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Temporomandibular disorders. Variation in clinical practice.
M R Von Korff1, J A Howard, E L Truelove
1Center for Health Studies, ACC, Group Health Cooperative of Puget Sound, Seattle, WA 98121.
Medical Care
|March 1, 1988
Summary
Variability in diagnosing and treating temporomandibular disorders (TMD) was significant between clinics. However, these differences did not impact patient outcomes for pain and dysfunction after one year.
Area of Science:
- Dentistry
- Health Services Research
Background:
- Temporomandibular disorders (TMD) present with orofacial pain and dysfunction.
- Significant variability exists in the diagnosis and treatment of TMD.
Purpose of the Study:
- To assess the extent of variability in TMD diagnosis and treatment.
- To relate this variability to patient treatment outcomes.
Main Methods:
- 145 patients with orofacial pain were referred to two TMD clinics.
- Data collected on diagnostic methods (e.g., tomography) and treatments (e.g., appliances, medications, referrals).
- Patient-reported pain and dysfunction assessed at 1-year follow-up.
Main Results:
- Clinics showed substantial differences in tomography use (28% vs. 64%) and moderate differences in diagnoses.
- Treatment variations included appliances for bruxism (64% vs. 5%), medications, and referrals (1% vs. 42%).
- Observed diagnostic and therapeutic practice variations were not linked to significant differences in patient outcomes at 1 year.
Conclusions:
- Wide variations in TMD diagnosis and treatment practices exist.
- These variations do not appear to influence patient-reported outcomes at one year.
- Systematic approaches are needed to standardize TMD care due to lack of reliable evaluation methods and accepted clinical standards.