The TMD Screener

I wanted to take a moment to introduce you to the TMD Screener if you are not familiar with it. It came out in 2011 due to the great work of Dr. Yoly M. Gonzalez, DDS, MS, MPH, and Dr. Eric Schiffman, DDS, MS.

Using this instrument will allow clinicians to identify more readily and cost-effectively, most patients with painful Temporomandibular conditions or TMJ Pain for whom early and reliable identification would have a significant effect on diagnosis, treatment, and prognosis.

The goal of the six-item TMD screener was to enhance its internal reliability (and thereby increase its precision) for use in clinical settings. Also, the three additional items in the instrument could be used as part of the formal diagnosis of a pain-related TMD.

In population settings, one could use the six-item version if more certainty about the likely diagnosis is desired. With the use of either version (short or long) of the screener, it is recognized that the clinician must perform a comprehensive pain assessment, including an interview and clinical examination, if the goal is to provide a diagnosis.

Another skillful use for the TMD Screener is for your headache population. Take a moment to read Hedwig A. van der Meer, PT, MSc research article entitled: Validation of the Temporomandibular Disorder Pain Screener in a Specialized Headache Center.

 For those of you that read my newsletters, you will recall Hedwig presented at the recent 2022 AAOP Conference in Boston. So once again, I thank her for her research work on our behalf. Approximately 1 in 2 headache patients who visit a specialized headache clinic has a Temporomandibular Disorder. Headache is present in 67% to 85% of patients with TMDs, with migraine being the most prevalent (23% to 60%), followed by tension-type headache (TTH; 30% to 38%) and headache attributed to TMD (section 11.7 of the International Classification of Headache Disorders [ICHD-3]; prevalence 5%).

It was hypothesized and validated, that the TMD pain screener would accurately identify the presence of a painful TMD in a headache population. The TMD pain screener seems to be a valid tool to accurately screen for the presence of TMD to provide the most optimal treatment for headache patients.

Below is the Questionnaire:

1. In the last 30 days, which of the following best describes any pain in your jaw or temple area on either side?

• No pain
• Pain comes and goes
• Pain is always present

2. In the last 30 days, have you had pain or stiffness in your jaw on awakening?

• No
• Yes

3. In the last 30 days, did the following activities change any pain (that is, make it better or make it worse) in your jaw or temple area on either side?

A. Chewing hard or tough food

• No
• Yes

B. Opening your mouth or moving your jaw forward or to the side

• No
• Yes

C. Jaw habits such as holding teeth together, clenching/grinding, or chewing gum

• No
• Yes

D. Other jaw activities such as talking, kissing, or yawning

• No
• Yes

Items 1-3A represent the short screener, and items l-3D represent the long screener. An ‘a’ response is O points, a ‘b’ response is 1 point, and a ‘c’ response is 2 points.

Specificity: 95%

Sensitivity: 97%

Positive TMD pain screener:

Patients who have ≥3 points on the TMD pain screener (0-7 range) are anticipated to have a painful TMD based on the DC/TMD and are therefore considered to have a positive outcome on the TMD pain screener.

Negative TMD pain screener:

Patients who have <3 points on the TMD pain screener (0-7 range) are anticipated NOT to have a painful TMD based on the DC/TMD and are therefore considered to have a negative outcome on the TMD pain screener.

If you chose to use the short version vs. Long: ≥ 2 points for the short version of the screener, and ≥ 3 points for the full or long screener indicate a positive outcome on the TMD Screener.

Click the link below so you can see how we chose to incorporate the TMD screener on our TreatingTMJ Website as a means to screen people with or without TMD and then engage them to contact us for evaluation and treatment. https://www.treatingtmj.com/tmj-test/  

I hope you have found this helpful!

All The Best

Mike

1. Gonzalez YM, Schiffman E, Gordon SM, Seago B, Truelove EL, Slade G, Ohrbach R. Development of a brief and effective temporomandibular disorder pain screening questionnaire: reliability and validity. J Am Dent Assoc. 2011 Oct;142(10):1183-91.

2. Van der Meer HA, Bakke M, Schytz HW, Madsen BK. Validation of the Temporomandibular Disorder Pain Screener in a Specialized Headache Center. J Oral Facial Pain Headache. 2021 Spring;35(2):150-156.