Sensitivity, specificity and prevalences—comparison of four screening tests for temporomandibular disorders

Background: This prospective clinical study investigates whether functionally compensated but clinically inapparent temporomandibular disorder (TMD) findings can be detected in individuals without pre-existing medical conditions. Methods: A total of 200 participants (10–50 years) without a medical history were examined using screening methods: Craniomandibular Disorders (CMD)-Short Finding, CMD-Screening, Preventive Manual Structural Analysis (PMSA), and Preventive Structural Stress Screening (PSSS). The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I served as the reference standard. Five diagnoses were analyzed based on prevalence, sensitivity, specificity, predictive values, 95% confidence intervals, and p-values (McNemar, Cochran Q). Results: TMD findings were detectable. PMSA and PSSS always produced identical results (p = 1.000), differing significantly from CMD-Short Finding for arthralgia and disc displacement (p < 0.001), and from CMD-Screening for myogenic pain (p < 0.001). No significant differences were found between PMSA/PSSS and CMD-Screening for arthralgia (p = 0.528) or CMD-Short Finding for myogenic pain (p = 0.490). Not all tests achieved a 70% sensitivity and a 95%specificity. The most important results are summarized here: arthralgia (0.0%–15.0%) by PMSA/PSSS (sensitivity 96.00% [79.65–99.90], specificity 96.57% [92.69–98.73], p = 0.125); myogenic pain (34.5%–49.5%) by CMD-Screening (excluding digastric muscle: sensitivity 84.15% [74.42–91.28], specificity 100.00% [96.92–100.00], p < 0.001) and by PMSA/PSSS (including digastric muscle: sensitivity 98.02% [93.03–99.76], specificity 100.00% [96.34–100.00], p = 0.500); disc displacement (14.5%–20.5%) by CMD-Short Finding (sensitivity 100.00% [85.18–100.00], specificity 96.61%[92.77–98.75], p = 0.031); degenerative joint disease and disc displacement without reduction with limited opening showed very low prevalence (0.0%–1.0%), which results in limiting reliability. Conclusions: TMD findings were detectable in asymptomatic individuals. PMSA and PSSS were the most suitable screening tools. The results support the need for regular screening, and further studies. Clinical Trial Registration: DRKS00035175, https://drks.de/search/en/trial/DRKS00035175, retrospectively registered.

Temporomandibular disorder; Screening; Sensitivity; Specificity

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