Critical Commentary 1: Validity of the Research Diagnostic Criteria for Temporomandibular Disorders Axis I in Clinical and Research Settings

The authors of the Focus Article1 present a critical appraisal of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and its classification system. They recognize the impact that the cornerstone paper published by Dworkin and LeResche in 1992 has had on clinical research.2 Research has since yielded important changes and the authors raise a number of important issues, some being very well supported while others are more debatable. The authors conclude that the time has come to update and broaden the scope of the RDC/TMD, which should be more clinically oriented and better oriented to treatment decision making. My commentary addresses the major points from each of the four sections of the Focus Article.

Critical Commentary

1. Steenks MH, de Wijer A. Focus article: Validity of the research diagnostic criteria for temporomandibular disorders Axis I in clinical and research settings. J Orofac Pain 2009;23:9–16.

2. 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.

3. Rodrigues Conti PC, Sylva DSR, Nunes Rossetti LM, Ferreira Da Sylva RDO, Do Valle AL, Gelmini M. Palpation of the lateral pterygoid area in the myofascial pain diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e61–e66.

4. Shaefer JR, Jackson DL, Schiffmann EL, Anderson QN. Pressure pain thresholds and MRI effusions in TMJ arthralgia. J Dent Res 2001;80:1935–1939.

5. List T, Dworkin SF. Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders. J Orofac Pain 1996;10:240–253.

6. Yap AUJ, Dworkin SF, Chua EK, List T. Prevalence of temporomandibular disorders subtypes, psychologic distress, and psychological dysfunction in Asian patients. J Orofac Pain 2003;17:21–28.

7. Stohler CS. Temporomandibular joint disorders—the view widens while therapies are constrained. J Orofac Pain 2007;21:261.

8. John MT, Dworkin SF, Mancl LA. Reliability of clinical temporomandibular disorder diagnoses. Pain 2005; 118:61–69.

9. Schmitter M, Kress B, Rammelsberg P. Temporomandibular joint pathosis in patients with myofascial pain: A comparative analysis of magnetic resonance imag- ing 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 diagnosis 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. Kircos LT, Ortendahl DA, Mark AS, Arakawa M. Magnetic resonance imaging of the TMJ disc in asymptomatic volunteers. J Oral Maxillofac Surg 1987; 45:852–854.

13. Haley DP, Schiffman EL, Lindgren BR, Anderson Q, Andreasen K. The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain. J Am Dent Assoc 2001;132:476–481.

14. Drangsholt M, LeResche L. Temporomandibular disorder pain. In: Crombie IK, Croft PR, Linton SJ, LeResche L, Von Korff M (eds). Epidemiology of Pain. Seattle: IASP Press, 1999:203–233.