Ideologies and outcomes in temporomandibular disorders

Abstract

Temporomandibular disorders (TIVID) are a group of relatively common chronic disorders that often result in pain affecting the face, specifically the temporomandibular joint and associated muscles. Treatment strategies are varied, with only a minimal evidence base. The psychosocial aspects of TIVID are generally recognised to be important and complex. The aim of this thesis is to understand the philosophies of care that underpin the professional management of TIVID, and to explore the patients ) experiences of their illness and its management. The ultimate purpose is to use this information to target future interventions at specific points in the care pathway. Qualitative studies of professionals' and individuals' experiences of managing and living with TIVID were undertaken. In depth interviews were conducted with eighteen professionals and twenty-nine individuals suffering from TIVID. The data were then analysed and used to develop a map illustrating the patients' journey through care. The results exposed the large variation in clinical practice and considerable professional uncertainty about optimum management. Patients' experiences reflected the professional uncertainty, and some of the psychosocial effects experienced on the journey through care appeared to have an impact on outcome. The uncertainty over diagnosis in primary care led to a lack of legitimisation of the sufferer's complaint, which had concomitant effects on their day-to-day functioning. This, in turn, perpetuated any psychological distress they might already be experiencing. In conclusion, this thesis highlights the experiential basis of TIVID management, and the underlying ideology of, "do no harm". In primary care the sufferers experience a lack of legitimacy in their complaint due, in part, to a lack of a diagnosis. There is a need for a targeted programme of education in primary care in the diagnosis and management of TMD. This might reduce the level of uncertainty and concomitant psychosocial effects that sufferers experience currently.