Title
Author
DOI
Article Type
Special Issue
Volume
Issue
The Research Diagnostic Criteria for Temporomandibular Disorders. III: Validity of Axis I Diagnoses
1Univ Washington, Dept Oral Med, Seattle, WA 98195 USA
2Univ Minnesota, Dept Biostat, Minneapolis, MN 55455 USA
3Univ Minnesota, Dept Diagnost & Biol Sci, Minneapolis, MN 55455 USA
4Univ Washington, Dept Dent Publ Hlth Sci, Seattle, WA 98195 USA
5SUNY Buffalo, Dept Oral Diagnost Sci, Buffalo, NY 14260 USA
6McGill Univ, Quebec City, PQ, Canada
*Corresponding Author(s): Edmond Truelove E-mail: edmondt@u.washington.edu
Aims: To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I TMD diagnoses. Methods: A combined total of 614 TMD community and clinic cases and 91 controls were examined at three study sites. RDC/TMD Axis I diagnoses were algorithmically derived from an examination performed by calibrated dental hygienists. Reference standards (“gold standards”) were established by means of consensus diagnoses rendered by two TMD experts using all available clinical data, including imaging findings. Validity of the RDC/TMD Axis I TMD diagnoses was estimated relative to the reference-standard diagnoses (gold standard diagnoses). Target sensitivity and specificity were set a priori at k≥ 0.70 and k≥ 0.95, respectively. Results: Target sensitivity and specificity were not observed for any of the eight RDC/TMD diagnoses. The highest validity was achieved for Group Ia myofascial pain (sensitivity 0.65, specificity 0.92) and Group Ib myofascial pain with limited opening (sensitivity 0.79, specificity 0.92). Target sensitivity and specificity were observed only when both Group I diagnoses were combined (0.87 and 0.98, respectively). For Group II (disc displacements) and Group III (arthralgia, arthritis, arthrosis) diagnoses, all estimates for sensitivity were below target (0.03 to 0.53), and specificity ranged from below to on target (0.86 to 0.99). Conclusion: The RDC/TMD Axis I TMD diagnoses did not reach the targets set at sensitivity of k≥ 0.70 and specificity of ≥ 0.95. Target validity was obtained only for myofascial pain without differentiation between normal and limited opening. Revision of the current Axis I TMD diagnostic algorithms is warranted to improve their validity.
diagnostic criteria;gold standard;reference standard;temporomandibular disorders;temporomandibular muscle and joint disorders;validity
Edmond Truelove,Wei Pan,John O. Look,Lloyd A. Mancl,Richard K. Ohrbach,Ana M. Velly,Kimberly H. Huggins,Patricia Lenton,Eric L. Schiffman. The Research Diagnostic Criteria for Temporomandibular Disorders. III: Validity of Axis I Diagnoses. Journal of Oral & Facial Pain and Headache. 2010. 24(1);35-47.
1. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord Facial Oral Pain 1992;6:301–355.
2. Look J, John M, Tai F, et al. The research diagnostic criteria for temporomandibular disorders. II. Reliability of axis I diagnoses and selected clinical measures. J Orofac Pain 2010;24:25–34.
3. John MT, Dworkin SF, Mancl LA. Reliability of clinical temporomandibular disorder diagnoses. Pain 2005;118: 61–69.
4. Shaefer JR, Jackson DL, Schiffman EL, Anderson QN. Pressure-pain thresholds and MRI effusions in TMJ arthralgia. J Dent Res 2001;80:1935–1939.
5. Emshoff R, Brandlmaier I, Bosch R, Gerhard S, Rudisch A, Bertram S. Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup-Disc derangement with reduction. J Oral Rehabil 2002;29:1139–1145.
6. Ohlmann B, Rammelsberg P, Henschel V, Kress B, Gabbert O, Schmitter M. Prediction of TMJ arthralgia according to clinical diagnosis and MRI findings. Int J Prosthodont 2006;19:333–338.
7. Barclay P, Hollender LG, Maravilla KR, Truelove EL. Comparison of clinical and magnetic resonance imaging diagnosis in patients with disk displacement in the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:37–43.
8. Tognini F, Manfredini D, Montagnani G, Bosco M. Is clinical assessment valid for the diagnosis of temporomandibular joint disk displacement? Minerva Stomatol 2004;53:439–448.
9. Schmitter M, Kress B, Rammelsberg P. Temporomandibular joint pathosis in patients with myofascial pain: A comparative analysis of magnetic resonance imaging and a clinical examination based on a specific set of criteria. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:318–324.
10. Limchaichana N, Nilsson H, Ekberg EC, Nilner M, Petersson A. Clinical diagnoses and MRI findings in patients with TMD pain. J Oral Rehabil 2007;34:237–245.
11. Manfredini D, Guarda-Nardini L. Agreement between research diagnostic criteria for temporomandibular disorders and magnetic resonance diagnoses of temporomandibular disc displacement in a patient population. Int J Oral Maxillofac Surg 2008;37:612–616.
12. Huddleston Slater JJ, Lobbezoo F, Naeije M. Mandibular movement characteristics of an anterior disc displacement with reduction. J Orofac Pain 2002;16:135–142.
13. Bossuyt PM, Reitsma JB, Bruns DE, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. Clin Chem 2003;49:1–6.
14. Schiffman EL, Truelove E, Ohrbach R, et al. The research diagnostic criteria for temporomandibular disorders. I. Overview and methodology for assessment of validity. J Orofac Pain 2010;24:7–24.
15. Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain 1992;50:133–149.
16. Derogatis L. SCL-90-R: Symptom checklist-90-R. Administration, scoring and procedures manual. Psycho -pharmacol Bull 1994;9:12–28.
17. Derogatis LR, Lipman RS, Covi L. SCL-90: An outpatient psychiatric rating scale—Preliminary report. Psycho -pharmacology 1973;9:13–28.
18. Smith PJ, Hadgu A. Sensitivity and specificity for correlated observations. Stat Med 1992;11:1503–1509.
19. LeResche L. Epidemiology of orofacial pain. In: Lund JP, Levigne GJ, Dubner R, Sessle BJ (eds). Orofacial Pain. From Basic Science to Clinical Management. Chicago: Quintessence, 2001:15–25.
20. Fletcher RH, Fletcher SW,Wagner EH. Clinical Epidemiology: The Essentials. Baltimore: Wilkins & Wilkins, 1996.
21. Rogers R. Handbook of Diagnostic and Structured Interviewing. New York: Guilford, 2001.
22. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 1990;33:160–172.
23. Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: Validity of individual provocation tests and composites of tests. Man Ther 2005;10:207–218.
24. Schwarzer AC, Derby R, Aprill CN, Fortin J, Kine G, Bogduk N. The value of the provocation response in lumbar zygapophyseal joint injections. Clin J Pain 1994;10: 309–313.
25. Headache Classification Subcommittee of the Inter -national Headache Society. The international classification of headache disorders ICHD-II tension-type headache (TTH). Cephalalgia 2004;24 (suppl 1):37–43.
26. McFadden JW. The stress lumbar discogram. Spine 1988;13:931–933.
27. Thevenet P, Gosselin A, Bourdonnec C, et al. pHmetry and manometry of the esophagus in patients with pain of the angina type and a normal angiography. Gastroenterol Clin Biol 1988;12:111–117.
28. Janssens J, Vantrappen G, Ghillebert G. 24-hour record-ing of esophageal pressure and pH in patients with non-cardiac chest pain. Gastroenterology 1986;90:1978–1984.
29. Vaksmann G, Ducloux G, Caron C, Manouvrier J, Millaire A. The ergometrine test: Effects on esophageal motility in patients with chest pain and normal coronary arteries. Can J Cardiol 1987;3:168–172.
30. Davies HA, Kaye MD, Rhodes J, Dart AM, Henderson AH. Diagnosis of oesophageal spasm by ergometrine provocation. Gut 1982;23:89–97.
31. Wise CM, Semble EL, Dalton CB. Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: A study of 100 patients. Arch Phys Med Rehabil 1992; 73:147–149.
32. Kokkonen SM, Kurunlahti M, Tervonen O, Ilkko E, Vanharanta H. Endplate degeneration observed on magnetic resonance imaging of the lumbar spine: Correlation with pain provocation and disc changes observed on computed tomography diskography. Spine 2002;27:2274–2278.
Science Citation Index (SCI)
Science Citation Index Expanded (SCIE)
BIOSIS Previews
Scopus
Cumulative Index to Nursing and Allied Health Literature (CINAHL)
Top