Science in the News
International Research Team Develops New Evidence-Based Diagnostic Criteria for TMD
February 14, 2014
To improve the diagnostic assessment of patients with temporomandibular disorders (TMD), an international consortium of experts has issued the first evidence-based diagnostic criteria for TMD that can be used routinely for patient assessment in clinical settings. The new diagnostic criteria for TMD (DC/TMD) were developed by the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR) and the Orofacial Pain Special Interest Group of the International Association for the Study of Pain (IASP), and are presented in the winter 2014 issue of the Journal of Oral and Facial Pain and Headache.1 A complete set of DC/TMD assessment instruments is also available online from the International RDC/TMD Consortium Network.
The new DC/TMD are an evidence-based assessment protocol comprised of the following tools and resources for evaluating TMD manifestations in individual patients:
The DC/TMD protocol is an evidence-based revision of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), which were published in 1992 and became a widely used protocol for identifying and classifying individuals with TMD. The original RDC/TMD featured a dual-axis approach for identifying and classifying TMD, which integrated clinical assessment of the patient's physical disorders (Axis I) with an evaluation of psychological or behavioral factors and pain-related disability (Axis II). The RDC/TMD protocol was introduced as an expert-based classification system, and the criteria were rigorously investigated for reliability and validity over the course of two decades. The new DC/TMD criteria integrate the findings of several validation studies and international workshops addressing the RDC/TMD, with the ultimate goal of improved patient assessment and identification of TMD presentations in dental offices, orofacial pain clinics and other health care settings.
The DC/TMD protocol emphasizes the dual-axis diagnostic approach for TMD based upon a biopsychosocial model of pain, which served as a foundation for the original RDC/TMD. The diagnostic instruments in the DC/TMD protocol are intended to help clinicians perform a full physical assessment in tandem with an evaluation of the individual's pain-related disability and psychosocial symptoms (e.g., depression).
As the new DC/TMD protocol was developed, members of the IADR/IASP research groups and other organizations also prepared a new, consensus-based taxonomic classification system for TMD2,3 in order to support "an integrated approach to clinical diagnosis" and better accuracy in identifying TMD and related pain conditions. The diagnosis of TMD is a common challenge faced by dentists, physicians and other health professionals, as is the clinical management of patients with TMD and orofacial pain. Symptoms of TMD include but are not limited to: pain in the masticatory muscles or temporomandibular joint (TMJ); clicking or popping sounds in the TMJ region; and limitations in jaw movement.
In an editorial4 accompanying the newly published DC/TMD, the assessment protocol is described as an "important step in the evolution of the diagnostic paradigms for TMD to more accurately direct the clinician in his or her provision of personalized care for patients with TMD and other conditions manifesting orofacial pain." The DC/TMD protocol was developed to enhance the evidence-based assessment of temporomandibular disorders, and to facilitate more individualized and customized care of TMD based upon comprehensive evaluation of each patient. Visit the International RDC/TMD Consortium Network website for additional resources on the diagnosis and assessment of TMD.
1 Schiffman E, Ohrbach R, Truelove E et al. 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 and Facial Pain and Headache 2014 Winter; 28(1):6-27. Abstract. Accessed February 7, 2014.
2 Peck CC, Goulet JP, Lobbezoo F, et al. Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders. J Oral Rehabil 2014;41:2-23. Accessed February 7, 2014.
3 Ohrbach R, List T, Goulet JP, Svensson P. Recommendations from the International Consensus Workshop: convergence on an orofacial pain taxonomy. J Oral Rehabil. 2010;37:807–812.
4 Sessle BJ. Two new entities: Newly developed diagnostic criteria for temporomandibular disorders, and the Journal of Oral and Facial Pain and Headache 2014 Winter; 28(1):5. Accessed February 7, 2014.
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