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Diagnostic accuracy of temporomandibular disorder pain tests: a multicenter study
Corine M Visscher1, Machiel Naeije, Antoon De Laat
1Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, Louwesweg 1, 1066 EA Amsterdam, The Netherlands. c.visscher@acta.nl
Aims:
To estimate the diagnostic accuracy of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) clinical examination and of the dynamic/static tests for the recognition of TMD pain. Since the diagnosis of TMD pain is especially complicated in persistent orofacial pain patients, the test outcomes in persistent TMD pain patients were contrasted to those in two control groups: a group of persistent dental pain patients and a group of pain-free subjects.
Methods:
In 125 persistent TMD pain patients, 88 persistent dental pain patients, and 121 pain-free subjects, a blind and standardized clinical examination was performed.
Results:
For the RDC/TMD, sensitivity (88%) was high and specificity was low (pain-free group: 71%; dental pain group: 45%). For the dynamic/static tests, sensitivity was 65% and specificities were 91% and 84%, respectively. Comparing the outcomes of the two examinations showed higher positive likelihood ratios for dynamic/static tests (P < .001), and lower negative likelihood ratios for the RDC/TMD examination (P < .01).
Conclusion:
For the confirmation of a suspicion of TMD pain, it is better to rely on positive dynamic/static tests. To confirm the absence of TMD pain, it is better to rely on a negative RDC/TMD examination.
