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- Visscher, Corinne, et al.
(author)
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A multicentre study to diagnostic accuracy of temporomandibular pain tests
- 2008
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Conference paper (peer-reviewed)abstract
- Objectives: To study the diagnostic accuracy of the clinical examination of the Research Diagnostic Criteria (RDC) and of the dynamic and static pain tests for the recognition of temporomandibular disorder (TMD) pain. Methods: A blind examination, including all clinical tests needed for a RDC diagnosis of TMD pain, and the dynamic and static pain tests, was performed in 125 chronic TMD pain patients, 88 chronic dental pain patients, and 121 pain-free subjects. Allocation was based upon the results of an oral history and a dental examination. As indicators for diagnostic accuracy, sensitivity and specificity of the RDC examination and of the dynamic and static pain tests were compared to recommended levels of .70 and .90, respectively. Results: For the RDC examination, high sensitivity (.88), but lower specificity (.45-.71) was found. The specificity did not reach its recommended level. For the dynamic and static pain tests, specificity (.84-.91) and sensitivity (.65) did not differ from the recommended levels. Comparing the outcomes of the two examinations showed that the positive likelihood ratios of the dynamic and static pain tests were higher (p<.001), while the negative likelihood ratios of the RDC examination were lower (p<.01). Conclusion: For the confirmation of a suspected TMD origin of orofacial pain, it is better to rely on the dynamic and static pain tests. To rule out a TMD origin, more value should be attached to the RDC examination (no funding sources).
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- Visscher, Corinne, et al.
(author)
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Accuracy of RDC/TMD examination and dynamic/static tests
- 2008
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Conference paper (peer-reviewed)abstract
- Objectives: To study the diagnostic accuracy of the clinical examination of the Research Diagnostic Criteria (RDC) and of the dynamic and static pain tests for the recognition of temporomandibular disorder (TMD) pain and to improve the RDC accuracy by 1) changing the myofascial pain cutoff of 3 painful muscle palpation sites, or 2)omitting unreliable palpation sites. Methods: In 4 European dental faculties, a blind examination was performed in 125 chronic TMD pain patients, 88 chronic dental pain patients, and 121 pain-free subjects. Allocation was based upon the results of an oral history and a dental examination. Results: Sensitivity and specificity of the RDC were .88 and 45-.71, respectively. Increasing the myofascial pain cutoff better met the recommended levels for specificity and sensitivity of .70 and .90, respectively. When unreliable muscle palpation sites (i.e., the intraoral and submandibular sites) were omitted, the accuracy of the RDC/TMD examination did not change. For the dynamic and static pain tests, sensitivity (.65) and specificity (.84-.91) did not differ significantly from the recommended levels. Conclusion: A suspected TMD origin of orofacial pain is best confirmed by pain on the dynamic or static tests, while it is better denied by a negative outcome of the RDC examination. The intraoral and submandibular palpation sites of the RDC examination do not contribute to its diagnostic accuracy and can better be omitted, while the cutoff for a myofascial pain diagnosis should be increased.
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| 4. |
- Visscher, Corine M, et al.
(author)
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Diagnostic accuracy of temporomandibular disorder pain tests : a multicenter study
- 2009
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In: Journal of Orofacial Pain. - 1064-6655 .- 1945-3396. ; 23:2, s. 108-114
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Journal article (peer-reviewed)abstract
- AIMS: To estimate the diagnostic accuracy of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) clinical examination and of the dynamic/static tests for the recognition of TMD pain. Since the diagnosis of TMD pain is especially complicated in persistent orofacial pain patients, the test outcomes in persistent TMD pain patients were contrasted to those in two control groups: a group of persistent dental pain patients and a group of pain-free subjects. METHODS: In 125 persistent TMD pain patients, 88 persistent dental pain patients, and 121 pain-free subjects, a blind and standardized clinical examination was performed. RESULTS: For the RDC/TMD, sensitivity (88%) was high and specificity was low (pain-free group: 71%; dental pain group: 45%). For the dynamic/static tests, sensitivity was 65% and specificities were 91% and 84%, respectively. Comparing the outcomes of the two examinations showed higher positive likelihood ratios for dynamic/static tests (P < .001), and lower negative likelihood ratios for the RDC/TMD examination (P < .01). CONCLUSION: For the confirmation of a suspicion of TMD pain, it is better to rely on positive dynamic/static tests. To confirm the absence of TMD pain, it is better to rely on a negative RDC/TMD examination.
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