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"Prospective Clinical Validation of an Optimized TMD Screening Tool: Results of a Two-Stage Validation Process"
Raphael Matthias Faulhaber1,2, Ingrid Peroz3, Simon Peroz3
1Department of Prosthodontics, Geriatric Dentistry and Functional Sciences, Charité Berlin, Berlin, Germany. raphael.faulhaber@charite.de.
Objectives:
The aim of this prospective validation study was to evaluate the diagnostic performance of a newly developed TMD screening tool of the German Society for Craniomandibular Function (DGFDT) in its statistically optimized scoring version as well as in a clinically modified version, and to compare both with established screening instruments.
Materials And Methods:
A total of 121 consecutive patients treated at Charité - Universitätsmedizin Berlin were examined using the DC/TMD as reference standard. The DGFDT TMD screening tool was compared with the "CMD-Kurzbefund" according to Ahlers and Jakstat and the three TMD-related screening questions according to Lövgren et al. In addition to the primary analysis, a predefined sensitivity analysis excluded cases with isolated, painless temporomandibular joint noises (n = 110). Diagnostic performance metrics were calculated with 95% confidence intervals using exact binomial methods.
Results:
In the primary analysis, the statistically optimized version of the TMD screening tool achieved both sensitivity and specificity of 100.0%, representing the statistical optimum. The clinically modified DGFDT version achieved a sensitivity of 84.6% while maintaining a specificity of 100.0%. In the predefined sensitivity analysis, its sensitivity increased to 98.1%, while specificity remained 100.0%. Established comparator instruments showed lower sensitivities in the primary analysis ("CMD-Kurzbefund": 73.8%; 3Q/TMD: 75.4%) and in the sensitivity analysis ("CMD-Kurzbefund": 85.2%; 3Q/TMD: 90.7%).
Conclusions:
Both DGFDT screening versions demonstrated superior diagnostic performance in this single-center cohort. The clinically modified version represents a consensus- and evidence-based alternative that reduces the impact of isolated, painless temporomandibular joint noises without relevant loss of diagnostic accuracy.
Clinical Relevance:
The DGFDT TMD screening tool provides a standardized and practical instrument for early clinical detection of temporomandibular disorders and may contribute to the standardization of TMD diagnostics.
