Article Data

  • Views 174
  • Dowloads 22

Original Research

Open Access

Online validation of DC/TMD Axis II questionnaires for assessing temporomandibular disorders

  • Hande Uzunçıbuk1,*,
  • Maria Maddalena Marrapodi2,3
  • Aida Meto4
  • Marco Di Blasio5,*,
  • Vincenzo Ronsivalle6
  • Diana Russo7
  • Marco Cicciù6
  • Giuseppe Minervini7

1Department of Orthodontics, Faculty of Dentisty, Trakya University, 22030 Edirne, Türkiye

2Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy

3Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, 600077 Chennai, India

4Department of Dentistry, Faculty of Dental Sciences, University of Aldent, 1007 Tirana, Albania

5Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy

6Department of Biomedical and Surgical and Biomedical Sciences, University of Catania, 95123 Catania, Italy

7Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy

DOI: 10.22514/jofph.2026.040 Vol.40,Issue 3,May 2026 pp.105-117

Submitted: 17 October 2024 Accepted: 04 December 2024

Published: 12 May 2026

*Corresponding Author(s): Hande Uzunçıbuk E-mail: handeuzuncibuk@trakya.edu.tr
*Corresponding Author(s): Marco Di Blasio E-mail: marco.diblasio@unimi.it

Abstract

Background: The purpose of this study was to evaluate the consistency and dependability of the online and traditional analog versions of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis II Evaluation Questionnaires. Methods: In a randomized manner, 100 participants completed the questionnaires in both traditional analog and online formats using Google Forms. Internal consistency was tested using the Cronbach’s alpha coefficient, with the criterion being >0.700. Intraclass correlation coefficient (ICC) with 95% confidence interval (CI) was applied for the calculation of the analog–online test agreement levels. The mean differences between the online and analog questionnaires were used to calculate effect sizes (ES). Results: Cronbach’s alpha coefficients of all scales exceeded 0.700, suggesting satisfactory internal consistency. The ICC values ranged between 0.950 (95% CI: 0.926–0.966) and 0.999 (95% CI: 0.999–0.999), suggesting strong agreement between formats. All the effect sizes fell within the small to medium range, congruently supporting consistency between methods. Conclusions: The present findings indicate that the online version of the DC/TMD Axis II Evaluation Questionnaires can be a reliable instrument for evaluating symptoms in respect to temporomandibular disorders.


Keywords

DC/TMD; Orthodontics; Reproducibility of results; Surveys and questionnaires; Temporomandibular joint disorders


Cite and Share

Hande Uzunçıbuk,Maria Maddalena Marrapodi,Aida Meto,Marco Di Blasio,Vincenzo Ronsivalle,Diana Russo,Marco Cicciù,Giuseppe Minervini. Online validation of DC/TMD Axis II questionnaires for assessing temporomandibular disorders. Journal of Oral & Facial Pain and Headache. 2026. 40(3);105-117.

References

[1] Aranha RLB, Martins RC, de Aguilar DR, Moreno-Drada JA, Sohn W, Martins CC, et al. Association between stress at work and temporomandibular disorders: a systematic review. BioMed Research International. 2021; 2021: 2055513.

[2] Komo HA, Almutairi MH, Addus AA, Almaghrabi AI, Hidah EN, Alraddadi FM, et al. Prevalence, knowledge and awareness level of temporomandibular joint disorder among Saudi population. Medical Science. 2023; 26: e43ms2705.

[3] Al-Khotani A, Naimi-Akbar A, Albadawi E, Ernberg M, Hedenberg-Magnusson B, Christidis N. Prevalence of diagnosed temporomandibular disorders among Saudi Arabian children and adolescents. The Journal of Headache and Pain. 2016; 17: 41.

[4] Bertoli FMP, Bruzamolin CD, Pizzatto E, Losso EM, Brancher JA, de Souza JF. Prevalence of diagnosed temporomandibular disorders: a cross-sectional study in Brazilian adolescents. PLOS ONE. 2018; 13: e0192254.

[5] Bagis B, Ayaz EA, Turgut S, Durkan R, Özcan M. Gender difference in prevalence of signs and symptoms of temporomandibular joint disorders: a retrospective study on 243 consecutive patients. International Journal of Medical Sciences. 2012; 9: 539–544.

[6] Reddy LKV, Madithati P, Narapureddy BR, Ravula SR, Vaddamanu SK, Alhamoudi FH, et al. Perception about health applications (Apps) in smartphones towards telemedicine during COVID-19: a cross-sectional study. Journal of Personalized Medicine. 2022; 12: 1920.

[7] Yap AU, Lee DZR, Tan SHX. The physical symptom scale-8: psychometric characteristics of a short-form version of the PHQ-15 and its use in TMD-related assessment and research. Journal of Oral & Facial Pain and Headache. 2023; 37: 159–165.

[8] Warzocha J, Gadomska-Krasny J, Mrowiec J. Etiologic factors of temporomandibular disorders: a systematic review of literature containing diagnostic criteria for temporomandibular disorders (DC/TMD) and research diagnostic criteria for temporomandibular disorders (RDC/TMD) from 2018 to 2022. Healthcare. 2024; 12: 575.

[9] Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clinical Oral Investigations. 2021; 25: 441–453.

[10] Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al.; International RDC/TMD Consortium Network, International association for Dental Research; Orofacial Pain Special Interest Group, International Association for the Study of Pain. 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. 2014; 28: 6–27.

[11] Cigdem Karacay B, Sahbaz T. Investigation of the relationship between probable sleep bruxism, awake bruxism and temporomandibular disorders using the diagnostic criteria for temporomandibular disorders (DC/TMD). Dental and Medical Problems. 2023; 60: 601–608.

[12] da Cunha TA, Chaves TC, Pereira Júnior FJ, de Godoi Gonçalves DA, Alstergren P, Biasotto-Gonzalez DA. Brazilian portuguese version of the diagnostic criteria for temporomandibular disorders Axis II: translation, cross-cultural adaptation and measurement properties. Journal of Oral Rehabilitation. 2025; 52: 712–721.

[13] Assiri K. Relationships between personality factors and DC/TMD Axis II scores of psychosocial impairment among patients with pain related temporomandibular disorders. Scientific Reports. 2024; 14: 26869.

[14] Andrade C. The limitations of online surveys. Indian Journal of Psychological Medicine. 2020; 42: 575–576.

[15] Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. Journal of Clinical Epidemiology. 2010; 63: 737–745.

[16] Al-Abbadey M, Liossi C, Graham CA. The impact of female chronic pelvic pain questionnaire (IF-CPPQ): a validation study. The Clinical Journal of Pain. 2019; 35: 602–610.

[17] Kallenberg FG, IJspeert JE, Bossuyt PM, Aalfs CM, Dekker E. Validation of an online questionnaire for identifying people at risk of familial and hereditary colorectal cancer. Familial Cancer. 2015; 14: 401–410.

[18] Balls M, Clothier R. FRAME and the validation process. Alternatives to Laboratory Animals. 2009; 37: 631–640.

[19] Marsh TL, Janes H, Pepe MS. Statistical inference for net benefit measures in biomarker validation studies. Biometrics. 2020; 76: 843–852.

[20] Neuman MD. The importance of validation studies in perioperative database research. Anesthesiology. 2015; 123: 243–245.

[21] Sweet RM, Hananel D, Lawrenz F. A unified approach to validation, reliability, and education study design for surgical technical skills training. Archives of Surgery. 2010; 145: 197–201.

[22] Heusel-Gillig L, Santucci V, Hall CD. Development and validation of the modified motion sensitivity test. Otology & Neurotology. 2022; 43: 944–949.

[23] Cocoș DI, Bucur SM, Păcurar M, Earar K. Validation of the modified helkimo clinical index for diagnosing temporomandibular disorders in a Romanian patient sample. Diagnostics. 2025; 15: 2347.

[24] Costa H, Amaral O, Duarte J, Correia MJ, Veiga NJ, López-Marcos JF. Validity and reliability of the Portuguese version of the rapid estimate of adult literacy in dentistry: REALD-29 PT. BMC Oral Health. 2022; 22: 262.

[25] Zagalaz-Anula N, Sánchez-Torrelo CM, Acebal-Blanco F, Alonso-Royo R, Ibáñez-Vera AJ, Obrero-Gaitán E, et al. The short form of the Fonseca anamnestic index for the screening of temporomandibular disorders: validity and reliability in a Spanish-Speaking population. Journal of Clinical Medicine. 2021; 10: 5858.

[26] Rosi A, Ferraris C, Guglielmetti M, Meroni E, Charron M, Menta R, et al. Validation of a general and sports nutrition knowledge questionnaire in Italian early adolescents. Nutrients. 2020; 12: 3121.

[27] De Moraes ACF, Nascimento-Ferreira MV, Forjaz CLM, Aristizabal JC, Azzaretti L, Nascimento Junior WV, et al. Reliability and validity of a sedentary behavior questionnaire for South American pediatric population: SAYCARE study. BMC Medical Research Methodology. 2020; 20: 5.

[28] Ketenci B, Tuygun AK, Gorur A, Bicer M, Ozay B, Gunay R, et al. An approach to cultural adaptation and validation: the intermittent claudication questionnaire. Vascular Medicine. 2009; 14: 117–122.

[29] Sharma S, Kallen MA, Ohrbach R. Graded chronic pain scale. The Clinical Journal of Pain. 2022; 38: 119–131.

[30] Kim H, Shin C, Lee S, Han C. Standardization of the Korean version of the patient health questionnaire-4 (PHQ-4). Clinical Psychopharmacology and Neuroscience. 2021; 19: 104–111.

[31] Sun Y, Fu Z, Bo Q, Mao Z, Ma X, Wang C. The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry. 2020; 20: 474.

[32] Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. Journal of Dental Research. 2016; 95: 1093–1101.

[33] Toussaint A, Kroenke K, Baye F, Lourens S. Comparing the patient health questionnaire-15 and the somatic symptom scale-8 as measures of somatic symptom burden. Journal of Psychosomatic Research. 2017; 101: 44–50.

[34] Kim HK, Kim ME. Disturbed sleep may be a core risk factor for jaw functional limitation in patients with painful temporomandibular disorders. Journal of Oral Rehabilitation. 2021; 48: 1013–1024.

[35] Kelley K, Preacher KJ. On effect size. Psychological Methods. 2012; 17: 137–152.

[36] Terwee CB, Mokkink LB, Knol DL, Ostelo RWJG, Bouter LM, de Vet HCW. Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Quality of Life Research. 2012; 21: 651–657.

[37] Bland JM, Altman DG. Statistics notes: Cronbach’s alpha. The BMJ. 1997; 314: 572.

[38] Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychological Bulletin. 1979; 86: 420–428.

[39] Geldsetzer P. Use of rapid online surveys to assess people’s perceptions during infectious disease outbreaks: a cross-sectional survey on COVID-19. Journal of Medical Internet Research. 2020; 22: e18790.

[40] Mondal H, Mondal S, Ghosal T, Mondal S. Using Google Forms for medical survey: a technical note. International Journal of Clinical and Experimental Physiology. 2019; 5: 216–218.

[41] Wright KB. Researching internet-based populations: advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. Journal of Computer-Mediated Communication. 2005; 10: JCMC1034.

[42] Vaske JJ. Advantages and disadvantages of internet surveys: introduction to the special issue. Human Dimensions of Wildlife. 2011; 16: 149–153.

[43] Pretorius C, Chambers D, Coyle D. Young people’s online help-seeking and mental health difficulties: systematic narrative review. Journal of Medical Internet Research. 2019; 21: e13873.

[44] Spence T, Kander I, Walsh J, Griffiths F, Ross J. Perceptions and experiences of internet-based testing for sexually transmitted infections: systematic review and synthesis of qualitative research. Journal of Medical Internet Research. 2020; 22: e17667.

[45] Özdemir Kabalak M, Aytac EN, Tarhan N, Karabulut E, Keceli HG. Potential barriers to the rational antibiotic use in dental and periodontal practice: a questionnaire-based online survey. Dental and Medical Problems. 2024; 61: 373–383.

[46] Morris AC, Ibrahim Z, Heslin M, Moghraby OS, Stringaris A, Grant IM, et al. Assessing the feasibility of a web-based outcome measurement system in child and adolescent mental health services—myHealthE a randomised controlled feasibility pilot study. Child and Adolescent Mental Health. 2023; 28: 128–147.

[47] Sammut R, Griscti O, Norman IJ. Strategies to improve response rates to web surveys: a literature review. International Journal of Nursing Studies. 2021; 123: 104058.

[48] Rabasová P. Validation studies of nursing diagnoses in neonatology. Central European Journal of Nursing and Midwifery. 2016; 7: 402–410.

[49] Tsubono Y, Kobayashi M, Sasaki S, Tsugane S; JPHC. Validity and reproducibility of a self-administered food frequency questionnaire used in the baseline survey of the JPHC Study Cohort I. Journal of Epidemiology. 2003; 13: S125–S133.


Submission Turnaround Time

Top