Dentist Practice Patterns and Therapeutic Confidence in the Treatment of Pain Related to Temporomandibular Disorders in a Dental Practice-Based Research Network

Aims: To quantify the practice patterns of Japanese dentists in the management of pain related to temporomandibular disorders (TMD) and to identify specific characteristics that are significantly associated with the decision to perform occlusal adjustment for TMD-related pain. Methods: A cross-sectional study was conducted consisting of a questionnaire survey of dentists affiliated with the Dental Practice-Based Research Network Japan (JDPBRN) (n = 148). Participants were asked how they diagnosed and treated TMD-related pain. Associations between dentist characteristics and the decision to perform occlusal adjustment were analyzed via multiple logistic regression. Results: A total of 113 clinicians responded to the questionnaire (76% response rate), and 81% of them (n = 89) had treated TMD during the previous year. Dentists treated an average of 1.9 ± 1.8 (mean ± SD) patients with TMD-related pain per month. Most JDPBRN dentists used similar diagnostic protocols, including questions and examinations. The most frequent treatments were splints or mouthguards (96.5%), medications (84.7%), and self-care (69.4%). Occlusal adjustment for TMD-related pain was performed by 58% of the participants. Multiple logistic regression analysis identified two factors significantly associated with the decision to perform occlusal adjustment: dentist lack of confidence in curing TMD-related acute pain (odds ratio [OR] 5.60; 95% confidence interval [CI] 1.260 to 24.861) and proportion of patients with severe TMD-related pain (OR 0.95; 95% CI 0.909 to 0.999). Conclusion: The most common treatments for TMD-related pain were reversible treatments; however, over half of the dentists performed occlusal adjustment for TMD-related pain. The results of this study suggest that an evidence-practice gap exists for occlusal adjustment for TMD-related pain.

evidence-practice gap; practice pattern; practice-based research; temporomandibular disorders

1. Velly AM, Schiffman EL, Rindal DB, et al. The feasibility of a clinical trial of pain related to temporomandibular muscle and joint disorders: The results of a survey from the Collaboration on Networked Dental and Oral Research dental practice-based research networks. J Am Dent Assoc 2013;144:e1–e10.

2. Ministry of Health, Labour and Welfare. Statistical Tables of the Survey of Dental Diseases [in Japanese]. http://www.mhlw.go. jp/toukei/list/dl/62-17c23-1.pdf. Accessed 8 February 2017.

3. Management of temporomandibular disorders. National Institutes of Health Technology Assessment Conference Statement. J Am Dent Assoc 1996;127:1595–1606.

4. Hidemichi Yuasa, Kino K, Kubota E, et al. Primary treatment of temporomandibular disorders: The Japanese Society for the temporomandibular joint evidence-based clinical practice guidelines, 2nd edition. Jpn Dent Sci Rev 2013;49:89–98.

5. Gilbert GH, Williams OD, Rindal DB, et al. The creation and development of the Dental Practice-Based Research Network. J Am Dent Assoc 2008;139:74–81.

6. Gordan VV, Garvan CW, Heft MW, et al. Restorative treatment thresholds for interproximal primary caries based on radiographic images: Findings from the Dental Practice-Based Research Network. Gen Dent 2009;57:654–663.

7. Gordan VV, Bader JD, Garvan CW, et al. Restorative treatment thresholds for occlusal primary caries among dentists in the Dental Practice-Based Research Network. J Am Dent Assoc 2010;141:171–184.

8. Riley JL, Richman JS, Rindal DB, et al. Use of caries-preventive agents in children: Findings from the dental practice-based research network. Oral Health Prev Dent 2010;8:351–359.

9. Riley JL 3rd, Qvist V, Fellows JL, et al. Dentists’ use of caries risk assessment in children: Findings from the Dental Practice-Based Research Network. Gen Dent 2010;58:230–234.

10. Riley JL 3rd, Gordan VV, Ajmo CT, et al. Dentists’ use of caries risk assessment and individualized caries prevention for theiradult patients: Findings from the Dental Practice-Based Research Network. Community Dent Oral Epidemiol 2011;39: 564–573.

11. Kakudate N, Sumida F, Matsumoto Y, et al. Restorative treatment thresholds for proximal caries in dental PBRN. J Dent Res2012;91:1202–1208.

12. Yokoyama Y, Kakudate N, Sumida F, Matsumoto Y, Gilbert GH, Gordan VV. Dentists’ dietary perception and practice patterns in a Dental Practice-Based Research Network. PLoS One 2013; 8:e59615.

13. Yokoyama Y, Kakudate N, Sumida F, Matsumoto Y, Gilbert GH, Gordan VV. Dentists’ practice patterns regarding caries prevention: Results from a Dental Practice-Based Research Network. BMJ Open 2013;3:e003227.

14. Kakudate N, Sumida F, Matsumoto Y, Yokoyama Y, Gilbert GH, Gordan VV. Patient age and dentists’ decisions about occlusal caries treatment thresholds. Oper Dent 2014;39:473–480.

15. Kakudate N, Sumida F, Matsumoto Y, et al. Dentists’ decisions to conduct caries risk assessment in a Dental Practice-Based Research Network. Community Dent Oral Epidemiol 2015;43:128–134.

16. Yokoyama Y, Kakudate N, Sumida F, Matsumoto Y, Gilbert GH, Gordan VV. Evidence-practice gap for in-office fluoride application in a Dental Practice-Based Research Network. J Public Health Dent 2016;76:91–97.

17. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev 1977;84:191–215.

18. Bandura A. Reflections on self-efficacy. Adv Behav Res Ther 1978;1:237–269.

19. Bandura A. Self-Efficacy: The Exercise of Control. New York: W.H. Freeman, 1997.

20. Kakudate N, Morita M, Fujisawa M, Nagayama M, Kawanami M. Development of a Self-Efficacy Scale for Self-care (SESS) among periodontal disease patients-reliability and validity examination [in Japanese]. J Jpn Soc Periodontol 2007;49:285–295.

21. Kakudate N, Morita M, Kawanami M. Oral health care-specific self-efficacy assessment predicts patient completion of periodontal treatment: A pilot cohort study. J Periodontol 2008;79:1041–1047.

22. Kakudate N, Morita M, Sugai M, Kawanami M. Systematic cognitive behavioral approach for oral hygiene instruction: A shortterm study. Patient Educ Couns 2009;74:191–196.

23. Kakudate N, Morita M, Fukuhara S, et al. Development of the outcome expectancy scale for self-care among periodontal disease patients. J Eval Clin Pract 2011;17:1023–1029.

24. Kakudate N, Morita M, Yamazaki S, et al. Association between self-efficacy and loss to follow-up in long-term periodontal treatment. J Clin Periodontol 2010;37:276–282.

25. Kakudate N, Morita M, Sugai M, et al. Development of the self-efficacy scale for maternal oral care. Pediatr Dent 2010;32: 310–315.

26. Ministry of Health, Labour and Welfare. Survey of Physicians, Dentists and Pharmacists: Trends in the Number of Dentists [in Japanese]. Ministry of Health, Labour and Welfare, 2010. http://www.mhlw.go.jp/toukei/saikin/hw/ishi/10/dl/kekka_2. pdf. Accessed 8 February 2016.