# The Initial Treatment Plan Versus the Actually Performed Treatment of Patients With Temporomandibular Disorders in the First 6 Months After the Initial Visit

## TL;DR

This study examines how often the actual treatment for jaw disorders matches the planned treatment and what factors influence the treatment received.

## Contribution

The study identifies patient and clinician factors associated with the receipt of specific TMD treatments.

## Key findings

- High agreement between planned and actual treatment was observed, except for psychological treatment.
- Pain diagnosis and clinician experience were significant predictors for receiving certain treatments.
- No significant predictors were found for deviation from the indicated treatment.

## Abstract

Temporomandibular disorders (TMD) can impact on daily life, and are therefore important to treat with a fitting therapy. However, the factors that may influence the received treatment remain unknown.

To investigate the deviation between the indicated and received TMD treatment, and to identify patient and clinician characteristics that could influence the received treatment and the deviation from indicated treatment.

This retrospective cohort study collected data on the indicated and received treatment of 140 TMD patients. The treatment modalities were counselling, occlusal appliance (OA), physical therapy, psychological treatment, contingent electrical stimulation, ecological momentary assessment and medication. Potential predictors for receiving treatment and deviation from indicated treatment included patient‐related factors such as TMD diagnosis, bruxism, psychosocial factors and clinician‐related factors such as clinician's specialty level and experience.

A good to perfect agreement between indicated and received treatments was observed for all treatment (84.3%–100%), except psychological treatment (66.4%). Received OA was associated with having a pain diagnosis (OR [95% CI] = 2.596 [1.189, 5.669], p = 0.017). In addition, received physical therapy was significantly associated with a pain diagnosis (OR [95% CI] = 3.876 [1.401, 10.721], p = 0.009), awake bruxism (OR [95% CI] = 1.730 (1.112, 2.690), p = 0.015) and clinician's level–being staff (OR [95% CI] = 6.068 [1.729, 20.553], p = 0.016). Received psychological therapy was significantly associated with a pain diagnosis (OR [95% CI] = 4.013 [1.077, 14.951], p = 0.038), sleep bruxism (OR [95% CI] = 1.381 [1.041, 1.830], p = 0.025), and physical symptoms (OR [95% CI] = 2.578 [1.561, 4.259], p < 0.001). No significant predictors were found for deviation.

Receiving TMD treatment was associated with both patient‐related factors—such as a TMD diagnosis, bruxism and physical symptoms—and clinician‐related factors, such as the clinician's level of experience.

Predictors for receiving a specific type of treatment.