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The Initial Treatment Plan Versus the Actually Performed Treatment of Patients With Temporomandibular Disorders in
Kaylee van Ee1, Magdalini Thymi1, Naichuan Su2
1Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Background:
Temporomandibular disorders (TMD) can impact on daily life, and are therefore important to treat with a fitting therapy. However, the factors that may influence the received treatment remain unknown.
Objectives:
To investigate the deviation between the indicated and received TMD treatment, and to identify patient and clinician characteristics that could influence the received treatment and the deviation from indicated treatment.
Methods:
This retrospective cohort study collected data on the indicated and received treatment of 140 TMD patients. The treatment modalities were counselling, occlusal appliance (OA), physical therapy, psychological treatment, contingent electrical stimulation, ecological momentary assessment and medication. Potential predictors for receiving treatment and deviation from indicated treatment included patient-related factors such as TMD diagnosis, bruxism, psychosocial factors and clinician-related factors such as clinician's specialty level and experience.
Results:
A good to perfect agreement between indicated and received treatments was observed for all treatment (84.3%-100%), except psychological treatment (66.4%). Received OA was associated with having a pain diagnosis (OR [95% CI] = 2.596 [1.189, 5.669], p = 0.017). In addition, received physical therapy was significantly associated with a pain diagnosis (OR [95% CI] = 3.876 [1.401, 10.721], p = 0.009), awake bruxism (OR [95% CI] = 1.730 (1.112, 2.690), p = 0.015) and clinician's level-being staff (OR [95% CI] = 6.068 [1.729, 20.553], p = 0.016). Received psychological therapy was significantly associated with a pain diagnosis (OR [95% CI] = 4.013 [1.077, 14.951], p = 0.038), sleep bruxism (OR [95% CI] = 1.381 [1.041, 1.830], p = 0.025), and physical symptoms (OR [95% CI] = 2.578 [1.561, 4.259], p < 0.001). No significant predictors were found for deviation.
Conclusion:
Receiving TMD treatment was associated with both patient-related factors-such as a TMD diagnosis, bruxism and physical symptoms-and clinician-related factors, such as the clinician's level of experience.
