Date of Award

2017

Document Type

Thesis

Degree Name

Master of Science in Dentistry

Department

Orthodontics

College

College of Dental Medicine

First Advisor

Theresa Gonzales

Second Advisor

Ricky Harrell

Third Advisor

Roland Fulcher

Abstract

Objective: This project was undertaken to accomplish two objectives: 1) identify whether there is a discrepancy between orthodontists and “experts in TMD*” related to diagnosis and treatment of TMD patients and 2) influence the manner in which TMD curriculum is taught in orthodontic residency programs in order to better prepare future orthodontic specialists to diagnose and treat (and/or refer) patients with TMD who often seek care from orthodontic providers. This study will evaluate knowledge and beliefs regarding Temporomandibular Disorders (TMD) among orthodontists when compared to responses from “experts in TMD”; more specifically: A) to determine possible discrepancies related to knowledge and beliefs regarding TMD between these two groups of specialists as it pertains to diagnosis and/or treatment of TMD patients; B) to identify which specific domain (pathophysiologic, chronic pain, psychophysiological, psychiatric disorders) potentially yields the greatest knowledge gap among the specialty cohorts evaluated; C) to ascertain the practicing orthodontic providers’ comfort level in treating TMD patients., and D) to identify the manner in which orthodontists acquired their foundational and treatment knowledge regarding TMD. It is anticipated that orthodontists who respond to the survey will demonstrate similar knowledge base and beliefs regarding TMD when compared with “experts in TMD" Materials and Methods: A survey invitation was emailed to 8870 orthodontists (including residents in Orthodontics) who, at the time of the survey, were members of the American Association of Orthodontists. Participants were selected at random. The invitational email explained the purpose of the survey, and contained a secure link to an online survey program (REDCap). Participation was voluntary and not financially compensated. Two addition reminder emails were sent to the same groups after one week and one month from the date of the original solicitation. Items were answered on a 6-­‐point scale, which included: I don’t know, strongly disagree, disagree, neutral, agree, and strongly agree. A group consensus was attributed when more than 50% of the orthodontists supported one response; the agree response combined “strongly agree" and “agree", and the disagree response combined “strongly disagree” and “disagree”. The TMD experts‘ responses published on the paper from Porto et al (2016) were used as the reference to evaluate the orthodontists’ responses. Comparisons between the responses from the two groups were assessed using z-­‐test. Results: A total of 1545 participants responded the questionnaire. Among the participants 148 were residents, 1132 were private practitioners, and 61 were fulltime faculty. Almost half of the participants (48.3%) graduated more 20 years ago; 61.6% of the participants do not think they received enough training in TMD during their orthodontic residency. Twenty percent of the participants selected that they acquired most of the TMD knowledge at the dental school, 34.8% selected orthodontic residency, and 37.3% selected Continuing Education course. Sixty two percent of participants indicated they feel comfortable diagnosing TMD patients, but 50.2% do not feel comfortable treating patients with TMD. Among the orthodontists the pathophysiology domain was the specified domain with the highest degree of uncertainty. There was no significant difference between the two groups’ responses in less than one third of the questions. Conclusions: It is clear that the orthodontic residencies in the United States need to improve methods of teaching TMD concepts. Despite the fact most orthodontists feel comfortable diagnosing TMD patients, less than half feel comfortable treating those patients, and the difference in responses with the TMD expert group was significant in 71.05% of the questions.

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