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

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 psychosocial factors. 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 i...

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“…Somatic modulation was positive mainly for TMJ, with increased tinnitus loudness in 4/5 (80%) TMJ maneuvers and in 2/14 (14.3%) NECK maneuvers. Gnathological examination revealed the presence of a clinically evident TMJ disorder following DC/TMD Axis I classification [74][75][76][77][78] (Myalgia, Myofascial pain -ICD-9 729.1; Arthralgia -ICD-9 524.62). The patient was treated with a nocturnal occlusal splint for a period of 12 months, reporting a significant improvement in bruxism and TMJ pain and a complete resolution of her tinnitus about 8 months after initial assessment.…”

Report of the NIH Task Force on Research Standards for Chronic Low Back Pain

“…An iterative scientific process has successfully evolved the next generation of evidencebased measures for diagnosing and classifying the most common subtypes of TMD, including physical, behavioral and psychosocial domains. (99) Beyond viewing the present set of recommendations as appropriate topics for future research, the RTF identified several related knowledge gaps that limit our ability to define and classify critical domains and variables. These were seen as important topics for which further research should be encouraged.…”

“…While creation of research diagnostic criteria has proven beneficial to research for some other conditions (e.g., temporomandibular joint disorders, (99) Alzheimer's Disease (98) ), the multifactorial nature of most cases of cLBP decreased enthusiasm for attempting to do so in this condition. However, creation of an impact stratification and a uniform minimal dataset will achieve many of the same goals.…”