Temporomandibular disorders (TMDs) are characterized by pain of masticatory muscles (when in function), pain in the area of preauricular and/or temporomandibular joint (TMJ), limited and/or deviated mandibular movements, and TMJ sounds (i.e., clicking and/or crepitus) during function [
The most common nondental orofacial pain conditions are TMDs [
Although, both TMD’s basic examination and clinical management are in a curriculum of each dentistry programme taught in Poland, it is not clear how dentists cope with diagnosis and possible treatment in routine dental practice [
Unfortunately, due to the lack of previous studies, there are no data on the self-perceived knowledge level of TMD among the Polish dentists to be compared with those retrieved from other countries. Considering the scarcity of research on this topic, the objective of present study was to assess the level of dentists’ self-perceived knowledge of TMD in Poland.
400 dental offices in Kraków (Poland) were randomly selected from Register of Entities Performing Medical Activities by the study’s coordinator to randomly identify the study participants, of whom all studied and graduated from a Polish university. The selected dentists were contacted in person by one of the three dentistry students involved in the study. All participants were informed that no identifiable information will be published or released and that participation is voluntary. Each participant was given an anonymous questionnaire to be filled in a spare room, taking approximately 5–10 minutes to be completed. All data were confidentially analyzed.
Prior to the study, the participants were informed of its aim and asked to sign consent forms. The research program was approved by the Jagiellonian University Bioethics Committee (approval no. 1072.6120.83.2018KBET). The study was conducted in accordance with the recommendations of the Declaration of Helsinki. The research commenced in April 2018 and ended in August 2019.
The participants were given an anonymous questionnaire containing 8 questions in total regarding: 3 questions on their self-assessment knowledge of TMD diagnosis and therapy and education in the field of TMD, 3 questions on TMD patient population and referrals, and 2 in regards to the participant’s knowledge of TMD ethology and the symptoms which, in the participant’s opinion, might indicate a TMD condition (Figure
Anonymous questionnaire.
For qualitative variables, percentages and raw counts were reported. Comparisons of qualitative variables in groups were conducted with the chi-squared test (with Yates’ correction for 2 × 2 tables) or with Fisher’s exact test (when low expected values had occurred). Analyses were conducted at 0.05 level of significance.
A total of 201 volunteers participated in the anonymous study. The response rate was 50.3% (201/400).
Only 6.5% of the participants assessed their TMD knowledge as very good, 32.3% assessed it as good, 39.3% thought it was sufficient, 20.4% marked it as insufficient, and 1.5% considered it poor. 64.2% of the participating volunteers had received some training in diagnosing and/or treating TMD patients during their academic education. 50.2% of all the participants had attended some postgraduate training sessions after the graduation from a university.
Being asked if ever suspected any patients of having TMD symptoms, only 9% of the dentists chose the first option very often. 55.7% selected the second option often, 31.8% chose rarely, and 2.5% chose never. 9.4% of all participants have attempted to diagnose and treat TMD patients very often, 26.4% declared performing it often, 45.8% rarely, and 18.4% had never made such an attempt. Majority of the dentists reluctant to undertake diagnosis and implement some treatment for patients being suspected of TMD refers these patients to prosthetics specialists (56.7%). Some dentists refer their patients to physiotherapists (32.8%), and some others to maxillofacial surgeons (2%), dental surgeons (2.5%), and hardly never to orthodontists (1.5%) (Table
Descriptive statistics of questionnaire.
Question | Answer | |
---|---|---|
(1) How would you describe your TMD knowledge? | Very good knowledge | 13 (6.5%) |
Good knowledge | 65 (32.3%) | |
Sufficient knowledge | 79 (39.3%) | |
Insufficient knowledge | 41 (20.4%) | |
Poor knowledge | 3 (1.5%) | |
(2) Did you take part in TMD training during your academic education? | Training during study | 129 (64.2%) |
No training | 71 (35.3%) | |
No answer | 1 (0.5%) | |
(3) Have you taken part in TMD training after graduating from a university? | Postgraduate training | 101 (50.2%) |
No training | 98 (48.8%) | |
No answer | 2 (1%) | |
(4) How often do you suspect TMD at a patients coming to your office? | Very often | 18 (9%) |
Often | 112 (55.7%) | |
Rarely | 64 (31.8%) | |
Never | 5 (2.5%) | |
No data | 2 (1%) | |
(5) How often do you make an actual attempt to diagnose and treat patients with TMD? | Very often | 19 (9.4%) |
Often | 53 (26.4%) | |
Rarely | 92 (45.8%) | |
Never | 37 (18.4%) | |
(6) Which of the following specialists you refer your patients to if you do not feel confident enough to diagnose and treat TMD? | Physiotherapist | 66 (32.8%) |
Prosthetics specialist | 114 (56.7%) | |
Maxillofacial surgeon | 4 (2%) | |
Dental surgeon | 5 (2.5%) | |
Orthodontist | 3 (1.5%) | |
No answer | 9 (4.5%) | |
(7) Which of the following do you consider as an etiological factor of TMD? Mark all relevant. | Malocclusion | 174 (86.6%) |
Missing teeth | 185 (92%) | |
Parafunctions | 181 (90%) | |
Stress | 188 (93.5%) | |
Psychological problems | 152 (75.6%) | |
(8) In your opinion which of the following symptoms might indicate a TMD condition? Mark all relevant. | Pain in the TMJ | 194 (96.5%) |
Pain in the muscles | 182 (90.5%) | |
Tension headaches | 174 (86.6%) | |
Clicks or crepitations in TMJ | 186 (92.5%) | |
Limitation of mouth opening | 175 (87%) |
When asked of major causes of TMD, almost all participants (93.5%) indicated stress as the main one. Similarly, 92% of participants thought that missing teeth were to blame, 90% chose parafunction as the main cause of TMD, 86.6% selected malocclusion, whereas 75.6% of dentists blamed psychological factors. If it comes to the syndromes, TMJ pain was selected as the most frequent (96.5%), followed by sounds in the TMJ area (92.5%), myofascial pain (90.5%), and tension headache (86.6%). A limitation of mouth opening (87%) was the least often symptom chosen. Next, the relationship between the questions was examined. There was only one significant relationship (as
The relationship between the dentists’ knowledge and their attempts at diagnosing and treating TMD patients.
Attempts to diagnose and treat | Knowledge | ||||
---|---|---|---|---|---|
Very good ( | Good ( | Sufficient ( | Insufficient or poor ( | ||
Very often | 7 (53.85%) | 6 (9.23%) | 6 (7.59%) | 0 (0.00%) | |
Often | 5 (38.46%) | 25 (38.46%) | 14 (17.72%) | 9 (20.45%) | |
Rarely | 0 (0.00%) | 27 (41.54%) | 40 (50.63%) | 25 (56.82%) | |
Never | 1 (7.69%) | 7 (10.77%) | 19 (24.05%) | 10 (22.73%) |
The aim of the study was to assess the level of the self-perceived knowledge of diagnosing and treating TMD among the Polish dentists and to assess their knowledge of TMD ethology and symptoms.
According to the Regulation of the Minister of Health 2017 [
About half of the Polish respondents (50.2%) agreed to participate in the postgraduate training in diagnosing or treating TMD, which corresponds with a study carried out in Sweden (51%) [
The study clearly demonstrated that there was a significant relationship (
The Polish dentists who do not attempt to diagnose and treat patients suspected of TMD often refer them to a specialist in prosthetics instead. The latter were given over several months long training in TMD patients’ diagnosis and treatments comparing to other medical specializations. However, the fact that over one-third of the examined dentists refers TMD patients for diagnosis and treatment to physiotherapists is worrying. Orofacial pain has a prevalence of about 10% in the general population, and many conditions share similar clinical features [
The majority of the Polish dentists consider stress, parafunction, and psychological factors to be the main causes of TMD. 96% of the American dentists are convinced that stress plays an important role in causing TMD, 100% of Korean dentists agree with them, 88% of Mexican dentists, and 88% of Swedish agree too [
On the other hand, a similar number of the Polish dentists disagree with the idea, claiming that missing teeth and malocclusion are to be blamed. The results of this study are similar to those of Lopez-Frias et al.’s study carried out among the Spanish dentists, where 98.5% of respondents believed that occlusal alterations are accountable for TMD [
According to a Polish graduate curriculum, the topic of TMD is included in prosthetics studies, which covers 285 hours of lectures and clinical classes [
As the final remark, it must be pointed out that this is the first study on the self-perceived dentists’ knowledge of TMD in Central/East Europe. Generalization of findings may be limited by the sample of dentists included in this study, which might have influenced the representativeness of the sample, with respect to the general Polish dentist population. The crucial limitation of the study is the lack of information about the demographics of the participants such as gender, age, lack of specialty, and years of experience. It is suggested to separate specialists and general dentists in future studies as well as take into consideration their work experience. In terms of limitations, the study was carried out on a relatively small group of dentists; therefore, it should be considered as a pilot study. In further studies, the sample group should be expanded to volunteers from other cities allowing for a cross-cultural comparison. Therefore, the presented results should be interpreted with caution and some further studies based on a bigger sample and including different dental specialties are recommended.
The study is the first one in Central Europe carried out among the Polish dentists with the use of a questionnaire. The results are within the range of those from other countries. However, Polish dentists’ knowledge of TMD is still insufficient. Increasing TMD knowledge level among the dentists would considerably help them in referring their patients to the right specialist for further diagnosis and TMD treatment and/or interdisciplinary management of TMD patients. Therefore, it is very important to design a suitable study programme which would provide graduate dentists with necessary practice and knowledge of TMD.
The data used to support the findings of this study are available from the corresponding author upon request.
All authors state that they have no conflicts of interest.