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Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendationsof the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†

  • Eric Schiffman1,*,
  • Richard Ohrbach2
  • Edmond Truelove3
  • John Look1
  • Gary Anderson4
  • Jean-Paul Goulet5
  • Thomas List6
  • Peter Svensson7,8
  • Yoly Gonzalez2
  • Frank Lobbezoo9,10
  • Ambra Michelotti11
  • Sharon L. Brooks12
  • Werner Ceusters13,14,15
  • Mark Drangsholt3
  • Dominik Ettlin16
  • Charly Gaul17
  • Louis J. Goldberg2
  • Jennifer A. Haythornthwaite18
  • Lars Hollender3
  • Rigmor Jensen19
  • Mike T. John20
  • Antoon De Laat21,22
  • Reny de Leeuw23
  • William Maixner24
  • Marylee van der Meulen9,10
  • Greg M. Murray25
  • Donald R. Nixdorf26,27,28
  • Sandro Palla16
  • Arne Petersson29
  • Paul Pionchon30,31
  • Barry Smith32,33,34
  • Corine M. Visscher9,10
  • Joanna Zakrzewska35
  • Samuel F. Dworkin3,36

1Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA

2Department of Oral Diagnostic Sciences School of Dental Medicine, University at Buffalo, New York, New York USA

3Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, Washington, USA

4Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA

5Section of Stomatology, Faculty of Dentistry, Laval University, Quebec, Canada

6Department of Stomatognathic Physiology, Faculty of Odontology, Malmö University, Malmö, Sweden

7Department of Clinical Oral Physiology, School of Dentistry, Aarhus University, Aarhus, Denmark

8Center for Functionally Integrative Neuroscience, MindLab, Aarhus University Hospital, Aarhus, Denmark

9Department of Oral Kinesiology Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands

10VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands

11Department of Orthodontics and Gnathology, School of Dentistry, University of Naples Federico II Naples, Italy

12Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA

13Department of Psychiatry School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, NY 14260 USA

14Institute for Healthcare Informatics, Buffalo, NY USA

15New York State Center of Excellence in Bioinformatics and Life Sciences Buffalo, New York, USA

16University of Zurich, Zurich, Switzerland

17Department Migraine and Headache Clinic, Königstein, Germany

18Department of Psychiatry & Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA

19Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark

20Department of Diagnostic and Biological Sciences, 6-320 Moos Tower, University of Minnesota, Minneapolis, Minnesota, USA

21Department of Oral Health Sciences, Katholieke Univ Leuven, Leuven, Belgium

22University Hospital Leuven, Leuven, Belgium

23Department of oral Health Science, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA

24Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

25Faculty of Dentistry, University of Sydney, Sydney, Australia

26Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN USA

27Department of Neurology, University of Minnesota, Minneapolis, MN USA

28HealthPartners Institute for Education and Research, Bloomington, Minnesota, USA

29Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden

30Department of Orofacial Pain, Faculty of Odontology, Université d’Auvergne, Clermont Ferrand, France

31Department of Psychology, Faculty of Odontology, Université d’Auvergne, Clermont Ferrand, France

32Departments of Philosophy, University at Buffalo, Buffalo, New York, USA

33Departments of Neurology, University at Buffalo, Buffalo, New York, USA

34Departments of Computer Science, University at Buffalo, Buffalo, New York, USA

35Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, UCLH NHS Foundation Trust London, UK

36Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA

DOI: 10.11607/jop.1151 Vol.28,Issue 1,March 2014 pp.6-27

Published: 30 March 2014

*Corresponding Author(s): Eric Schiffman E-mail: schif001@umn.edu

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Abstract

Aims: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel’s recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project’s data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project—the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. Results: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocialfactors. The Axis II protocol is divided into screening and comprehensive self-report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. Conclusion: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.

Keywords

diagnostic criteria; diagnostic reliability; diagnostic validity; sensitivity; specificity; temporomandibular disorders

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Eric Schiffman,Richard Ohrbach,Edmond Truelove,John Look,Gary Anderson,Jean-Paul Goulet,Thomas List,Peter Svensson,Yoly Gonzalez,Frank Lobbezoo,Ambra Michelotti,Sharon L. Brooks,Werner Ceusters,Mark Drangsholt,Dominik Ettlin,Charly Gaul,Louis J. Goldberg,Jennifer A. Haythornthwaite,Lars Hollender,Rigmor Jensen,Mike T. John,Antoon De Laat,Reny de Leeuw,William Maixner,Marylee van der Meulen,Greg M. Murray,Donald R. Nixdorf,Sandro Palla,Arne Petersson,Paul Pionchon,Barry Smith,Corine M. Visscher,Joanna Zakrzewska,Samuel F. Dworkin. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendationsof the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. Journal of Oral & Facial Pain and Headache. 2014. 28(1);6-27.

URL:

https://www.jofph.com/articles/10.11607/jop.1151

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