The Reliability and Validity of Self-reported Temporomandibular Disorder Pain in Adolescents

Aims: To evaluate the reliability and validity of self-reported pain associated with temporomandibular disorders (TMD) in adolescents and to determine how this validity may change over time. The authors' hypothesis was that self-reported pain can be used to reliably and accurately detect adolescents with TMD pain. Methods: One hundred twenty adolescents, 60 with self-reported TMD pain and 60 age- and gender-matched controls without TMD pain, were examined twice. At the first examination at a Public Dental Service clinic, self-reported TMD pain was recorded for each patient. At the second examination, a clinical examination was completed, blind to the patients' self-report of pain symptoms, after which self-reported TMD pain was again recorded. The clinical examination was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). Self-reported TMD pain in this investigation was based upon the subjects' responses to 2 questions: (1) Do you have pain in your temples, face, temporomandibular joint (TMJ), or jaws once a week or more? and (2) Do you have pain when you open your mouth wide or chew once a week or more? Results: Test-retest reliability of .83 (kappa) was found for the 2 questions. The sensitivity was .98 (95% CI, .90 to 1.0) and specificity was .90 (95% CI, .81 to .95) for comparison of assessments made on the same day. Sensitivity was .96 (95% CI, .85 to .99) and specificity .83 (95% CI, .72 to .90) for assessments made 2 to 4 weeks apart. Conclusion: Very good reliability and high validity were found for the self-reported pain questions. A short time interval between the screening question and examination slightly increased the accuracy of the measure. In adolescent populations, the questions in this study can be used to screen for TMD pain. Keywords: adolescents, diagnosis, reliability, sensitivity, specificity, temporomandibular pain