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Cited by 4,567Temporomandibular Joint DisordersMusculoskeletal pain and rehabilitationFibromyalgia and Chronic Fatigue Syndrome Research

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†

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Schiffman, Eric, Ohrbach, Richard, Truelove, Edmond, Look, John, Anderson, Gary, Goulet, Jean-Paul, List, Thomas, Svensson, Peter +22 more·2014·Journal of Oral & Facial Pain and Headache
DOI 10.11607/jop.1151PMC PMC4478082
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Abstract

Eric Schiffman, DDS, MS/Richard Ohrbach, DDS, PhD/Edmond Truelove, DDS, MSD/John Look, DDS, PhD/Gary Anderson, DDS, MS/Jean-Paul Goulet, DDS, MSD/Thomas List, DDS, Odont Dr/Peter Svensson, DDS, PhD, Dr Odont/Yoly Gonzalez, DDS, MS, MPH/Frank Lobbezoo, DDS, PhD/Ambra Michelotti, DDS/Sharon L. Brooks, DDS, MS/Werner Ceusters, MD/Mark Drangsholt, DDS, PhD/Dominik Ettlin, MD, DDS/Charly Gaul, MD/Louis J. Goldberg, DDS, PhD/Jennifer A. Haythornthwaite, PhD/Lars Hollender, DDS, Odont Dr/Rigmor Jensen, MD, PhD/Mike T. John, DDS, PhD/Antoon De Laat, DDS, PhD/Reny de Leeuw, DDS, PhD/William Maixner, DDS, PhD/Marylee van der Meulen, PhD/Greg M. Murray, MDS, PhD/Donald R. Nixdorf, DDS, MS/Sandro Palla, Dr Med Dent/Arne Petersson, DDS, Odont Dr/Paul Pionchon, DDS, PhD/Barry Smith, PhD/Corine M. Visscher, PT, PhD/Joanna Zakrzewska, MD, FDSRCSI/Samuel F. Dworkin, DDS, PhD: 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 selfreport 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. J Oral Facial Pain Headache 2014;28:6–27. doi: 10.11607/jop.1151

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  • Боль в области ВНЧС является основным симптомом его дисфункции и второй по частоте среди болей опорно-двигательного аппарата после боли в спине.

    “Боль в области ВНЧС является основным симптомом его дисфункции и второй по частоте среди болей опорно-двигательного аппарата после боли в спине [20].”

    From Results of the osteopathic treatment of the temporomandibular joint dysfunction (meta-analysis) (2023) · cites this paper as [20]

    The paper’s Conclusion states that temporomandibular disorders (TMD) are the second most common musculoskeletal condition causing pain and disability, after chronic low-back pain. Its diagnostic discussion treats pain as important in TMD, but does not establish that pain specifically in the temporomandibular joint is the main symptom or that this localized pain itself ranks second among musculoskeletal pains. No page number is available in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Most studies employed the DC/TMD diagnostic criteria and the Wilkes TMJ staging system.

    “Most studies employed the DC/TMD diagnostic criteria [3,45], and the Wilkes TMJ staging system [46].”

    From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [3]

  • The development of Research Diagnostic Criteria for temporomandibular disorders shows that an iterative scientific process can successfully refine evidence-based measures for diagnosing and classifying subtypes of a chronic pain condition.

    “The potential for such an iterative approach to re-evaluate scientific measures of chronic pain was successfully modeled in developing Research Diagnostic Criteria for Temporomandibular Disorders (TMD).”

    From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [99]

  • Creation of research diagnostic criteria has proven beneficial for research in some other conditions.

    “While creation of research diagnostic criteria has proven beneficial to research for some other conditions (e.g., temporomandibular joint disorders,99 Alzheimer’s Disease98 )”

    From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [99]

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Cites

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Research works printed but not linked: 6

  1. [4]Loeser JD Fordyce WE Carr JE Dengerink HA Chronic pain. Behavioral Science in the Practice of Medicine 1983 331 346 Elsevier New York
  2. [5]Merskey H Giamberardino MA Jensen TS Introduction. Pain Comorbidities: Understanding and Treating the Complex Patient 2012 1 20 IASP Press Seattle
  3. [44]Garofalo JP Wesley AL Research Diagnostic Criteria for Temporomandibular Disorders: Reflection of the physicalpsychological interface. APS Bulletin 4–16 May-Jun 1997
  4. [49]Headache Classification Subcommittee of the International Headache Society The International Classification of Headache Disorders Cephalalgia 2004 24 suppl 1 9 160 ed 2. 14979299
  5. [82]Schiffman EL Ohrbach R List T Diagnostic criteria for headache attributed to temporomandibular disorders. Cephalalgia 2012 32 683 692 22767961 PMC4521766
  6. [125]Okeson JP Okeson JP History and examination for temporomandibulars disorders. Management of Temporomandibular Disorders and Occlusion 2008 228 301 Mosby St Louis

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Authors
Schiffman, E., Ohrbach, R., Truelove, E., Look, J., Anderson, G., Goulet, J.-P., List, T., Svensson, P., Gonzalez, Y., Lobbezoo, F., Michelotti, A., Brooks, S. L., Ceusters, W., Drangsholt, M., Ettlin, D., Gaul, C., Goldberg, L. J., Haythornthwaite, J. A., Hollender, L., Maixner, W., van der Meulen, M., Murray, G. M., Nixdorf, D. R., Palla, S., Petersson, A., Pionchon, P., Smith, B., Visscher, C. M., Zakrzewska, J., & Dworkin, S. F.
Affiliations
  • University of Minnesota (US)
  • University at Buffalo, State University of New York (US)
  • University of Washington (US)
  • Université Laval (CA)
  • Malmö University (SE)
  • Aarhus University (DK)
  • Academic Center for Dentistry Amsterdam (NL)
  • University of Naples Federico II (IT)
  • University of Michigan (US)
  • University of Zurich (CH)
  • Migräne Klinik Königstein (DE)
  • Johns Hopkins University (US)
  • University of North Carolina at Chapel Hill (US)
  • The University of Sydney (AU)
  • University of Copenhagen (DK)
  • Université Clermont Auvergne (FR)
ORCID
Venue
Journal of Oral & Facial Pain and Headache
Publisher
MRE Press
Published
2014-01
Volume
28
Issue
1
Pages
6-27
ISSN
  • 2333-0376 (ISSN-L)
  • 2333-0384
DOI
10.11607/jop.1151
PMC
PMC4478082
OpenAlex
W2011545725
Cited by
4,567
References
112
Citations by year
2026: 569 · 2025: 613 · 2024: 556 · 2023: 544 · 2022: 488 · 2021: 437 · 2020: 352 · 2019: 266 · 2018: 236 · 2017: 177 · 2016: 161 · 2015: 107 · 2014: 45 · 2013: 6
FWCI
292.35
Type
journal article
Language
en
Open access
Locations
  • Journal of Oral & Facial Pain and Headache (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • UvA-DARE (University of Amsterdam) (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
  • PubMed Central (acceptedVersion)
  • UvA-DARE (University of Amsterdam) (submittedVersion, public-domain)
  • UCL Discovery (University College London) (submittedVersion)
  • Malmö University Publications (Malmö University) (submittedVersion, public-domain)
  • VU Research Portal (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, public-domain)
Funders
  • National Institutes of Health
  • Canadian Institutes of Health Research
  • National Human Genome Research Institute (U54HG004028)
  • National Institute of Dental and Craniofacial Research (U01DE013331, U01DE019784, U01DE017018)
Topics
  • Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Keywords
temporomandibular disorders, RDC/TMD, diagnostic criteria, diagnostic algorithm, Axis II, orofacial pain, sensitivity and specificity, consensus recommendations, temporomandibular myalgia, temporomandibular joint osteoarthritis
MeSH terms
Diagnosis, Differential, Joint Dislocations, Facial Pain, Headache, Humans, Mass Screening, Masticatory Muscles, Terminology as Topic, Osteoarthritis, Sensitivity and Specificity, Temporomandibular Joint Disorders, Temporomandibular Joint Dysfunction Syndrome, Reproducibility of Results, Arthralgia, Temporomandibular Joint Disc, Consensus, Referred Pain, Evidence-Based Dentistry, Myalgia

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