'Management is a black art' – professional ideologies with respect to temporomandibular disorders

Key Points Readers will understand the nature of primary care difficulties in the management of temporomandibular disorders (TMD). Readers will understand the basis of management of TMD and the biases it is liable to. Readers will be aware of the potential for mismanagement of TMD due to the lack of good quality evidence. Objective To gain a deeper understanding of the range of influences on the full range of dental professionals who provide treatment for temporomandibular disorders (TMD). Design Qualitative semi-structured interviews. Setting Primary and secondary care in the North and South of the United Kingdom. Sample and method A criterion-based purposive sample was taken of dental practitioners, comprising primary and secondary care practitioners. In-depth interviews were conducted and data collection and analysis occurred concurrently until data saturation was achieved. Data and discussion There was a reported lack of adequate remuneration for provision of treatment for TMD within primary care. This alongside the primary care practitioners' reported uncertainty in diagnosis of TMD appeared to lead to a propensity for referral to secondary care. Practitioners recognised a poor and scanty evidence base on which to base their care, and this allowed for idiosyncratic practice. Often the outcome measure for treatment was a subjective questioning of the patient focussing mainly on relief of pain. Conclusion There is a need for better quality evidence on which to base TMD treatment, more continuing professional development and improvement in contracting arrangements to enable primary practitioners to feel confident in managing TMD.