The Research Diagnostic Criteria For Temporomandibular Disorders. II: reliability of Axis I diagnoses and selected clinical measures.

AIMS: The primary aim was to determine new estimates for the measurement reliability of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms. A second aim was to present data on the reliability of key clinical measures of the diagnostic algorithms. METHODS: Kappa (k), computed by generalized estimate equation procedures, was selected as the primary estimate of interexaminer reliability. Intersite reliability of six examiners from three study sites was assessed annually over the 5-year period of the RDC/TMD Validation Project. Intrasite reliability was monitored throughout the validation study by comparing RDC/TMD data collections performed on the same day by the test examiner and a criterion examiner. RESULTS: Intersite calibrations included a total of 180 subjects. Intersite reliability of RDC/TMD diagnoses was excellent (k > 0.75) when myofascial pain diagnoses (Ia or Ib) were grouped. Good reliability was observed for discrete myofascial pain diagnoses Ia (k = 0.62) and Ib (k = 0.58), for disc displacement with reduction (k = 0.63), disc displacement without reduction with limited opening (k = 0.62), arthralgia (k = 0.55), and when joint pain (IIIa or IIIb) was grouped (k = 0.59). Reliability of less frequently observed diagnoses such as disc displacements without reduction without limited opening, and osteoarthrosis (IIIb, IIIc), was poor to marginally fair (k = 0.31-0.43). Intrasite monitoring results (n = 705) approximated intersite reliability estimates. The greatest difference in paired estimates was 0.18 (IIc). CONCLUSION: Reliability of the RDC/TMD protocol was good to excellent for myofascial pain, arthralgia, disc displacement with reduction, and disc displacement without reduction with limited opening. Reliability was poor to marginally fair for disc displacement without reduction without limited opening and osteoarthrosis.

The Research Diagnostic Criteria for Temporomandibular Disorders. III: validity of Axis I diagnoses.

AIMS: To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I TMD diagnoses. METHODS: A combined total of 614 TMD community and clinic cases and 91 controls were examined at three study sites. RDC/TMD Axis I diagnoses were algorithmically derived from an examination performed by calibrated dental hygienists. Reference standards ("gold standards") were established by means of consensus diagnoses rendered by two TMD experts using all available clinical data, including imaging findings. Validity of the RDC/TMD Axis I TMD diagnoses was estimated relative to the reference-standard diagnoses (gold standard diagnoses). Target sensitivity and specificity were set a priori at greater than or equal to 0.70 and greater than or equal to 0.95, respectively. RESULTS: Target sensitivity and specificity were not observed for any of the eight RDC/TMD diagnoses. The highest validity was achieved for Group Ia myofascial pain (sensitivity 0.65, specificity 0.92) and Group Ib myofascial pain with limited opening (sensitivity 0.79, specificity 0.92). Target sensitivity and specificity were observed only when both Group I diagnoses were combined (0.87 and 0.98, respectively). For Group II (disc displacements) and Group III (arthralgia, arthritis, arthrosis) diagnoses, all estimates for sensitivity were below target (0.03 to 0.53), and specificity ranged from below to on target (0.86 to 0.99). CONCLUSION: The RDC/TMD Axis I TMD diagnoses did not reach the targets set at sensitivity of > or = 0.70 and specificity of > or = 0.95. Target validity was obtained only for myofascial pain without differentiation between normal and limited opening. Revision of the current Axis I TMD diagnostic algorithms is warranted to improve their validity.