Sprache:
Unbestimmte Sprache
Dissertationsvermerk:
Dissertation Trinity College Dublin. School of Linguistic Speech & Comm Sci. Discipline of Clin Speech & Language Studies 2019
DDC:
306
Kurzfassung:
APPROVED ; Abstract Introduction: Temporomandibular disorders (TMDs) are caused by changes in the structure and/or function of the temporomandibular joint (TMJ), masticatory muscles, and/or osseous components, which develop secondary to non-inflammatory (e.g.: myalgia) or inflammatory-based conditions (e.g.: rheumatoid arthritis (RA)). TMDs are the most common non-dental orofacial pain conditions, with up to 90% of the general population experiencing TMDs during their lifespan. Symptoms include: TMJ pain, dysfunction, and reduced range of motion, all of which can impair mastication. It is hypothesised that masticatory impairments may impact on overall eating and swallowing, with the potential for additional repercussions for physical functioning and emotional well-being. It is also hypothesised that due to inflammatory joint destruction, adults with TMDs associated with RA may experience more severe problems than those with non-inflammatory disorders. However, little is currently known about the epidemiology, nature, impact, or management of TMD-related eating and swallowing problems. Research Aims: To investigate the epidemiology, nature, impact, and management of TMD-related eating and swallowing problems in adults with non-inflammatory and inflammatory-based conditions. Materials and Methods: Ethical approval was granted for all studies. The epidemiology, nature, and impact of TMD-related eating and swallowing problems was initially investigated via systematic reviews, with subsequent conduct of cross-sectional prospective studies of treatment-seeking patients presenting to national specialist centres of care. Patient data was gathered using both validated tools and new cohort-specific assessment protocols developed here. In addition, perspectives on the management of TMD-related eating and swallowing problems were investigated via surveying the views of both professionals and patients, with development of novel educational resources to address reported needs. Descriptive and statistical techniques were used in analysis. Results: Masticatory difficulties were common (89%), resulting in subsequent swallowing difficulties (53%), choking experiences (45%), and strangling sensations on swallowing (48%). Patients with RA reported higher rates of swallowing difficulties, although the sample size for this group was limited. Eating and swallowing problems moderately impacted on the completion of family, social, and recreational activities, with additional emotional impact, regardless of TMD aetiology. Professionals reported limited awareness of, or clinical experience with, these problems, with 34% viewing them as insignificant, and 47.5% reporting dissatisfaction with and negative perceptions of typical care delivered to this group. Professional and patient concerns related to the lack of evidence-based guidelines, resources, information sharing, or MDT interaction to support service delivery in this field. Discussion and Conclusion: This research highlighted: 1) the range of eating and swallowing problems reported by adults with TMDs; 2) the impact which these problems have on physical functioning and emotional well-being; 3) the status of clinical practice in this field, and 4) the resultant dissatisfaction of both surveyed patients and professionals with current care provision. Recommendation for future clinical practice and research include: the refinement of assessments and educational tools developed here, and the recruitment of larger and more diverse cohorts of patients and professionals in future epidemiological and interventionist research on TMD-related eating and swallowing problems.
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