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†

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; International RDC/TMD Consortium Network, International association for Dental Research

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†

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 JensenMike 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, International RDC/TMD Consortium Network, International association for Dental Research

1216 Citations (Scopus)

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 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.

Original language	English
Journal	Journal of Oral & Facial Pain and Headache
Volume	28
Issue number	1
Pages (from-to)	6-27
Number of pages	22
ISSN	2333-0384
Publication status	Published - 2014

Keywords

Arthralgia
Consensus
Diagnosis, Differential
Dislocations
Evidence-Based Dentistry
Facial Pain
Headache
Humans
Mass Screening
Masticatory Muscles
Myalgia
Osteoarthritis
Pain, Referred
Reproducibility of Results
Sensitivity and Specificity
Temporomandibular Joint Disc
Temporomandibular Joint Disorders
Temporomandibular Joint Dysfunction Syndrome
Terminology as Topic

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Schiffman, E., Ohrbach, R., Truelove, E., Look, J., Anderson, G., Goulet, J.-P., List, T., Svensson, P., Gonzalez, Y., Lobbezoo, F., Michelotti, A., Brooks, S. L., Ceusters, W., Drangsholt, M., Ettlin, D., Gaul, C., Goldberg, L. J., Haythornthwaite, J. A., Hollender, L., ... International RDC/TMD Consortium Network, International association for Dental Research (2014). 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†. Journal of Oral & Facial Pain and Headache, 28(1), 6-27.

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†. / Schiffman, Eric; Ohrbach, Richard; Truelove, Edmond et al.
In: Journal of Oral & Facial Pain and Headache, Vol. 28, No. 1, 2014, p. 6-27.

Research output: Contribution to journal › Journal article › Research › peer-review

Schiffman, E, Ohrbach, R, Truelove, E, Look, J, Anderson, G, Goulet, J-P, List, T, Svensson, P, Gonzalez, Y, Lobbezoo, F, Michelotti, A, Brooks, SL, Ceusters, W, Drangsholt, M, Ettlin, D, Gaul, C, Goldberg, LJ, Haythornthwaite, JA, Hollender, L, Jensen, R, John, MT, De Laat, A, de Leeuw, R, Maixner, W, van der Meulen, M, Murray, GM, Nixdorf, DR, Palla, S, Petersson, A, Pionchon, P, Smith, B, Visscher, CM, Zakrzewska, J, Dworkin, SF & International RDC/TMD Consortium Network, International association for Dental Research 2014, '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†', Journal of Oral & Facial Pain and Headache, vol. 28, no. 1, pp. 6-27.

@article{8b9fcbc6aa714c7cbb6241f79c73f239,

title = "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 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 = "Arthralgia, Consensus, Diagnosis, Differential, Dislocations, Evidence-Based Dentistry, Facial Pain, Headache, Humans, Mass Screening, Masticatory Muscles, Myalgia, Osteoarthritis, Pain, Referred, Reproducibility of Results, Sensitivity and Specificity, Temporomandibular Joint Disc, Temporomandibular Joint Disorders, Temporomandibular Joint Dysfunction Syndrome, Terminology as Topic",

author = "Eric Schiffman and Richard Ohrbach and Edmond Truelove and John Look and Gary Anderson and Jean-Paul Goulet and Thomas List and Peter Svensson and Yoly Gonzalez and Frank Lobbezoo and Ambra Michelotti and Brooks, {Sharon L} and Werner Ceusters and Mark Drangsholt and Dominik Ettlin and Charly Gaul and Goldberg, {Louis J} and Haythornthwaite, {Jennifer A} and Lars Hollender and Rigmor Jensen and John, {Mike T} and {De Laat}, Antoon and {de Leeuw}, Reny and William Maixner and {van der Meulen}, Marylee and Murray, {Greg M} and Nixdorf, {Donald R} and Sandro Palla and Arne Petersson and Paul Pionchon and Barry Smith and Visscher, {Corine M} and Joanna Zakrzewska and Dworkin, {Samuel F} and {International RDC/TMD Consortium Network, International association for Dental Research}",

year = "2014",

language = "English",

volume = "28",

pages = "6--27",

journal = "Journal of Oral & Facial Pain and Headache",

issn = "2333-0384",

publisher = "Quintessence Publishing",

number = "1",

}

TY - JOUR

T1 - Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications

T2 - recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†

AU - Schiffman, Eric

AU - Ohrbach, Richard

AU - Truelove, Edmond

AU - Look, John

AU - Anderson, Gary

AU - Goulet, Jean-Paul

AU - List, Thomas

AU - Svensson, Peter

AU - Gonzalez, Yoly

AU - Lobbezoo, Frank

AU - Michelotti, Ambra

AU - Brooks, Sharon L

AU - Ceusters, Werner

AU - Drangsholt, Mark

AU - Ettlin, Dominik

AU - Gaul, Charly

AU - Goldberg, Louis J

AU - Haythornthwaite, Jennifer A

AU - Hollender, Lars

AU - Jensen, Rigmor

AU - John, Mike T

AU - De Laat, Antoon

AU - de Leeuw, Reny

AU - Maixner, William

AU - van der Meulen, Marylee

AU - Murray, Greg M

AU - Nixdorf, Donald R

AU - Palla, Sandro

AU - Petersson, Arne

AU - Pionchon, Paul

AU - Smith, Barry

AU - Visscher, Corine M

AU - Zakrzewska, Joanna

AU - Dworkin, Samuel F

AU - International RDC/TMD Consortium Network, International association for Dental Research

PY - 2014

Y1 - 2014

N2 - 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 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.

AB - 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 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.

KW - Arthralgia

KW - Consensus

KW - Diagnosis, Differential

KW - Dislocations

KW - Evidence-Based Dentistry

KW - Facial Pain

KW - Headache

KW - Humans

KW - Mass Screening

KW - Masticatory Muscles

KW - Myalgia

KW - Osteoarthritis

KW - Pain, Referred

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Temporomandibular Joint Disc

KW - Temporomandibular Joint Disorders

KW - Temporomandibular Joint Dysfunction Syndrome

KW - Terminology as Topic

M3 - Journal article

C2 - 24482784

SN - 2333-0384

VL - 28

SP - 6

EP - 27

JO - Journal of Oral & Facial Pain and Headache

JF - Journal of Oral & Facial Pain and Headache

IS - 1

ER -