Practitioner/Practice- and Patient-Based Factors Contributing to Dental Practitioner Treatment Recommendations for Patients with Pain-Related TMDs: Findings from the National Dental PBRN.

IF 1.9 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE
Joseph L Iii Riley, D Brad Rindal, Ana Miriam Velly, Gary C Anderson, Kimberly S Johnson, Gregg H Gilbert, Eric L Schiffman
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Abstract

Aims: To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit.

Methods: This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire.

Results: Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts.

Conclusions: Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines.

医生/实践和患者为基础的因素,有助于牙科医生治疗建议的患者与疼痛相关的tmd:从国家牙科PBRN的发现。
目的:记录以国家牙科实践为基础的研究网络(PBRN)从业者对疼痛性颞下颌疾病(TMDs)患者的治疗建议,并确定在初次临床访问时做出治疗建议的从业者/实践和患者相关因素。方法:本前瞻性单样本队列研究根据185名牙科医生治疗1901例疼痛性颞下颌关节痛患者的治疗建议分组。在本文描述的基线就诊中,医生向患者提供诊断和治疗方案,然后完成一份全面的问卷调查。结果:自我护理、口腔内矫治器、药物治疗和医生推荐的下颌运动是最常被推荐的治疗方法。医生向大多数患者推荐多种治疗方法。TMD的体征、症状和诊断是治疗计划的主要考虑因素,但医生对改善的期望仅对口腔内器具和自我护理有意义。与同行相比,女性从业者和具有tmd专业知识的从业者更经常推荐以患者为导向的多学科治疗。结论:从业人员使用了广泛的治疗患者很少一致的模式。在提出治疗建议时,倾向于使用TMD体征、症状和诊断,表明倾向于使用生物医学模型概念化患者。很少转诊到非牙科提供者表明缺乏这些提供者的可用性,对tmd的复杂性的误解,和/或不适应评估心理社会因素。这意味着需要在牙科学校对TMD患者的评估和管理进行全面的培训,并按照循证指南参加TMD继续教育课程。
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来源期刊
Journal of Oral & Facial Pain and Headache
Journal of Oral & Facial Pain and Headache DENTISTRY, ORAL SURGERY & MEDICINE-
CiteScore
5.10
自引率
4.00%
发文量
18
期刊介绍: Founded upon sound scientific principles, this journal continues to make important contributions that strongly influence the work of dental and medical professionals involved in treating oral and facial pain, including temporomandibular disorders, and headache. In addition to providing timely scientific research and clinical articles, the journal presents diagnostic techniques and treatment therapies for oral and facial pain, headache, mandibular dysfunction, and occlusion and covers pharmacology, physical therapy, surgery, and other pain-management methods.
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