Orthodontists' Perceived Knowledge, Confidence, and Clinical Practices in Pediatric Temporomandibular Disorders

Temporomandibular disorders (TMD) are common in pediatric patients, yet limited data exist on orthodontists' knowledge, confidence, and clinical practices related to pediatric TMD. This cross-sectional study aimed to characterize orthodontists' perceived knowledge, confidence, training, and practice patterns, and examine associations between routine screening behaviors and perceived confidence.

A 34-item anonymous survey was distributed to orthodontists and orthodontic residents enrolled in or graduated from U.S. Commission on Dental Accreditation (CODA)-accredited programs. The survey assessed perceived knowledge, confidence in screening, diagnosis, and management of pediatric TMD, adequacy of residency training (on 0-10 numerical rating scale), frequency of routine TMD screening and examination practices, and referral patterns. Respondents were compared in study outcomes according to years of clinical practice with ANOVA. Respondents were categorized according to frequency of TMD screening (always/some of the time vs. sometimes/never) and compared in study outcomes using independent t-tests.

Out of 83 respondents, perceived knowledge (56.8 ± 26.9), confidence with screening (62.0 ± 30.5), diagnosis (59.4 ± 29.8), and management (50.8 ± 30.9) of pediatric TMD were moderate. Less than half of respondents (45.8%) reported routinely screening pediatric patients using standardized screening questions. Orthodontists who reported routine screening demonstrated significantly greater perceived knowledge and confidence in screening, diagnosis, and management compared with those who screened less frequently (all p's ≤ 0.018, effect size between 0.57 and 0.78). Greater use of specific history-taking and clinical examination components was also associated with higher perceived confidence (all p's between 0.001 and 0.046, effect size between 0.53 and 1.01). Confidence differed by years in practice, with lower scores reported among residents and mid-career practitioners (p < 0.05).

Variability exists in orthodontists' perceived knowledge, confidence, and clinical practices regarding pediatric TMD. Routine screening was associated with greater perceived competence. These findings highlight potential alignment between structured screening behaviors and self-reported confidence and may inform educational strategies in orthodontic training.