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Lookup NU author(s): Professor Justin DurhamORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Valid diagnostic criteria for classifying pain-related temporomandibular disorders (TMDs) existand can be applied with high inter-examiner reliability to patients. However, adoption in mostclinical settings, both generalist and specialist, remains limited due to the examinationcomplexity and time constraints in clinics. To address this limitation, we created a simplifiedexamination protocol and we test it here against reference standards based on the DiagnosticCriteria for TMD (DC/TMD). DC/TMD assessments include multiple provocation tests five rangeof motion tasks and 40 palpation points—as well as imaging for definitive joint diagnoses. Wetested the simplified protocol using data from two multi-center studies: the TMD Impact Project(n=401) and OPPERA (n=547). Examiners were trained and assessed annually for reliability,supporting generalizability. Diagnostic validity was assessed using area under the curve (AUC),sensitivity, specificity, and likelihood ratios (positive and negative). Using 2-second palpation atthe full muscle (bilateral temporalis, masseter) and TMJ lateral pole, results showed highdiagnostic performance: AUC=0.93, sensitivity=0.88, and specificity=0.98 for identifying painfulTMD. Targeted single-band palpation within each muscle yielded comparable results. Addingother joint pain provocation procedures to the index test did not improve diagnostic accuracy.For acute closed lock, other disc-based TMDs, and degenerative joint disease, sensitivityremained ≤0.12 while specificity was ≥0.92. For subluxation, sensitivity/specificity was0.81/0.97. Based on the likelihood ratios, clinical decision-making guidelines were developed forbDC diagnoses. In conclusion, a simplified and shortened version of the DC/TMD protocoldemonstrates excellent validity for identifying painful TMDs and is feasible for clinical practice.This approach reduces examination time while maintaining diagnostic accuracy, potentiallyimproving patient care across broader clinical settings.
Author(s): Sharma S, Drangsholt M, Durham J, Alstergen P, Ohrbach R
Publication type: Article
Publication status: Published
Journal: Journal of Dental Research
Year: 2026
Pages: epub ahead of print
Online publication date: 08/03/2026
Acceptance date: 21/12/2025
Date deposited: 19/02/2026
ISSN (print): 0022-0345
ISSN (electronic): 1544-0591
Publisher: Sage
URL: https://doi.org/10.1177/00220345251414019
DOI: 10.1177/00220345251414019
ePrints DOI: 10.57711/2phf-q456
Data Access Statement: The dataset is available at doi:10.5061/dryad.4xgxd25qf
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