The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms
have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below
the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development
of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related
TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown
to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened,
from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments.
a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I
algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal
structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for
validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ
Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive
search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in
the public domain, and currently are being used in medical settings.
The newly recommended Diagnostic
Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid
diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for
one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular
disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability
for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85).
Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis
II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function
as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive
self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological
distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain.
The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological
distress as well as additional constructs of anxiety and presence of comorbid pain conditions.
recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive
instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification
of patients with a range of simple to complex TMD presentations.