title: Telemedicine as an effective tool for the management of temporomandibular joint disorders.
abstract: OBJECTIVE
  To evaluate the effectiveness of a store-and-forward telemedicine system (SFTMS) as an optimal method for the selection, diagnosis and treatment of patients with TMJ disorders (TMJD) referred from primary care sites to the Maxillofacial Surgery Unit (hospital-based).
  
  
  METHODS
  A multicenter, analytical, quasi-experimental, non-randomized clinical study of a SFTMS aimed towards the management of patients with TMJD was conducted at the Oral and Maxillofacial Surgery Unit of the Virgen Macarena University Hospital (Seville, Spain) and 10 primary care areas of the North area of Seville located between 15 and 180 km from the hospital. The study was carried out between January 2008 and February 2010 including a non-random sample consisting of all patients with TMJD treated at primary care sites during the study period. We describe the development and effectiveness of this method based on the rates of diagnosis of myofascial syndrome and/or internal deragement Wilkes Stages I-II-III, internal deragement Wilkes Stages IV-V, other arthropathies, resolved teleconsultations, second teleconsultations, referrals to hospital, mean treatment delay, lost hours working/patient and complaints. The same variables were also described for the TMJD conventional consultation system at hospital (standard system). Descriptive statistics (frequency tables, means and medians, and dispersion measures), T-Student test was used to compare the differences in the average quantitative variables (time) and Chi2 test was used to compare the differences in the average qualitative variables.
  
  
  RESULTS
  Over a 24-month period, 710 patients with TMJD were assisted at hospital by conventional consultation from 1-1-2008 to 2-25-2010, of which 587 (82.7%) were women and 123 (17.3%) were men with a mean age of 41.08 years. The mean time elapsed until treatment onset was 78.6 days, with a mean cost of 32 lost working hours per patient. In this period, 342 patients with TMJD were assisted by teleconsultation, of which 276 (80.7%) were women and 66 (19.2%) were men with a mean age of 38.3 years. Only 35 (10%) patients presented some other TMJ pathology that required maxillofacial surgery. The remaining 307 (89.7%) received non-surgical treatment in the primary care center (high resolutive consultations) in a mean time of 2.3 days (p<0.05), and a mean cost of 16 lost working hours/patient (p<0.05).
  
  
  CONCLUSIONS
  Telemedicine allows a correct diagnosis and an adequate treatment for the majority of TMJD from primary care sites and shortens the delay in treatment onset, preventing displacement and unnecessary costs for these patients.
authors.affiliation: Virgen Macarena Hospital Area, Seville, Spain. clarasalazarf@gmail.com
authors.forename: Clara Isabel
authors.initials: CI
authors.lastname: Salazar-Fernandez
authors.forename: Javier
authors.initials: J
authors.lastname: Herce
authors.forename: Alfonso
authors.initials: A
authors.lastname: Garcia-Palma
authors.forename: Jose
authors.initials: J
authors.lastname: Delgado
authors.forename: Jose Felix
authors.initials: JF
authors.lastname: Martín
authors.forename: Teresa
authors.initials: T
authors.lastname: Soto
mesh_terms: D000041:Absenteeism; D000328:Adult; D003796:Dental Service, Hospital; D005157:Facial Pain / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis; D008297:Male; D008410:Masticatory Muscles / Q000503:physiopathology; D008487:Medical History Taking; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D018579:Patient Selection; D011320:Primary Health Care; D016059:Range of Motion, Articular / Q000502:physiology; D012017:Referral and Consultation; D019114:Remote Consultation; D017216:Telemedicine / Q000379:methods*; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000175:diagnosis; D013997:Time Factors