title: Factors associated with clinical decision-making in relation to treatment need for temporomandibular disorders.
abstract: OBJECTIVE
  The aim of this study was to analyze dentist's clinical decision-making related to treatment need for temporomandibular disorders (TMD) in an adult population.
  
  
  METHODS
  The study population comprised 779 randomly selected 35, 50, 65 and 75 year old individuals living in the county of Västerbotten, Sweden. The participants filled out a questionnaire and were examined clinically according to a structured protocol. The four examiners (two men, two women) were experienced dentists and were calibrated before the start of the study. After examination they individually assessed the need of treatment owing to TMD.
  
  
  RESULTS
  In total, 15% of the study population was considered to have a treatment need owing to TMD. The highest estimate was noted for 35 and 50 years old women and the lowest for 65 and 75 years old men. Overall, 21% of the women and 8% of the men were considered to have a treatment need owing to TMD, with statistically significant differences between men and women for the 35 and 50 years old groups. Inter-individual variations in dentists' decisions were observed. In a multivariate analysis, female gender, signs and symptoms of TMD pain, signs and symptoms of TMD dysfunction and smoking were associated with estimated treatment need.
  
  
  CONCLUSIONS
  The prevalence of estimated treatment need owing to TMD was fairly high, but the dentists' clinical decision-making process showed large inter-individual variability. The observation calls for further research on the factors affecting the decision-making process in care providers.
authors.affiliation: a Department of Clinical Oral Physiology, Umeå University , Umeå, Sweden.
authors.forename: Negin
authors.initials: N
authors.lastname: Yekkalam
authors.affiliation: a Department of Clinical Oral Physiology, Umeå University , Umeå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Wänman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D002012:Bruxism / Q000175:diagnosis / Q000628:therapy; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D003815:Dentists; D005157:Facial Pain / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019558:Occlusal Adjustment / Q000706:statistics & numerical data; D017090:Occlusal Splints / Q000706:statistics & numerical data; D009910:Oral Hygiene; D012017:Referral and Consultation / Q000706:statistics & numerical data; D057566:Self Report; D012737:Sex Factors; D012959:Socioeconomic Factors; D013548:Sweden; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000628:therapy*
keywords: Clinical decision-making; craniomandibular disorder; gender; orofacial pain; treatment need