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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†
Abstract and Figures
AIMS: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments.
METHODS: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings.
RESULTS: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions.
CONCLUSION: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.
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... Although the validity of individual RDC/TMD diagnoses has been extensively studied, an assessment of the criterion validity for the complete spectrum of RDC/ TMD diagnoses was absent until recently [6]. In 2014, the new Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol was introduced for both clinical and research applications based on extensive experience with the RDC/TMD [7]. A bibliographic search of databases identified various systematic reviews (SRs) and original research articles on the treatment of TMDs. ...
Purpose: This guideline aimed to make evidence-based clinical practice guidelines for the primary treatment of temporomandibular disorders (TMDs) for general practitioners who do not specialize in TMD.
Review process: Following the principles of evidence-based medicine, a systematic review and network meta-analysis (NMA) of multiple treatments was conducted, assessing the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Randomized controlled trials published between January 2000 and December 2020 were included. Patients diagnosed with TMD according to the Diagnostic Criteria for Temporomandibular Disorders were considered. Myalgia, arthralgia, and maximal mouth opening were selected as outcomes, and 12 treatments were included in the NMA. The modified Delphi method was used to reach a consensus on recommendations during clinical guideline panel meetings of the Japanese Society for the Temporomandibular Joint.
Results: Self-administered mouth opening exercises, stabilization-type oral appliances, and low-level laser therapy (LLLT) were recognized as effective primary treatments, although the evidence level was graded as “very low” (Grade 2D). During the clinical guideline panel meetings, decisions were developed based on the NMA results, and recommendations for clinical practice guidelines were finalized following consensus.
Conclusions: This guideline recommends mouth opening exercises and the use of stabilization-type oral appliances as primary treatments for TMD. Additionally, it suggests that LLLT be a conditional recommendation, supplemented with additional considerations.
... Our research offers new insights and strategies for preventing and treating TMDs. The current diagnostic criteria for TMDs (DC/TMD) incorporate assessments for psychological conditions like generalized anxiety disorder-7 and PHQ-9 [54]. However, it may be necessary to evaluate the spectrum of well-being and other positive mental health factors, such as life satisfaction and positive affect, given their potential causal link to metabolism. ...
Objectives
This Mendelian randomization (MR) study aims to explore the causal effect of well-being spectrum on temporomandibular disorders (TMDs).
Materials and methods
We employed the largest available summary-level data from genome-wide association studies on the well-being spectrum and its four dimensions–life satisfaction, positive affect, neuroticism and depressive symptoms–along with data on TMDs. Univariable and multivariable MR analyses were used to assess causal effects and their independence from socioeconomic factors, including income, education, and occupation. Additionally, 125 potential mediators were examined for their role in the well-being spectrum–TMDs relationships using two-step MR.
Results
A higher well-being spectrum was causally linked to a reduced risk of TMDs, independent of income (OR: 3.39, 95% CI: 1.78–6.43, p < 0.001), education (OR: 3.52, 95% CI: 1.68–7.33, p = 0.001), and occupation (OR: 3.74, 95% CI: 2.12–6.53, p < 0.001). Similar patterns were observed for life satisfaction, positive affect, neuroticism and depressive symptoms. Daily smoking (mediation proportion: 12.9%) and HDL-C (1.8%) were identified as significant mediators. No evidence of pleiotropy was detected (p > 0.05).
Conclusions
A higher well-being spectrum has a protective effect against TMDs, partially mediated by daily smoking and lipid metabolism.
Clinical relevance
These findings underscore the critical role of well-being spectrum in the management of TMDs. Among individuals with lower well-being, smokers and those with low HDL-C levels may be at an increased risk for TMDs, warranting focused monitoring and personalized preventive strategies.
... 7 In OFP and headache, chronic pain is defined as the pain occurring more than 15 days per month and lasting more than 4 h per day for at least the last 3 months. 8,9 The aim of this preliminary study was to assess the relationship between SB, reported pain, headache, selected health factors, and general health conditions among TMD patients. ...
The etiology of temporomandibular disorders (TMDs) has been linked to various factors, including functional and psychological factors, which makes it difficult to identify associations between a single etiological factor and the signs and symptoms of TMDs. Objectives: This study aimed to describe the presence of TMD symptoms and their relationship with sleep disturbances and emotional disorders in children and adolescents. Methods: This observational study included Spanish children aged between 8 and 13 years. The measurement instruments consisted of the BRUNI survey for sleep disorders and the Educational-Clinical Questionnaire: Anxiety and Depression (CECAD) survey. A clinical examination was subsequently performed following the DC/TMD guidelines for diagnosing TMDs. Frequencies, means, and standard deviations were applied, along with the prevalence ratio as a measure of association and the chi-square test. The significance level was set at 5%. Results: A total of 128 participants participated in the study with a mean age of 10.89 (±2.15) years. The prevalence of TMDs was 54%, while the most common symptoms were muscle pain at 26%, joint pain at 14%, and a combination of both at 14%. Children who presented muscle pain had a mean anxiety score of 44.87 (±11.85), whereas those without symptoms had a mean score of 36 (±10.78, and 0.03 p-value). The BRUNI index revealed that 78.13% of patients with TMDs had difficulty initiating and maintaining sleep, with a prevalence ratio (PR) of 3.57 (p-value 0.041). Conclusions: The present study reveals that temporomandibular disorders are common in children and adolescents, with 54% presenting at least one clinical sign or symptom. Emotional disturbances and sleep problems were also prevalent, affecting 41% and 56% of participants, respectively. Early interdisciplinary screening is essential to manage the co-occurrence of TMDs, emotional distress, and sleep problems in children.
Background
Splint therapy is a common treatment approach for temporomandibular disorders (TMDs), but the role of doctor–patient communication in enhancing therapeutic outcomes remains underexplored.
Purpose
This study aimed to assess the impact of integrating a structured doctor–patient communication concept with splint therapy on psychological and clinical outcomes and patient satisfaction in managing TMDs.
Study Design
A randomised clinical trial was conducted on patients diagnosed with TMDs at the Oral and Maxillofacial Surgery Department Clinics, Mansoura University. 435 participants were randomised into two groups: the control group (splint therapy alone) and the study group (splint therapy combined with doctor–patient communication).
Main Outcome Variables
The psychological distress evaluated using the Depression Anxiety Stress Scale‐10 (DASS‐10) and clinical outcomes, including intra‐articular pain, unassisted maximal interincisal mouth opening, joint sounds and muscular pain, were measured at baseline (before intervention) and 6 months post‐intervention. Patient satisfaction was analysed based on overall clinical satisfaction and postoperative expectations at 6 and 12 months after the intervention.
Results
Significant improvements in clinical and psychological outcomes were observed within both groups at 6 months compared to baseline ( p < 0.001). The study group showed significantly improved anxiety and stress levels ( p < 0.001), better clinical outcomes ( p < 0.01), higher overall clinical satisfaction and better alignment with postoperative expectations at 6 months ( p < 0.001) compared to the control group.
Conclusion
Integrating a structured doctor–patient communication concept with splint therapy significantly enhances psychological and clinical outcomes in managing TMDs, particularly enhancing long‐term satisfaction and alignment with postoperative expectations.
Trial Registration: ClinicalTrials.gov ID: NCT06783530. First Posted Date: 01/09/2025. Last Update Posted 01/14/2025. Retrospectively registered
Background
Temporomandibular disorders (TMD) are a group of diseases that affect the temporomandibular joint (TMJ), masticatory muscles and associated structures.
Objective
This present study aims to explore the clinical comparative efficacy of digital 3D‐printed and conventional handmade stable occlusal splints in the treatment of TMD and provide evidence for clinical promotion.
Methods
A total of 130 patients diagnosed with TMD using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were recruited and randomly assigned to two groups. One group received conventional handmade occlusal splints, while the other group received digital 3D‐printed splints. The treatment efficacy, craniomandibular index scores and splint fabrication time were compared between the two groups at follow‐up.
Results
The findings indicated that digital 3D‐printed stable occlusal splints offered comparable efficacy and satisfaction levels to traditional stabilisation splints while significantly cutting down on production time and enhancing overall efficiency. This study demonstrated that the use of fully digital technology, including digital intraoral scanning, virtual adjustments, computer‐aided design and 3D printing, in fabricating occlusal splints for TMD patients not only maintained therapeutic effectiveness but also streamlined the production process.
Conclusions
Digital 3D‐printed stable occlusal splints can not only alleviate TMD symptoms as effectively and satisfactorily as the conventional handmade stable splint, but also reduce production time and improve accuracy and efficiency, promising good clinical application prospects.
In order to ensure optimal function, aesthetics, and patient comfort, accurate diagnosis is essential for prosthodontic rehabilitation in fixed partial dentures (FPDs), implant prosthodontics, and temporomandibular joint (TMJ) disorders. Diagnostic techniques used in FPDs, such as bitewing radiographs, intraoral periapical (IOPA) radiographs, and cone beam computed tomography (CBCT), evaluate the pulp anatomy, periodontal bone support, and abutment tooth health in order to inform crown and bridge design. Digital intraoral scanners and occlusal analysis tools (such as T-Scan and articulating paper) improve occlusal harmony and preparation precision, extending the life of restorations. In order to enable precise implant placement and prosthetically driven restorations, CBCT, panoramic radiographs (OPG), and digital scanners assess bone volume, density (e.g., Lekholm & Zarb classification), and anatomical landmarks (e.g., inferior alveolar nerve) in implant prosthodontics. Resonance frequency analysis (RFA) and surgical guides help to further maximize implant stability and osseointegration. In TMJ disorders, electromyography (EMG) and psychometric questionnaires (e.g., DC/TMD Axis II) measure muscle activity and pain, guiding occlusal splint therapy or prosthetic adjustments, while magnetic resonance imaging (MRI), CBCT, and joint vibration analysis (JVA) diagnose disc displacement, bony changes, and joint dysfunction. Workflows in these fields are streamlined by digital innovations like CAD/CAM and 3D imaging, which enhance accuracy and patient outcomes. Together, these diagnostic instruments guarantee customized treatment planning, reduce complications, and improve prosthodontics' functional and aesthetic rehabilitation.
This overview aimed at assessing botulinum toxin type A (BoNT-A)’s effectiveness in managing bruxism compared to a placebo, the absence of treatment, or other interventions in adults. Only systematic reviews (SRs), with or without a meta-analysis, were included. A comprehensive literature search was conducted on 16 June 2024, encompassing seven databases and grey literature sources. Experts and reference lists of the included SRs were also consulted. Study selection was conducted in two phases by two independent authors. Methodological quality was evaluated using AMSTAR-2. Overlap was assessed using the corrected covered area. The 14 included SRs addressed several outcomes. In most studies, BoNT-A showed effectiveness in reducing pain (n = 10), the frequency of bruxism events (n = 7), and the maximum bite force (n = 5). None of the SRs effectively evaluated BoNT-A’s impact on functional movements. All of the included SRs scored “critically low” and “low” confidence rates in AMSTAR-2. Only one SR attempted to assess the certainty of the evidence, although unsuccessfully. The overlap across included SRs was rated as “high”, with a corrected covered area of 10.11%. The current systematic reviews on BoNT-A for bruxism lack methodological quality, limiting the reliability of their findings. Despite evidence indicating a potential reduction in pain, bruxism events, and the maximum bite force, methodological limitations prevent definitive conclusions from being drawn. High-quality research with standardized methodologies is essential to establish BoNT-A’s efficacy and support evidence-based clinical practice.
(1) Background: A sedentary lifestyle may aggravate temporomandibular disorder (TMD) symptoms, increasing pain sensitivity and functional limitations. Physical exercise is recommended for pain management and improving quality of life. Comparing CrossFit® athletes to sedentary individuals allows for examining whether regular high-intensity exercise impacts pain sensitivity and functional limitations associated with TMD. This cross-sectional study assessed the signs and symptoms of TMD in CrossFit® athletes compared to sedentary individuals. (2) Methods: Participants (n = 121) were divided into four groups: sedentary with TMD (n = 39), sedentary without TMD (n = 37), CrossFit® athletes with TMD (n = 23), and CrossFit® athletes without TMD (n = 22). TMD signs and symptoms were evaluated using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I, including mandibular movement patterns, range of motion, joint sounds, muscle pain, and jaw dysfunctions. Statistical analyses included chi-square and Dunn’s post hoc tests, ANOVA, and Kruskal–Wallis tests. Correlation and regression analyses were performed to examine associations between CrossFit® practice and TMD (p ≤ 0.05). (3) Results: Myofascial pain was the most common diagnosis. All athlete groups exhibited greater mandibular movement amplitudes (unassisted opening without pain, p < 0.001, and protrusion, p = 0.039) and less pain (p < 0.001) than sedentary individuals. Pain reports and palpation-induced pain in muscles and joints were significantly associated with a sedentary lifestyle and TMD (p < 0.001). Joint and muscle pain were more prevalent (frequent) among sedentary participants, regardless of TMD diagnosis. Linear regression analysis showed that sedentary individuals without TMD had significantly reduced unassisted mouth opening amplitudes compared to athletes without TMD (p < 0.05). (4) Conclusions: Pain in the masseter, temporalis, posterior digastric, and medial pterygoid muscles was the most common symptom in sedentary individuals with TMD. They experience higher frequency and intensity of pain, as well as greater limitations in mouth movement. Athletes showed higher frequency of joint noises.
Diagnosing and treating temporomandibular muscle disorders is a challenging yet very rewarding venture. It requires carefully listening to patients so as to obtain a thorough history and identify potential contributing factors. An in-depth clinical exam confirms or refutes the suspicious structures contributing to the temporomandibular muscle disorder.
Identifying and reducing the contributing factors is the key to developing the most cost-effective long-term management for patients with temporomandibular muscle disorders.
With the patients’ participation, methodically develop the most cost-effective treatment plan, focusing upon each patient’s identified contributors. TMD self-management and education are the foundation for empowering self-reliance and enhancing a positive patient to practitioner relationship.
Treatment often involves enlisting the help of other practitioners who provide therapies that are outside of the dentist’s realm of treatment, e.g., physical therapist and psychologist.
As treatments are implemented, ensure the patient’s temporomandibular muscle pain is sufficiently reduced and the masticatory function is restored.
Patients are not passive recipients of our therapies but are active partners in obtaining and maintaining their treatment goals.
Background. The authors compiled information about recent advances in screening for psychosocial risk factors considered to be yellow flags for potentially poor outcomes among patients with chronic orofacial pain (most commonly temporomandibular disorders). Types of Studies Reviewed. The authors conducted MEDLINE searches for the period 1995 through 2002 using the terms "temporomandibular disorders", "assessment" and "psychological", as well as "primary care," "screening" and "psychological disorders. They also searched personal files for relevant articles. Results. Psychosocial dysfunction is prevalent among patients with chronic orofacial pain. Yellow flags include high levels of disability; psychological disorders; and prolonged or excessive use of opiates, benzodiazepines, alcohol or other drugs. The authors identified several reliable, valid and brief patient self-administered questionnaires that can be use to screen for these yellow flags. Some of these are the Research Diagnostic Criteria/Temporomandibular Disorders Axis II, Alcohol Use Disorders Identification Test and Patient Health Questionnaire. Clinical Implications. Dentists can improve the quality of care for patients with chronic orofacial pain by screening for psychosocial risk factors and by referring patients with risk factors for psychological or psychiatric assessment and treatment.
Background. The aim of this study was to use a biopsychosocial perspective to characterize patients who were identified as being at high risk, or HR, of progressing from acute to chronic jaw-related pain. Methods. The authors classified 74 subjects as being at HR or low risk, or LR, according to the predictive algorithm. They used a variety of functional and biopsychosocial measures to evaluate subjects. Results. The HR group had significantly higher levels of self-reported pain as measured by the Characteristic Pain Inventory and significantly higher levels of depression as measured by the Beck Depression Inventory-II. They were 11 times more likely to have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV, Axis I clinical diagnosis, and more than three times as likely to have a DSM-IV Axis II personality disorder. Logistic regression analyses identified variables that differentiated, with 77 percent, accuracy, the HR and LR patients. Conclusions. Overall, the HR subjects had more psychopathology than did the LR subjects, used poorer coping styles and had greater self-reported pain. Six psychosocial factors alone enabled the authors to correctly classify 77 percent of the subjects as being in the HR group. Clinical Implications. Future research, in conjunction with the above findings, may enable the authors to determine, with greater certainty, if patients who are more anxious are at greater risk of developing chronic pain. If so, this provides further evidence of the need for early detection of patients at risk of developing chronic pain and the need to refer them for adjunctive care, such as cognitive-behavioral intervention.
