Exploring temporomandibular disorders : longitudinal and qualitative perspectives ; Smärta och funktionsstörning i käksystemet : longitudinellt och kvalitativt perspektiv

Background: Ideally, all clinical decision-making should enable care provision on the best available scientific evidence, clinical experience, and evaluated risks and benefits. Even though there are validated and evaluated decision tools for identification, diagnostics and treatment of temporomandibular disorders (TMD), patients with TMD still seem to go undetected, undiagnosed and undertreated in dentistry. Reasons for this discrepancy are unclear, but this clearly is a disadvantage for patients with TMD. Therefore, this project aimed to explore TMD in relation to the longitudinal course of the symptoms, dentists’ decision-making, and patients’ experiences. Methods: The project was conducted at the Public Dental Health Services in the Region of Västerbotten, Northern Sweden. Data in the longitudinal studies were based on the screening instrument for TMD, the 3Q/TMD, and included self-reported orofacial pain and jaw dysfunction, specifically jaw catching/locking, from 2010 to 2017 (n=180,308; age 5-104). Descriptive statistics, generalized estimating equation models, and Poisson regression were used for analyses. Data included in the qualitative studies were the transcribed individual interviews with dentists (n=22, age 25-64) and patients (n=16, age 20-65). Analyses were based on the Grounded Theory and the Qualitative Context Analysis. Results: The prevalence of orofacial pain increased over time (p<.01), but the prevalence of jaw catching/locking remained similar. The incidence, prevalence, and persistence of orofacial pain and jaw catching/locking were significantly higher in women than in men (p<.01). Women were at a higher risk for reporting both the first onset and the persistent orofacial pain (IRR 2.37; 95% CI, 2.25-2.50 and IRR 2.56; 95% CI, 2.28-2.87, respectively), and jaw catching/locking (IRR 2.29; 95% CI, 2.11-2.49 and IRR 2.32; 95% CI, 2.04-2.63, respectively) when compared to men. The onset of pain or jaw catching/locking was mostly independent and exclusive, i.e. without the other symptom ...