Physical Modalities for Temporomandibular Disorders: A Cross-Sectional Survey of Knowledge, Perceptions, and Practice Patterns Among Dental Professionals in Sana'a, Yemen.

Abstract

Background: Temporomandibular disorders (TMDs) are common musculoskeletal conditions for which physical modalities-including manual therapy, therapeutic jaw exercises, thermotherapy, electrotherapy, posture correction, and patient education-are recommended as first-line management. However, their implementation remains inconsistent, particularly in low- and middle-income and conflict-affected settings. This study evaluated knowledge, attitudes, clinical practices, and perceived barriers related to physical modalities for TMD management among dental practitioners in Sana'a, Yemen, and identified factors associated with adequate knowledge and practice.

Methods: A cross-sectional survey was conducted between February and April 2026 among 426 licensed dentists working in universities, private clinics, and public hospitals in Sana'a. A validated, self-administered questionnaire assessed knowledge (10 items), attitudes (6), practices (6), and barriers (5). Content validity (S-CVI=0.89) and reliability (Cronbach's α: 0.78-0.831) were confirmed. Adequacy was defined as ≥70% of the maximum score. Descriptive statistics, chi-square tests, and multivariable logistic regression were performed.

Results: The mean knowledge score was 5.65 ± 1.99/10, with only 32.9% achieving adequate knowledge. Although 68.3% reported positive attitudes, only 37.1% demonstrated adequate clinical practice. The main moderate-to-major barriers were limited access to physiotherapy resources/equipment (63.1%) and lack of formal training (59.9%). Attendance at a TMD course/workshop was the strongest predictor of adequate knowledge (AOR=3.11, 95% CI: 1.95-4.96), positive attitude (AOR=2.74, 95% CI: 1.62-4.63), and adequate practice (AOR=3.86, 95% CI: 2.39-6.23). Six or more TMD patients per month and having ten or more years of clinical experience were also significant predictors.

Conclusion: Among dental practitioners in Sana'a, knowledge about evidence-based physical modalities for TMD is insufficient, with a notable gap between positive attitudes and actual clinical practice. These findings highlight the need for strengthened undergraduate and continuing education, improved interprofessional collaboration with physiotherapy services, and enhanced access to physical therapy resources in this resource-limited, conflict-affected setting.