"What if it doesn't unlock?": A qualitative study into the lived experiences of adults with persistent intra-articular temporomandibular disorders. (August 2021) - Dinsdale, Alana
Abstract: Background: Temporomandibular disorders (TMD) are associated with increased self-reported disability and psychosocial issues, although little is known about those who specifically experience mechanical signs and symptoms such as clicking and locking. Understanding the lived experiences of individuals with persistent intra-articular TMD is an important first step to gaining insight into specific domains of self-reported disability associated with these conditions. This information can be helpful to improve clinical management of this subgroup. Objectives: To explore the lived experiences of adults with persistent intra-articular TMD, including its impact on activity, participation and psychological wellbeing, and the influence of contextual factors on disability. Design: Qualitative study. Methods: Semi-structured interviews explored the lived experiences of adults with persistent intra-articular TMD, and data were analysed using thematic analysis. Participants were recruited via convenience sampling from private physiotherapy and dental practices, and the community. Results: Sixteen participants were interviewed. Four themes emerged from the data: i) The challenge of living with intra-articular TMD, ii) Living with uncertainty, iii) Seeking control, and iv) Learning to live with it. Novel findings included the impact of persistent intra-articular TMD on dreams, work, intimacy and socialising; and the role of non-pain symptoms (e.g. locking) in disability. Conclusions: Persistent intra-articular TMD are associated with numerous activity limitations, participation restrictions and psychological issues. Disability is complex and multi-directional, and influenced by various contextual factors including individuals' thoughts, beliefs and support networks. These findings emphasise the need for biopsychosocial and person-centred care in clinical practice. Highlights: Mechanical symptoms and perceived jaw fragility contribute to disability in IA-TMD. Vivid dreams and psychological distress may accompany IA-TMD. The impact of IA-TMD varies; biopsychosocial care should be individualised. IA-TMD often affects eating and yawning, and limitations can be multi-faceted.