Reliability and Validity of the Diagnostic Criteria for Temporomandibular Disorders Axis I in Clinical and Research Settings: A Critical Appraisal

The recently published Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I, which is recommended for use in clinical and research settings, has provided an update of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The authors of the DC/TMD based their publication on the results of a Validation Project (2001-2008) and consecutive workgroup sessions held between 2008 and 2013. The DC/TMD represents a major change in both content and procedures; nonetheless, earlier concerns and new insights have only partly been followed up when drafting the new recommendations. Moreover, the emphasis on immediate implementation in clinical and research settings is not in line with the provided external evidence on which the DC/TMD is based. This Focus Article describes these concerns with regard to several aspects of the DC/TMD: the additional classification categories; the high dependency on pressure-pain results from use of the recommended palpation technique; the TMD pain screening instrument; the test population characteristics; the utility of additional subgroups; the use of a reference standard; the dichotomy between pain and dysfunction; and the DC/TMD algorithms. Thus, although the DC/TMD represents an improvement over the RDC/TMD, its immediate implementation in research and clinical care does not yet appear to be adequately substantiated. Keywords: classification, diagnosis, facial pain, reference standards, temporomandibular disorders