Brief Diagnostic Criteria for Temporomandibular Disorders (Tmd): Enhancing Sensitivity in Diagnosing Headache Attributed to Tmd (A Multi‐Centre Study)

Abstract

<h3>Background</h3><p>The brief Diagnostic Criteria for Temporomandibular Disorders (bDC/TMD) was developed to simplify the original DC/TMD for wider clinical use. While its diagnostic accuracy for most painful TMDs is acceptable, the sensitivity for headache attributed to TMD (HaTMD) was reported to be poor.</p><h3>Objectives</h3><p>To improve the diagnostic sensitivity of HaTMD within the bDC/TMD framework by reintroducing selected examination items from the original DC/TMD protocol.</p><h3>Methods</h3><p>This retrospective multicentre study used data from Finland and Israel. The cohort included 114 individuals previously diagnosed with HaTMD according to the DC/TMD and with myalgia and/or arthralgia diagnoses in both DC/TMD and bDC/TMD. Four examination items excluded from the bDC/TMD—E1b (headache location in temple), E4c (familiar headache on assisted opening), E5a/b (lateral movements) and E5c (protrusive movements)—were reintroduced individually. Four calibrated examiners reassessed each modified dataset. Inter-examiner reliability (Cohen's kappa) and diagnostic sensitivity were calculated using DC/TMD as the gold standard.</p><h3>Results</h3><p>Inter-examiner reliability for HaTMD diagnosis was almost perfect (κ = 0.81–1.00) across all items. Sensitivity improved markedly from the previously reported 0.16–0.38 to 0.82 (E1b)–0.90 (E5c). Item E1b (temple headache confirmation) was present in 95% of Finnish and 86% of Israeli cases, identifying it as the most representative finding.</p><h3>Conclusion</h3><p>Reintroducing item E1b into the bDC/TMD examination substantially increases the diagnostic sensitivity for HaTMD while maintaining brevity. Refinement of the painful TMD diagnostic decision tree and prospective validation of the modified bDC/TMD are recommended to ensure reliability and clinical applicability.</p>