Can we improve the management of patients with Temporomandibular Disorders?

Objectives: To identify ways in which the management of patients with Temporomandibular Disorders (TMD) can be improved by critically examining sufferers' accounts of living with TMD and their experiences of care.

Methods: Qualitative interviews were conducted with a purposive sample of TMD sufferers (n=29). All data were audio-recorded and transcribed verbatim. Data collection and analysis was iterative, and followed the principles of the constant comparative method (Glaser 1965). All the data were analysed independently by two members of the research team, and the emergent themes agreed.

Results: Four main themes were identified: genesis; seeking help; negative impacts; coping. Sufferers experienced different symptoms, some providing what they believed to be plausible causes. Regardless of this, however, all attended their general dental or primary care medical practitioner to seek help. Individuals did not only want treatment for their condition, but to be given a legitimate diagnosis. However, often they did not receive a clear diagnosis in primary care, and were referred on to specialists (secondary care). This uncertainty caused considerable distress, with some people beginning to worry that their symptoms may be indicative of a sinister or serious illness. The physical symptoms they were experiencing, coupled with the lack of a definite diagnosis, had negative impacts on their personal relationships, job performance and social activities. Individuals reported that coping with their condition became easier once they had received a diagnosis in secondary care.

Conclusions: It is well established that uncertainty of diagnosis is a significant cause of distress in patients for a myriad of different conditions. This is also the case for TMD. Improving the diagnosis of TMD and providing reassurance for patients within primary care may significantly improve patients' experiences of their condition and reduce the number of referrals to secondary care.