816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate knowledge, competency, and attitudes related to temporomandibular disorders (TMD) among predoctoral dental students, and to investigate the curricular organization of contents related to TMD and occlusion. METHODS Predoctoral dental students (n = 147) answered a questionnaire with topics related to TMD. Another questionnaire evaluated the organization of TMD and occlusion courses. RESULTS Contents related to TMD and occlusion were taught in the same course in all dental schools. The students' responses showed low agreement with the current gold standards pertaining to TMD. Most students declared that they did not feel confident to treat patients with TMD (62.6%), were not satisfied with the content pertaining to TMD (55.8%), and considered a lack of clinical practice to be the primary limitation in their training (59.2%). DISCUSSION Students' knowledge of basic concepts related to TMD was limited, highlighting the need for readjustment of the dental curriculum to increase clinical experience.
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Affiliation(s)
| | - George Azevedo Lemos
- Biological and Health Sciences Institute, Federal University of Alagoas, Maceió, Brazil
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Penlington C, Bowes C, Taylor G, Otemade AA, Waterhouse P, Durham J, Ohrbach R. Psychological therapies for temporomandibular disorders (TMDs). Cochrane Database Syst Rev 2022; 8:CD013515. [PMID: 35951347 PMCID: PMC9370076 DOI: 10.1002/14651858.cd013515.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Temporomandibular disorders (TMDs) are a group of musculoskeletal disorders affecting the jaw. They are frequently associated with pain that can be difficult to manage and may become persistent (chronic). Psychological therapies aim to support people with TMDs to manage their pain, leading to reduced pain, disability and distress. OBJECTIVES To assess the effects of psychological therapies in people (aged 12 years and over) with painful TMD lasting 3 months or longer. SEARCH METHODS Cochrane Oral Health's Information Specialist searched six bibliographic databases up to 21 October 2021 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of any psychological therapy (e.g. cognitive behaviour therapy (CBT), behaviour therapy (BT), acceptance and commitment therapy (ACT), mindfulness) for the management of painful TMD. We compared these against control or alternative treatment (e.g. oral appliance, medication, physiotherapy). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We reported outcome data immediately after treatment and at the longest available follow-up. We used the Cochrane RoB 1 tool to assess the risk of bias in included studies. Two review authors independently assessed each included study for any risk of bias in sequence generation, allocation concealment, blinding of outcome assessors, incomplete outcome data, selective reporting of outcomes, and other issues. We judged the certainty of the evidence for each key comparison and outcome as high, moderate, low or very low according to GRADE criteria. MAIN RESULTS We identified 22 RCTs (2001 participants), carried out between 1967 and 2021. We were able to include 12 of these studies in meta-analyses. The risk of bias was high across studies, and we judged the certainty of the evidence to be low to very low overall; further research may change the findings. Our key outcomes of interest were: pain intensity, disability caused by pain, adverse events and psychological distress. Treatments varied in length, with the shortest being 4 weeks. The follow-up time ranged from 3 months to 12 months. Most studies evaluated CBT. At treatment completion, there was no evidence of a benefit of CBT on pain intensity when measured against alternative treatment (standardised mean difference (SMD) 0.03, confidence interval (CI) -0.21 to 0.28; P = 0.79; 5 studies, 509 participants) or control (SMD -0.09, CI -0.30 to 0.12; P = 0.41; 6 studies, 577 participants). At follow-up, there was evidence of a small benefit of CBT for reducing pain intensity compared to alternative treatment (SMD -0.29, 95% CI -0.50 to -0.08; 5 studies, 475 participants) and control (SMD -0.30, CI -0.51 to -0.09; 6 studies, 639 participants). At treatment completion, there was no evidence of a difference in disability outcomes (interference in activities caused by pain) between CBT and alternative treatment (SMD 0.15, CI -0.40 to 0.10; P = 0.25; 3 studies, 245 participants), or between CBT and control/usual care (SMD 0.02, CI -0.21 to 0.24; P = 0.88; 3 studies, 315 participants). Nor was there evidence of a difference at follow-up (CBT versus alternative treatment: SMD -0.15, CI -0.42 to 0.12; 3 studies, 245 participants; CBT versus control: SMD 0.01 CI - 0.61 to 0.64; 2 studies, 240 participants). There were very few data on adverse events. From the data available, adverse effects associated with psychological treatment tended to be minor and to occur less often than in alternative treatment groups. There were, however, insufficient data available to draw firm conclusions. CBT showed a small benefit in terms of reducing psychological distress at treatment completion compared to alternative treatment (SMD -0.32, 95% CI -0.50 to -0.15; 6 studies, 553 participants), which was maintained at follow-up (SMD -0.32, 95% CI -0.51 to -0.13; 6 studies, 516 participants). For CBT versus control, only one study reported results for distress and did not find evidence of a difference between groups at treatment completion (mean difference (MD) 2.36, 95% CI -1.17 to 5.89; 101 participants) or follow-up (MD -1.02, 95% CI -4.02 to 1.98; 101 participants). We assessed the certainty of the evidence to be low or very low for all comparisons and outcomes. The data were insufficient to draw any reliable conclusions about psychological therapies other than CBT. AUTHORS' CONCLUSIONS We found mixed evidence for the effects of psychological therapies on painful temporomandibular disorders (TMDs). There is low-certainty evidence that CBT may reduce pain intensity more than alternative treatments or control when measured at longest follow-up, but not at treatment completion. There is low-certainty evidence that CBT may be better than alternative treatments, but not control, for reducing psychological distress at treatment completion and follow-up. There is low-certainty evidence that CBT may not be better than other treatments or control for pain disability outcomes. There is insufficient evidence to draw conclusions about alternative psychological therapeutic approaches, and there are insufficient data to be clear about adverse effects that may be associated with psychological therapies for painful TMD. Overall, we found insufficient evidence on which to base a reliable judgement about the efficacy of psychological therapies for painful TMD. Further research is needed to determine whether or not psychological therapies are effective, the most effective type of therapy and delivery method, and how it can best be targeted. In particular, high-quality RCTs conducted in primary care and community settings are required, which evaluate a range of psychological approaches against alternative treatments or usual care, involve both adults and adolescents, and collect measures of pain intensity, pain disability and psychological distress until at least 12 months post-treatment.
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Affiliation(s)
- Chris Penlington
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte Bowes
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Greig Taylor
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Paula Waterhouse
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA
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Dinsdale A, Forbes R, Thomas L, Treleaven J. The management experiences, needs and preferences of individuals seeking care for persistent intra-articular temporomandibular disorders: A qualitative study. J Oral Rehabil 2021; 49:10-21. [PMID: 34622974 DOI: 10.1111/joor.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the management experiences, needs and preferences of individuals seeking care for persistent intra-articular temporomandibular disorders (TMD). Investigating these experiences may improve understanding of the impact management has on individuals, and factors that shape these experiences. This information may advance current practice and guide future management of individuals with intra-articular TMD. OBJECTIVES To investigate the management experiences, needs and preferences of individuals with persistent intra-articular TMD. METHODS A qualitative study was performed. Thirteen eligible participants (mean age 32.7 years, 12 female) were recruited via purposive sampling, and interviewed using a semi-structured framework. Data were analysed using a thematic analysis approach. RESULTS Four themes were established from interview data: (i) searching for help; (ii) wanting answers; (iii) wanting to regain control; and (iv) meeting needs, preferences and expectations, and the implications on care. Numerous factors influenced the experiences of those seeking care, including the ability to navigate care and management expectations. Specific to intra-articular TMD, the absence of pain made seeking care harder, and often, patients perceived neglect of mechanical symptoms by healthcare practitioners, which negatively impacted care. Often, those wanting management expressed the need for answers and to regain control over their jaw symptoms. CONCLUSIONS Strategies to improve healthcare navigation are needed for those wanting help for intra-articular TMD. Within management, a person-centred approach is encouraged. Practitioners should respect individuals' specific needs and preferences, and address underlying management expectations, to facilitate positive care experiences. Consideration of symptoms other than pain in intra-articular TMD populations is paramount.
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Affiliation(s)
- Alana Dinsdale
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, Australia
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, Australia
| | - Lucy Thomas
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, Australia
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Aggarwal VR, Wu J, Fox F, Howdon D, Guthrie E, Mighell A. Implementation of biopsychosocial supported self-management for chronic primary oro-facial pain including temporomandibular disorders: A theory, person and evidence-based approach. J Oral Rehabil 2021; 48:1118-1128. [PMID: 34273180 DOI: 10.1111/joor.13229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aims of the study were to: Implement supported self-management for chronic primary oro-facial pain in a clinical setting. Evaluate its impact on consultation rates, pain severity, interference with life and patient experience. METHODS Sixty-six patients with chronic primary oro-facial pain received the intervention at a facial pain clinic at Leeds Dental Institute, UK. Brief Pain Inventory (BPI) scores measured pain severity and interference with life before and after the intervention. Process mining outlined patient care pathways. Monthly consultation rates measured 12 months before and after the intervention were used to evaluate burden on healthcare services and economic impact. Patient feedback was assessed via Patient and Public involvement discussion groups. RESULTS Mean BPI scores significantly improved after intervention-from 5.70 (SD 1.89) to 3.78 (SD 2.34) (p < .001); mean pain interference score reduced from 19.95 (SD 9.41) to 12.05 (SD 9.64) (p < .001). Average monthly consultations significantly (p = .001) reduced from 0.42/month before the intervention to 0.16/month after the intervention. Economic assessment showed cost savings of £293 per patient per year. Process mining showed high rates of service usage with 31 patients also attending 51 other specialist services between them. Patient and Public Involvement discussion groups with 5 patients identified that the intervention was a 'constant companion' and should be implemented at the outset in the care pathway. CONCLUSION Supported self-management for chronic primary oro-facial pain has a positive impact on health outcomes (physical functioning, pain intensity and patient experience), as well as service usage and healthcare costs when implemented in a secondary care clinical setting. Reconfiguring current care pathways to upscale early implementation of such interventions should be a priority for future testing.
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Affiliation(s)
- Vishal R Aggarwal
- School of Dentistry, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - Frank Fox
- School of Dentistry, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Faculty of Medicine & Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elspeth Guthrie
- Faculty of Medicine & Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alan Mighell
- School of Dentistry, Faculty of Medicine & Health, University of Leeds, Leeds, UK
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Ilgunas A, Lövgren A, Fjellman-Wiklund A, Häggman-Henrikson B, Karlsson Wirebring L, Lobbezoo F, Visscher CM, Durham J. Conceptualizing the clinical decision-making process in managing temporomandibular disorders: A qualitative study. Eur J Oral Sci 2021; 129:e12811. [PMID: 34145628 DOI: 10.1111/eos.12811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
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 for TMD. 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.
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Affiliation(s)
- Aurelia Ilgunas
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | | | | | | | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle, UK.,Newcastle Hospitals' NHS Foundation Trust, Newcastle, UK
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12
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Moore RJ, Dave M, Stocker J, Aggarwal VR. Simplifying differential diagnoses of orofacial conditions - a guide to surgical sieves and red flags. Br Dent J 2021; 230:289-293. [PMID: 33712778 DOI: 10.1038/s41415-021-2717-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/21/2020] [Indexed: 11/09/2022]
Abstract
Formulation of a differential diagnosis with appropriate diagnostic tests is critical in day-to-day clinical practice. Many specialists or hospital-based practitioners in specialties such as oral medicine and oral surgery will be familiar with the use of surgical sieves and the term 'red flags' in their practice. However, it is the authors' experience that general dental practitioners may not be as familiar with such tools. Primary care practitioners are often the first port of call for patients with uncommon symptoms; therefore, it is essential that appropriate and timely referrals are made. The use of a surgical sieve and heightened awareness of red flags will assist practitioners significantly.
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Affiliation(s)
- Richard J Moore
- Division of Oral Surgery & Oral Medicine, University of Leeds, UK.
| | - Manas Dave
- Division of Dentistry, University of Manchester, UK
| | - Judith Stocker
- Department of Oral & Maxillofacial Surgery, University Hospitals Coventry & Warwickshire, UK
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13
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Decision-making in the management of TMJ disc displacement without reduction: A qualitative study. J Dent 2019; 91:103223. [DOI: 10.1016/j.jdent.2019.103223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 11/18/2022] Open
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14
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Sharma S, Breckons M, Brönnimann Lambelet B, Chung J, List T, Lobbezoo F, Nixdorf DR, Oyarzo JF, Peck C, Tsukiyama Y, Ohrbach R. Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain. J Oral Rehabil 2019; 47:87-100. [DOI: 10.1111/joor.12871] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/18/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Sonia Sharma
- Department of Oral Diagnostic Sciences, School of Dental Medicine University at Buffalo Buffalo NY USA
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology Malmö University Malmö Sweden
| | | | - Ben Brönnimann Lambelet
- Psychiatric Services of District Aargau Ambulatory Center for Psychiatry and Psychotherapy Aarau Switzerland
| | - Jin‐Woo Chung
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry Seoul National University Seoul Korea
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology Malmö University Malmö Sweden
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Donald R. Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry University of Minnesota Minneapolis MN USA
| | - Juan Fernando Oyarzo
- TMD and Orofacial Pain, Faculty of Odontology Universidad Andres Bello Santiago Chile
| | - Christopher Peck
- Faculty of Dentistry The University of Sydney Surry Hills NSW Australia
| | - Yoshihiro Tsukiyama
- Section of Dental Education, Faculty of Dental Science Kyushu University Fukuoka Japan
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, School of Dental Medicine University at Buffalo Buffalo NY USA
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15
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Näsström A, Fallgren J, Wänman A, Lövgren A. The implementation of a decision-tree did not increase decision-making in patients with temporomandibular disorders in the public dental health service. Acta Odontol Scand 2019; 77:394-399. [PMID: 30806118 DOI: 10.1080/00016357.2019.1577989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Many patients with temporomandibular disorders (TMD) seem to go undetected within primary dental health care. Primarily we evaluated if the implemented intervention increased the clinical decision-making for TMD patients; secondarily we evaluated if other factors could be identified that predicted performed or recommended TMD treatment. MATERIAL AND METHODS This case-control study was carried out within the Public Dental Health service in Västerbotten County, Sweden. An intervention based on a decision-tree with three screening questions for TMD (3Q/TMD) was implemented during 2015 in four clinics and compared with the remaining county. A total of 400 individuals were selected-200 3Q-positives and 200 3Q-negatives. The 3Q/TMD consists of Q1-frequent jaw pain, Q2-frequent pain on function, and Q3-frequent catching and/or locking of jaw. The 3Q/TMD answers were analyzed in relation to TMD treatment and any TMD related decision that was collected from the digital dental records. RESULTS The intervention did not increase the frequencies of traceable clinical decisions among patients with TMD. CONCLUSIONS Despite the implemented intervention aimed, the indicated undertreatment of patients with TMD remains. Future studies are still needed to gain a deeper understanding of the clinical decision-making process for TMD patients in general practice dentistry.
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Affiliation(s)
- Anna Näsström
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Jakob Fallgren
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Anders Wänman
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Anna Lövgren
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
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16
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Fjellman‐Wiklund A, Näsström A, Wänman A, Lövgren A. Patients' perceived treatment need owing to temporomandibular disorders and perceptions of related treatment in dentistry—A mixed‐method study. J Oral Rehabil 2019; 46:792-799. [DOI: 10.1111/joor.12813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/24/2019] [Accepted: 04/27/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - Anna Näsström
- Department of Clinical Oral Physiology, Faculty of Medicine, Institution of Odontology Umeå University Umeå Sweden
| | - Anders Wänman
- Department of Clinical Oral Physiology, Faculty of Medicine, Institution of Odontology Umeå University Umeå Sweden
| | - Anna Lövgren
- Department of Clinical Oral Physiology, Faculty of Medicine, Institution of Odontology Umeå University Umeå Sweden
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17
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Aggarwal VR, Fu Y, Main CJ, Wu J. The effectiveness of self‐management interventions in adults with chronic orofacial pain: A systematic review, meta‐analysis and meta‐regression. Eur J Pain 2019; 23:849-865. [DOI: 10.1002/ejp.1358] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/20/2018] [Accepted: 12/30/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Vishal R. Aggarwal
- Faculty of Medicine & Health, School of Dentistry University of Leeds Leeds UK
| | - Yu Fu
- Faculty of Medicine & Health, School of Healthcare University of Leeds Leeds UK
| | - Chris J. Main
- Research Institute for Primary Care & Health Keele University Keele UK
| | - Jianhua Wu
- Faculty of Medicine & Health, School of Dentistry University of Leeds Leeds UK
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18
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Thymi M, Rollman A, Visscher CM, Wismeijer D, Lobbezoo F. Experience with bruxism in the everyday oral implantology practice in the Netherlands: a qualitative study. BDJ Open 2018; 4:17040. [PMID: 30425840 PMCID: PMC6226535 DOI: 10.1038/s41405-018-0006-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 12/29/2022] Open
Abstract
Objective To explore how bruxism is dealt with by accredited oral implantologists within daily clinical practice. Materials and methods Nine semi-structured interviews of oral implantologists practicing in non-academic clinical practices in the Netherlands were performed, and thematic analysis was conducted using a framework-based approach. Results Oral implant treatments in bruxing patients were a generally well-accepted practice. Complications were often expected, with most being of minor impact. Contradictive attitudes emerged on the topic of bruxism being an etiologic factor for peri-implant bone loss and loss of osseointegration. Views on the ideal treatment plan varied, though the importance of the superstructure’s occlusion and articulation features was repeatedly pointed at. Similarly, views on protective splints varied, regarding their necessity and material choice. Bruxism was diagnosed mainly by clinical examination, alongside with patient anamnesis and clinician’s intuition. There was little attention for awake bruxism. Discussion Bruxism was generally not considered a contraindication for implantological treatments by accredited oral implantologists. Views on the interaction between bruxism and bone loss/loss of osseointegration varied, as did views on the ideal treatment plan. Conclusions There is a need for better understanding of the extent to which, and under which circumstances, sleep and/or awake bruxism can be seen as causal factors for the occurrence of oral implant complications.
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Affiliation(s)
- Magdalini Thymi
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Annemiek Rollman
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Corine M Visscher
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Daniel Wismeijer
- 2Section of Oral Implantology and Prosthetic Dentistry, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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19
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Lövgren A, Karlsson Wirebring L, Häggman-Henrikson B, Wänman A. Decision-making in dentistry related to temporomandibular disorders: a 5-yr follow-up study. Eur J Oral Sci 2018; 126:493-499. [DOI: 10.1111/eos.12572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Anna Lövgren
- Department of Odontology; Faculty of Medicine; University of Umeå; Umeå Sweden
| | | | - Birgitta Häggman-Henrikson
- Department of Odontology; Faculty of Medicine; University of Umeå; Umeå Sweden
- Department of Orofacial Pain and Jaw function; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Anders Wänman
- Department of Odontology; Faculty of Medicine; University of Umeå; Umeå Sweden
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20
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Lövgren A, Parvaneh H, Lobbezoo F, Häggman-Henrikson B, Wänman A, Visscher CM. Diagnostic accuracy of three screening questions (3Q/TMD) in relation to the DC/TMD in a specialized orofacial pain clinic. Acta Odontol Scand 2018; 76:380-386. [PMID: 29448865 DOI: 10.1080/00016357.2018.1439528] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic. MATERIAL AND METHODS Consecutive patients, >18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre for Dentistry Amsterdam, the Netherlands, were included in the study. All patients (n = 449; mean age 44 years; 72% females), answered the 3Q/TMD and the DC/TMD questionnaire before a DC/TMD examination. The 3Q/TMD constitutes of two questions on weekly pain from the jaw, face and temple region (Q1), and on function (Q2), and one function-related question on weekly catching and/or locking of the jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard. RESULTS In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an intra-articular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was high (0.83-0.94), whereas specificity was low (0.41-0.55). For the function-related question, sensitivity was low (0.48), whereas specificity was high (0.96). CONCLUSIONS In a specialized pain clinic, the two pain questions (Q1, Q2) are positive in most patients with pain-related TMD. Therefore, in case of a positive response, further diagnostic procedures for TMD pain are warranted. For the functional screening question (Q3), a positive response is indicative for an intra-articular DC/TMD diagnosis, while in case of a negative outcome, an intra-articular TMD might still be present.
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Affiliation(s)
- Anna Lövgren
- Department of Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Hasti Parvaneh
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Birgitta Häggman-Henrikson
- Department of Clinical Oral Physiology, Umeå University, Umeå, Sweden
- Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Anders Wänman
- Department of Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Corine Mirjam Visscher
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
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21
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Breckons M, Shen J, Bunga J, Vale L, Durham J. DEEP Study: Indirect and Out-of-pocket Costs of Persistent Orofacial Pain. J Dent Res 2018; 97:1200-1206. [DOI: 10.1177/0022034518773310] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Persistent orofacial pain (POFP) is common and caused by a group of conditions affecting the face, head, or mouth. Recent research highlighted a problematic care pathway with high costs to the health care provider, but the financial impact on patients and employers is not understood. This study aimed to describe patient (out-of-pocket) and employer (indirect) costs of POFP and to identify whether the dichotomized Graded Chronic Pain Scale (GCPS) was predictive of costs. A cohort of 198 patients was recruited from primary and secondary care settings in North East England and followed over a 24-mo period. Patients completed the GCPS and Use of Services and Productivity Questionnaire every 6 mo and a Time and Travel Questionnaire at 14 mo. Questionnaires examined the implications of health care utilization on patients’ everyday lives and personal finances. Time and travel costs were calculated and applied to use-of-services data to estimate out-of-pocket costs, while the human capital method and QQ method (quantity and quality of work completed) were used to estimate absenteeism and presenteeism costs, respectively. Per person per 6-mo period (in 2017 pounds sterling), mean out-of-pocket costs were £333 (95% CI, £289 to £377), and indirect costs were £1,242 (95% CI, £1,014 to £1,470). Regression analyses indicated that over 6 mo, the GCPS was predictive of the following: out-of-pocket costs—a difference of £311 between low and high GCPS per person per 6-mo period (95% CI, £280 to £342; P < 0.01, n = 705 observations over 24 mo); indirect costs—a difference of £2,312 between low and high GCPS per person per 6-mo period (95% CI, £1,886 to £2,737; P < 0.01; n = 352 observations over 24 mo). This analysis highlights “hidden” costs of POFP and supports the use of the dichotomized GCPS to identify patients at risk of higher impact and associated costs and thereby stratify care pathways and occupational health support appropriately.
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Affiliation(s)
- M. Breckons
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J. Shen
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J. Bunga
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - L. Vale
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J. Durham
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals’ NHS Foundation Trust, Newcastle upon Tyne, UK
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22
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Mejersjö C, Bertilsson O, Bäck K. Short clinical examination for temporomandibular symptoms in general practice. Acta Odontol Scand 2018; 76:183-187. [PMID: 29140141 DOI: 10.1080/00016357.2017.1401657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aims of the study are to assess the reliability of the short clinical examination, and to compare the information gained with a well-known and validated examination, the diagnostic criteria for temporomandibular disorders (DC/TMD). MATERIALS AND METHODS The study comprises 52 consecutive, newly referred patients at their first visit and examination to an Orofacial Pain and TMD Clinic, 15 years and older, mean age 44 years. The patients first answered three screening questions for reported symptoms. The clinical examination was performed using both the short examination and the DC/TMD and the result was compared. Another group of 40 newly referred patients, with similar inclusion criteria, was examined twice according to the short clinical examination by two examiners, and the inter-examiner variation was studied. The protocol of the short clinical examination is described. RESULT The overall agreement between the two methods was fairly good to excellent, as was the degree of agreement between repeated examinations and two examiners using the short clinical examination method. The sensitivity and specificity of the short examination for diagnoses were acceptable to high (with DC/TMD as the golden standard). CONCLUSIONS The short clinical examination has acceptable reliability and, together with three screening questions, provides enough information about the jaw function to decide whether there is a dysfunction.
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Affiliation(s)
- Christina Mejersjö
- Clinic of Orofacial Pain, Sahlgrenska Academy and Public Dental Health, Gothenburg, Sweden
| | - Ove Bertilsson
- Clinic of Orofacial Pain, Sahlgrenska Academy and Public Dental Health, Gothenburg, Sweden
| | - Karin Bäck
- Clinic of Orofacial Pain, Sahlgrenska Academy and Public Dental Health, Gothenburg, Sweden
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23
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Lövgren A, Marklund S, Visscher CM, Lobbezoo F, Häggman-Henrikson B, Wänman A. Outcome of three screening questions for temporomandibular disorders (3Q/TMD) on clinical decision-making. J Oral Rehabil 2017; 44:573-579. [DOI: 10.1111/joor.12518] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2017] [Indexed: 12/22/2022]
Affiliation(s)
- A. Lövgren
- Department of Odontology, Clinical Oral Physiology; Faculty of Medicine; Umeå University; Umeå Sweden
| | - S. Marklund
- Department of Odontology, Clinical Oral Physiology; Faculty of Medicine; Umeå University; Umeå Sweden
| | - C. M. Visscher
- Department of Oral Kinesiology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - F. Lobbezoo
- Department of Oral Kinesiology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - B. Häggman-Henrikson
- Department of Odontology, Clinical Oral Physiology; Faculty of Medicine; Umeå University; Umeå Sweden
- Department of Orofacial Pain and Jaw function; Faculty of Odontology; Malmö University; Malmö Sweden
| | - A. Wänman
- Department of Odontology, Clinical Oral Physiology; Faculty of Medicine; Umeå University; Umeå Sweden
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24
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Breckons M, Bissett SM, Exley C, Araujo-Soares V, Durham J. Care Pathways in Persistent Orofacial Pain: Qualitative Evidence from the DEEP Study. JDR Clin Trans Res 2016; 2:48-57. [PMID: 28879244 DOI: 10.1177/2380084416679648] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the "fluidity of the care pathway," in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a "failure to progress," where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the "effects of unmanaged pain," where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.
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Affiliation(s)
- M Breckons
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - S M Bissett
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
| | - C Exley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - V Araujo-Soares
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - J Durham
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
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25
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Yule PL, Durham J, Wassell RW. Pain part 6: temporomandibular disorders. ACTA ACUST UNITED AC 2016; 43:39-42, 45-8. [DOI: 10.12968/denu.2016.43.1.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Pamela L Yule
- Specialty Registrar and Associate Clinical Lecturer in Restorative Dentistry, Newcastle Dental Hospital, Richardson Road, Newcastle upon Tyne NE2 4AZ
| | - Justin Durham
- Senior Lecturer in Oral Surgery and Orofacial Pain and Honorary Consultant Oral Surgeon, School of Dental Sciences, Newcastle University
| | - Robert W Wassell
- Senior Lecturer and Honorary Consultant in Restorative Dentistry, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, Tyne and Wear NE2 4BW, UK
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26
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Ghurye S, McMillan R. Pain-Related Temporomandibular Disorder - Current Perspectives and Evidence-Based Management. ACTA ACUST UNITED AC 2015; 42:533-6, 539-42, 545-6. [PMID: 26506809 DOI: 10.12968/denu.2015.42.6.533] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pain-related temporomandibular disorder (TMD) is one of the top three most common chronic pain conditions, along with headaches and back pain. TMD has complex pathophysiology and significant associations with a variety of other chronic pain conditions, eg fibromyalgia, irritable bowel syndrome and migraine. Chronic TMD is associated with a negative impact upon quality of life and high levels of healthcare utility. It is important that clinicians are able to diagnose TMD correctly, provide appropriate management in keeping with current evidence-based practice, and identify when to refer patients to specialist care. The presence of risk factors, eg anxiety, depression, pain-related disability and chronic pain conditions elsewhere in the body, may help to identify which TMD patients require referral for multidisciplinary management. TMD should be managed using a holistic approach, incorporating patient education and encouragement towards self-management. TMD care pathways should consider using the three'pillars'of pain management: physical therapies, pharmacotherapy and clinical psychology.
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Robinson LJ, Durham J, Newton JL. A systematic review of the comorbidity between Temporomandibular Disorders and Chronic Fatigue Syndrome. J Oral Rehabil 2015; 43:306-16. [PMID: 26549386 DOI: 10.1111/joor.12367] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED The most common cause of chronic oro-facial pain is a group of disorders collectively termed temporomandibular disorders (TMDs). Chronic painful TMD is thought to be a 'central sensitivity syndrome' related to hypersensitivity of the nervous system, but the cause is unknown. A similar understanding is proposed for other unexplained conditions, including chronic fatigue syndrome (CFS). Exploring the comorbidity of the two conditions is a valuable first step in identifying potential common aetiological mechanisms or treatment targets. METHOD Systematic literature review. Studies were included if they recruited community or control samples and identified how many reported having both TMD and CFS, or if they recruited a sample of patients with either TMD or CFS and measured the presence of the other condition. RESULTS Six papers met inclusion criteria. In studies of patients with CFS (n = 3), 21-32% reported having TMD. In a sample of people with CFS and fibromyalgia, 50% reported having TMD. Studies in people with TMD (n = 3) reported 0-43% having CFS. Studies in samples recruited from oro-facial pain clinics (n = 2) reported a lower comorbidity with CFS (0-10%) than a study that recruited individuals from a TMD self-help organisation (43%). CONCLUSION The review highlights the limited standard of evidence addressing the comorbidity between oro-facial pain and CFS. There is a valuable signal that the potential overlap in these two conditions could be high; however, studies employing more rigorous methodology including standardised clinical assessments rather than self-report of prior diagnosis are needed.
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Affiliation(s)
- L J Robinson
- Academic Psychiatry, Newcastle University, Newcastle upon Tyne, UK.,Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Durham
- Centre for Oral Health Research and Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - J L Newton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Durham J, Raphael KG, Benoliel R, Ceusters W, Michelotti A, Ohrbach R. Perspectives on next steps in classification of oro-facial pain - part 2: role of psychosocial factors. J Oral Rehabil 2015; 42:942-55. [PMID: 26257252 DOI: 10.1111/joor.12329] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/30/2022]
Abstract
This study was initiated by a symposium, in which the present authors contributed, organised by the International RDC/TMD Consortium Network in March 2013. The purpose of the study was to review the status of biobehavioural research - both quantitative and qualitative - related to oro-facial pain (OFP) with respect to the aetiology, pathophysiology, diagnosis and management of OFP conditions, and how this information can optimally be used for developing a structured OFP classification system for research. In particular, we address representation of psychosocial entities in classification systems, use of qualitative research to identify and understand the full scope of psychosocial entities and their interaction, and the usage of classification system for guiding treatment. We then provide recommendations for addressing these problems, including how ontological principles can inform this process.
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Affiliation(s)
- J Durham
- Centre for Oral Health Research & Institute of Health & Society, Newcastle University, Newcastle, UK
| | - K G Raphael
- New York University College of Dentistry, New York, NY, USA
| | - R Benoliel
- Rutgers School of Dental Medicine, Newark, NJ, USA
| | | | | | - R Ohrbach
- University at Buffalo, Buffalo, NY, USA
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Peters S, Goldthorpe J, McElroy C, King E, Javidi H, Tickle M, Aggarwal VR. Managing chronic orofacial pain: A qualitative study of patients', doctors', and dentists' experiences. Br J Health Psychol 2015; 20:777-91. [DOI: 10.1111/bjhp.12141] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 03/25/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Sarah Peters
- Manchester Centre for Health Psychology; School of Psychological Sciences; University of Manchester; UK
| | | | | | - Elizabeth King
- Manchester Centre for Health Psychology; School of Psychological Sciences; University of Manchester; UK
| | - Hanieh Javidi
- School of Clinical Dentistry; University of Sheffield; UK
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Summary of Royal College of Surgeons' (England) clinical guidelines on management of temporomandibular disorders in primary care. Br Dent J 2015; 218:355-6. [DOI: 10.1038/sj.bdj.2015.194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 11/08/2022]
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Al-Baghdadi M, Durham J, Araujo-Soares V, Robalino S, Errington L, Steele J. TMJ Disc Displacement without Reduction Management: A Systematic Review. J Dent Res 2014; 93:37S-51S. [PMID: 24659775 PMCID: PMC4293719 DOI: 10.1177/0022034514528333] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Various interventions have been used for the management of patients with temporomandibular joint (TMJ) disc displacement without reduction (DDwoR), but their clinical effectiveness remains unclear. This systematic review investigated the effects of these interventions and is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic and manual searches up to November 1, 2013, were conducted for English-language, peer-reviewed, publications of randomized clinical trials comparing any form of conservative or surgical interventions for patients with clinical and/or radiologic diagnosis of acute or chronic DDwoR. Two primary outcomes (TMJ pain intensity and maximum mouth opening) and a number of secondary outcomes were examined. Two reviewers performed data extraction and risk of bias assessment. Data collection and analysis were performed according to Cochrane recommendations. Twenty studies involving 1,305 patients were included. Data analysis involved 21 comparisons between a variety of interventions, either between interventions, or between intervention and placebo or no intervention. Meta-analysis on homogenous groups was conducted in 4 comparisons. In most comparisons made, there were no statistically significant differences between interventions relative to primary outcomes at short- or long-term follow-up (p > .05). In a separate analysis, however, the majority of reviewed interventions reported significantly improved primary outcome measures from their baseline levels over time (p < .05). Evidence levels, however, are currently insufficient for definitive conclusions, because the included studies were too heterogeneous and at an unclear to high risk of bias. In view of the comparable therapeutic effects, paucity of high-quality evidence, and the greater risks and costs associated with more complex interventions, patients with symptomatic DDwoR should be initially treated by the simplest and least invasive intervention.
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Affiliation(s)
- M Al-Baghdadi
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, UK Institute of Health and Society, Newcastle University, UK
| | - J Durham
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, UK Institute of Health and Society, Newcastle University, UK
| | | | - S Robalino
- Institute of Health and Society, Newcastle University, UK
| | | | - J Steele
- Institute of Health and Society, Newcastle University, UK Department of Restorative Dentistry, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Retrospective examination of the healthcare 'journey' of chronic orofacial pain patients referred to oral and maxillofacial surgery. Br Dent J 2014; 214:E12. [PMID: 23470414 DOI: 10.1038/sj.bdj.2013.221] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To gain a deeper understanding of the clinical journey taken by orofacial pain patients from initial presentation in primary care to treatment by oral and maxillofacial surgery. DESIGN Retrospective audit. SAMPLE AND METHODS Data were collected from 101 consecutive patients suffering from chronic orofacial pain, attending oral and maxillofacial surgery clinics between 2009 and 2010. Once the patients were identified, information was drawn from their hospital records and referral letters, and a predesigned proforma was completed by a single examiner (EVB). Basic descriptive statistics and non-parametric inferential statistical techniques (Krushal-Wallis) were used to analyse the data. DATA AND DISCUSSION: Six definitive orofacial pain conditions were represented in the data set, 75% of which were temporomandibular disorders (TMD). Individuals within our study were treated in nine different hospital settings and were referred to 15 distinct specialties. The mean number of consultations received by the patients in our study across all care settings is seven (SD 5). The mean number of specialities that the subjects were assessed by was three (SD 1). The sample set had a total of 341 treatment attempts to manage their chronic orofacial pain conditions, of which only 83 (24%) of all the treatments attempted yielded a successful outcome. CONCLUSION Improved education and remuneration for primary care practitioners as well as clear care pathways for patients with chronic orofacial pain should be established to reduce multiple re-referrals and improve efficiency of care. The creation of specialist regional centres for chronic orofacial pain may be considered to manage severe cases and drive evidence-based practice.
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Developing Effective and Efficient care pathways in chronic Pain: DEEP study protocol. BMC Oral Health 2014; 14:6. [PMID: 24447722 PMCID: PMC3909482 DOI: 10.1186/1472-6831-14-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/13/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pain affecting the face or mouth and lasting longer than three months ("chronic orofacial pain", COFP) is relatively common in the UK. This study aims to describe and model current care pathways for COFP patients, identify areas where current pathways could be modified, and model whether these changes would improve outcomes for patients and use resources more efficiently. METHODS/DESIGN The study takes a prospective operations research approach. A cohort of primary and secondary care COFP patients (n = 240) will be recruited at differing stages of their care in order to follow and analyse their journey through care. The cohort will be followed for two years with data collected at baseline 6, 12, 18, and 24 months on: 1) experiences of the care pathway and its impacts; 2) quality of life; 3) pain; 4) use of health services and costs incurred; 5) illness perceptions. Qualitative in-depth interviews will be used to collect data on patient experiences from a purposive sub-sample of the total cohort (n = 30) at baseline, 12 and 24 months. Four separate appraisal groups (public, patient, clincian, service manager/commissioning) will then be given data from the pathway analysis and asked to determine their priority areas for change. The proposals from appraisal groups will inform an economic modelling exercise. Findings from the economic modelling will be presented as incremental costs, Quality Adjusted Life Years (QALYs), and the incremental cost per QALY gained. At the end of the modelling a series of recommendations for service change will be available for implementation or further trial if necessary. DISCUSSION The recent white paper on health and the report from the NHS Forum identified chronic conditions as priority areas and whilst technology can improve outcomes, so can simple, appropriate and well-defined clinical care pathways. Understanding the opportunity cost related to care pathways benefits the wider NHS. This research develops a method to help design efficient systems built around one condition (COFP), but the principles should be applicable to a wide range of other chronic and long-term conditions.
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Shephard MK, Macgregor EA, Zakrzewska JM. Orofacial pain: a guide for the headache physician. Headache 2013; 54:22-39. [PMID: 24261452 DOI: 10.1111/head.12272] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 12/19/2022]
Abstract
Orofacial pain represents a significant burden in terms of morbidity and health service utilization. It includes very common disorders such as toothache and temporomandibular disorders, as well as rare orofacial pain syndromes. Many orofacial pain conditions have overlapping presentations, and diagnostic uncertainty is frequently encountered in clinical practice. This review provides a clinically orientated overview of common and uncommon orofacial pain presentations and diagnoses, with an emphasis on conditions that may be unfamiliar to the headache physician. A holistic approach to orofacial pain management is important, and the social, cultural, psychological and cognitive context of each patient needs to be considered in the process of diagnostic formulation, as well as in the development of a pain management plan according to the biopsychosocial model. Recognition of psychological comorbidities will assist in diagnosis and management planning.
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Affiliation(s)
- Martina K Shephard
- Oral Medicine Unit, Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
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Zakrzewska JM. Multi-dimensionality of chronic pain of the oral cavity and face. J Headache Pain 2013; 14:37. [PMID: 23617409 PMCID: PMC3642003 DOI: 10.1186/1129-2377-14-37] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 04/09/2013] [Indexed: 11/10/2022] Open
Abstract
Orofacial pain in its broadest definition can affect up to 7% of the population. Its diagnosis and initial management falls between dentists and doctors and in the secondary care sector among pain physicians, headache neurologists and oral physicians. Chronic facial pain is a long term condition and like all other chronic pain is associated with numerous co-morbidities and treatment outcomes are often related to the presenting co-morbidities such as depression, anxiety, catastrophising and presence of other chronic pain which must be addressed as part of management . The majority of orofacial pain is continuous so a history of episodic pain narrows down the differentials. There are specific oral conditions that rarely present extra orally such as atypical odontalgia and burning mouth syndrome whereas others will present in both areas. Musculoskeletal pain related to the muscles of mastication is very common and may also be associated with disc problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are specific diagnosis with defined care pathways. Other trigeminal neuropathic pain which can be associated with neuropathy is caused most frequently by trauma but secondary causes such as malignancy, infection and auto-immune causes need to be considered. Management is along the lines of other neuropathic pain using accepted pharmacotherapy with psychological support. If no other diagnostic criteria are fulfilled than a diagnosis of chronic or persistent idiopathic facial pain is made and often a combination of antidepressants and cognitive behaviour therapy is effective. Facial pain patients should be managed by a multidisciplinary team.
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Affiliation(s)
- Joanna M Zakrzewska
- Facial pain unit, Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, UCLH NHS Foundation Trust, 256 Gray's Inn Road, London, WC1X 8LD, UK.
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Moufti MA, Wassell RW, Meechan JG, Allen PF, John MT, Steele JG. The Oral Health Impact Profile: ranking of items for temporomandibular disorders. Eur J Oral Sci 2011; 119:169-74. [DOI: 10.1111/j.1600-0722.2011.00809.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Durham J, Steele J, Moufti MA, Wassell R, Robinson P, Exley C. Temporomandibular disorder patients’ journey through care. Community Dent Oral Epidemiol 2011; 39:532-41. [DOI: 10.1111/j.1600-0528.2011.00608.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Temporomandibular disorders (TMDs) are a common group of chronic illnesses. There is evidence that health professionals find them difficult to diagnose and manage. A consequence of this difficulty in diagnosis might be that sufferers of TMDs have an experience of illness comparable with other chronic illnesses. To explore the sufferers’ experience of TMDs, we conducted a qualitative study with a purposive maximum variation sample of secondary care TMD patients. Semi-structured interviews were conducted with the sample and were recorded and transcribed verbatim. Data collection and analysis continued until data saturation (n = 19). For analysis, we broadly followed the constant comparative method and used frameworks to organize the data. The key finding was that a lack of diagnosis caused uncertainty over the nature of the cause of the sufferer’s complaint. This uncertainty reportedly caused negative impacts on sufferers’ daily lives. Clearly, diagnosis of TMDs needs to be encouraged at the first point of contact.
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Affiliation(s)
- J. Durham
- Newcastle University’s Institute of Health and Society, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle NE2 4BW, UK
| | - J.G. Steele
- Newcastle University’s Institute of Health and Society, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle NE2 4BW, UK
| | - R.W. Wassell
- Newcastle University’s Institute of Health and Society, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle NE2 4BW, UK
| | - C. Exley
- Newcastle University’s Institute of Health and Society, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle NE2 4BW, UK
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Hasanain F, Durham J, Moufti A, Steen IN, Wassell RW. Adapting the diagnostic definitions of the RDC/TMD to routine clinical practice: A feasibility study. J Dent 2009; 37:955-62. [DOI: 10.1016/j.jdent.2009.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 08/03/2009] [Accepted: 08/05/2009] [Indexed: 10/20/2022] Open
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Exley C. Bridging a gap: the (lack of a) sociology of oral health and healthcare. SOCIOLOGY OF HEALTH & ILLNESS 2009; 31:1093-1108. [PMID: 19659738 DOI: 10.1111/j.1467-9566.2009.01173.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article provides an historical review of international research related to sociology and oral health and healthcare. I begin by considering the relevance of the mouth and oral health to social interactions and physical health, and outline existing inequalities in oral health and healthcare experiences. The paper examines critically some of the existing published research in the field - considering both what might be described as sociology of oral health and healthcare and sociology in oral healthcare - and demonstrates the dearth of sociological research related to this subject compared to other areas of interest within the field of sociology of health and illness. I conclude by suggesting some ways in which this area could be expanded and developed further. I suggest that sociological analyses of how individuals experience, understand and manage their mouth and oral health, can add to and enhance the broader field of the sociology of health and illness. Further, examining experiences and provision of oral healthcare may provide sociology with a new opportunity to explore the neglected field of private healthcare, but also to engage with health policy makers who seek to address oral healthcare needs.
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Affiliation(s)
- Catherine Exley
- Institute of Health and Society, Newcastle University, 21 Claremont Road, Newcastle upon Tyne, NE2 4AA.
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