title: 'Management is a black art'--professional ideologies with respect to temporomandibular disorders.
abstract: 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).
  
  
  METHODS
  Qualitative semi-structured interviews.
  
  
  METHODS
  Primary and secondary care in the North and South of the United Kingdom.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Newcastle University School of Dental Sciences, Framlington Place, Newcastle-upon-Tyne, UK. J.A.Durham@ncl.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Durham
authors.forename: C
authors.initials: C
authors.lastname: Exley
authors.forename: R
authors.initials: R
authors.lastname: Wassell
authors.forename: J G
authors.initials: JG
authors.lastname: Steele
mesh_terms: D001291:Attitude of Health Personnel; D003815:Dentists / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D017090:Occlusal Splints / Q000191:economics; D017063:Outcome Assessment, Health Care; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D006113:United Kingdom