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Published on: October 5, 2020
Subtype-specific screening for temporomandibular disorders: Diagnostic performance and cut-point optimization of the
Adrian Ujin Yap1, Cheng-Ge Liu2, Kai-Yuan Fu3
1Professor, Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, PR China; Division of Dentistry, Ng Teng Fong General Hospital, National University Center for Oral Health, and Faculty of Dentistry, National University Health System, Singapore; and National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore.
Statement Of Problem:
Effective screeners for temporomandibular disorders (TMDs) should be concise, inexpensive, straightforward to complete, diagnostically accurate, and ideally self-administered. Existing instruments have notable limitations, underscoring the need for a multidimensional screener that addresses these gaps.
Purpose:
This study evaluated the reliability, diagnostic accuracy, and cut-point optimization of the multidimensional 6Ts-4D screener for identifying pain-related (PT) and intra-articular (IT) TMDs and assessed its clinical utility across specific TMD subtypes.
Material And Methods:
A case-control study was conducted with 344 adults recruited from a university-based dental hospital. Participants completed the 6Ts-4D screener, followed by standardized Diagnostic Criteria for TMD (DC/TMD) interviews and clinical examinations, supplemented with diagnostic imaging to establish reference standards. Reliability was assessed using the Cronbach alpha and intraclass correlation coefficients. Diagnostic performance was evaluated with area under the receiver operating characteristic curve (AUC) analysis and conventional accuracy metrics. Optimal cut-points were determined using the Youden Index.
Results:
The 6Ts-4D demonstrated acceptable reliability (Cronbach alpha 0.67) and excellent diagnostic performance for all TMDs (AUC 0.97; sensitivity 86.8%; specificity 100%). Subscale analyses showed good accuracy for PT (AUC 0.83) and IT (AUC 0.81). Item-level screening yielded moderate-to-good AUCs for myalgia (0.80), arthralgia (0.82), disc displacement with reduction (0.77), disc displacement without reduction with limited opening (0.82), and TMJ subluxation (0.79).
Conclusions:
The 6Ts-4D screener was found to be a brief, reliable, and subtype-sensitive tool for TMD triage, with robust diagnostic metrics supporting its use in clinical, telehealth, and research settings.
