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

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.

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).

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.

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.

DRKS00035175, https://drks.de/search/en/trial/DRKS00035175, retrospectively registered.