Temporomandibular disorder patients' journey through care.

UNLABELLED: Temporomandibular disorders (TMDs) are a common group of chronic disorders (illnesses) that health care providers can find difficult to diagnose and explain. Similar difficulties in the diagnosis of other chronic conditions have been shown to have a negative impact on health. An understanding of TMD patients' experiences and journey through care could indicate time points and strategies to help patients. OBJECTIVE: To develop a robust empirically derived map of TMD sufferers' journey through care. METHODS: A qualitative study using semi-structured interviews was undertaken using a purposive sample of patients with TMDs. Analysis followed the principles of the constant comparative method where data collection and thematic analysis occurred concurrently and continued until data saturation (n = 29). RESULTS: The experiences of patients could be grouped into three key stages: genesis of problem, seeking help in primary care and secondary care intervention. A wide variety of negative effects were described throughout these stages. An empirically derived map of the patients' reported journey through care emerged. CONCLUSIONS: The experiences of patients with TMDs mirror experiences of other types of chronic illness. Mapping the journey through care for TMDs highlights the potential for interaction between the stages of the journey and the individual's illness. It may be possible to target interventions at specific stages on the map to help minimize the psychosocial effects of TMDs.

A method for clinically defining "improvers" in chronic pain studies.

AIMS: To test a measurement model based on clinicians' assessments of patient data that allows simple and confident clinical validation of any statistical or numerical technique designed to separate patients improving with treatment from those who are not, particularly for pain that shows large daily variation. METHODS: Diaries using daily visual analog scales (VAS) of pain intensity were obtained from 39 patients treated for chronic temporomandibular disorders. Three experienced clinicians visually assessed 39 VAS/time graphs. Criteria indicating improvement (general trend, height and apparent frequency of graph spikes) evolved over 3 assessments. The third assessment defined improvers visually. Numeric analyses considered the difference between first and last months of treatment for mean, area under the curve (AUC), and maximum VAS scores. Thresholds of 40%, 50%, or 60% pain reduction defined improvement numerically. Aggregate sensitivity and specificity was compared with visual definition to find the optimal threshold. RESULTS: Patients were defined visually as improvers, nonimprovers, and borderline cases. Interexaminer reliability for identifying improvers was good (k = 0.79). Mean VAS and AUC were highly correlated (r = 0.999). The optimal threshold of mean and maximum VAS relative to visual definition was 50% pain reduction. Cases defined as improvers by both mean and maximum agreed best with the visual definition (sensitivity 90%, specificity 84%). CONCLUSION: Visual assessment of VAS demonstrates distinct pain/time patterns that can validate numeric definition of complex pain recovery. No single numeric method can be guaranteed to give a clinically valid outcome.

How to make a well-fitting stabilization splint.

UNLABELLED: This article demonstrates a clinical step-by-step approach to constructing stabilization splints. These splints can be invaluable for many restorative procedures and for TMD management. To help the busy practitioner, we have included tips on trouble shooting problems encountered during splint fitting. CLINICAL RELEVANCE: Knowledge of how to make a stabilization splint is a welcome addition to the dental practitioner's armamentarium.