A meta‐synthesis of qualitative data exploring the experience of living with temporomandibular disorders: The patients' voice

Abstract

Temporomandibular disorder (TMD) refers to a group of conditions that affect the temporomandibular joint and surrounding muscles. 1 Patients often report symptoms of pain in the jaw area and surrounding musculature, clicking sounds, alterations to the joint activities such as: deviation in the arc of movement, limitation to mouth opening, headache and earache. 2,3 TMD represents the most common cause of chronic pain in the orofacial region, 4 and is only behind headache and backache as reason for chronic pain in general. 5 Accepting the nature of chronic pain can be difficult for patients, therefore creating challenges to their daily lives. 6 Simple physical activities could become burdensome, and social interactions with family and friends may become more difficult. Chronic pain is also linked with depression, which may go unrecognised and therefore untreated in such patients. 7,8 It is likely that the relationship is bidirectional, with chronic pain thought to contribute and also result in poor mental health. 9 Similarly with anxiety and fear of pain, which are both linked to increased likelihood of chronic pain and poorer recovery should it develop. 10 It is therefore important for clinicians to be aware of the influence of chronic pain on patients and address the modifiable risk factors such as lifestyle and behaviour to reduce the impact it has on their lives. 11 The aim of this review was to synthesise the available qualitative evidence about the experience of living with TMD and the effects it has on daily life. Qualitative evidence

How dental teams can help patients with temporomandibular disorders receive general dental care: An International Delphi process

“…Evaluation of the existing literature 8,13,15,17 including a recent meta‐synthesis of qualitative evidence 9 identified several themes relating to the experiences of patients with TMD. The three general themes listed below were used to support the recommendations suggested by patient participants in the Delphi process.…”

“…Following the Delphi process, the results of a recently published meta‐synthesis of qualitative data on the experiences of people living with TMD 9 and other relevant qualitative papers 13–15 identified by TMD clinicians and patients were used to ensure that any missed themes were identified from the literature and included in the recommendations. The recommendations were then distributed to all participants for their final approval.…”

“…6 Importantly, many patients report their frustration in being unable to receive effective care in a timely manner 7,8 and difficulties in getting healthcare professionals to understand their condition. 9 General consensus for the management of TMD is that treatment should mainly focus on conservative and reversible therapies in the first instance, without the need for unnecessary irreversible dental procedures, and with surgical interventions reserved only for when there are specific indications. [10][11][12] For many patients with TMD, their existing painful symptoms, the need for prolonged jaw opening, previous TMJ surgery or the impact of comorbid conditions make receiving routine dental care difficult.…”

“…Additionally, many patients with TMD also suffer from other extensive and impactful comorbidities, such as primary headache disorders, fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome 6 . Importantly, many patients report their frustration in being unable to receive effective care in a timely manner 7,8 and difficulties in getting healthcare professionals to understand their condition 9 …”

Focus Groups to Inform the Development of a Patient-Reported Outcome Measure (PROM) for Temporomandibular Joint Disorders (TMDs)

“…Like our study, past studies have found that patients with TMDs report somatic symptoms such as involuntary grinding, clenching, or chewing [ 19 – 24 ], jaw pain [ 25 ], jaw misalignment or dislocation, jaw noises including clicking and popping [ 25 – 30 ], headaches [ 31 – 33 ], and ear sensations, such as tinnitus [ 34 – 36 ], and deficits in physical function, such as the ability to eat and chew [ 20 , 22 ]. As in our study, affective symptoms including depression and anxiety were particularly prevalent among patients with TMD, especially among those with severe TMDs [ 37 – 44 ], as were effects on social function (e.g., restrictions in social interactions due to shame or embarrassment) [ 45 ], sleep quality [ 46 – 48 ], and sexual function (e.g., loss of sexual interest) [ 49 ].…”