Critical Commentary 2: Validity of the Research Diagnostic Criteria for Temporomandibular Disorders Axis I in Clinical and Research Settings

The temporomandibular disorder (TMD) research community has been using the Research Diagnostic Criteria for TMD (RDC/TMD) since 1992, and its original developers have much to be proud of because of their widespread acceptance.1 They have accomplished their initial goal of getting researchers to use some common language in classifying TMD patients, and by forming the International Consortium for RDC/TMD-Based Research they have enabled clinical researchers around the world to apply this system in their native languages. However, even from the very beginning there have been some doubts and concerns about the validity as well as the utility of this taxonomic system. During the past 16 years, other classification systems for TMD such as the one proposed by the American Academy of Orofacial Pain (AAOP),2 as well as the broader headache classification system of the International Headache Society (IHS),3 have coexisted with the RDC/TMD, but a direct confrontation was avoided by describing the former two as clinical classifications while the latter was intended for research purposes.

Among the critics of the RDC/TMD have been a number of prominent Dutch researchers, including the authors of the Focus Article.4 Now Drs Steenks and de Wijer have consolidated their concerns by writing this insightful article, and I believe they deserve a lot of credit for their perceptive analysis as well as their forthright presentation of this critique. In my response to it, I will attempt to highlight the points that appear to me to be valid criticisms and, in a few instances, I will note some points with which I do not agree. Overall, however, I must say that their observations about the flaws of the RDC/TMD are definitely worth considering.

Before commenting further on this Focus Article, it is important to note that the original RDC/TMD proponents and several colleagues have recently conducted an extensive critical analysis of the 1992 version of this classification system, via a 5-year US National Institute of Dental and Craniofacial Research (NIDCR)-funded study that was performed in three American dental schools. This multicenter study, which was entitled “Research Diagnostic Criteria: Reliability and Validity,” was started in 2001 and data collection was completed in 2006. At the International Association for Dental Research (IADR) meeting in Toronto, Canada, in July 2008, a full-day symposium on this topic was sponsored by the International RDC/TMD Consortium Network. During the morning session of that symposium, the summary results of this study were reported publicly for the first time, while the afternoon session presented critical responses invited from other prominent researchers from around the world. The papers from this conference, as well as papers from the study itself, are expected to be appearing in this and other journals in the near future, and ultimately a revised version of the RDC/TMD (version 2) will be released. However, the reader should keep in mind that this Focus Article by Steenks and de Wijer was written before all of that information was presented. Therefore, my commentary on their paper will not include any of the findings or conclusions from that 5-year multicenter study.

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. de Leeuw R (ed). Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management, ed 4. Chicago: Quintessence, 2008:142–158.

3. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, ed 2. Cephalalgia 2004;24:9–160.

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

5. Okeson JP. Diagnosis of temporomandibular disorders. In: Management of Temporomandibular Disorders and Occlusion. St Louis: Mosby, 2008:286–289.

6. Lobbezoo-Scholte AM, Steenks MH, Faber JAJ, Bosman

F. Diagnostic value of orthopedic tests in patients with craniomandibular disorders. J Dent Res 1993; 72:1443–1453.

7. International consortium for RDC/TMD-based research. Available at: www.rdctmdinternational.org. Accessed 2004.

8. LeResche L, Mancl L, Drangsholt MT, Huang G, Von Korff M. Predictors of onset of facial pain and temporomandibular disorders in early adolescence. Pain 2007; 129:269–278.

9. Laskin DM. Temporomandibular disorders: A term past its time? J Am Dent Assoc 2008;139:124–128.