Adapting the diagnostic definitions of the RDC/TMD to routine clinical practice: A feasibility study

The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) is a well-known diagnostic tool for clinical trials on TMD. Objectives: This study aims to assess the reliability, validity and feasibility of a new method of physically diagnosing temporomandibular disorders (TMD), designed for routine clinical use. This version, known as Clinical Examination Protocol-TMD (CEP-TMD), was compared to the gold standard original RDC/TMD. Methods: A total of 49 subjects (41 referred TMD patients and 8 symptom free subjects) were examined using both RDC/TMD and CEP-TMD versions. Three examiners, with varying levels of experience in diagnosing TMD, worked in pairs. Each member of a pair saw the same patient twice, once for the RDC/TMD and once for the CEP-TMD examination. The examination order was randomized. Each patient's examinations alternated between examiners to reduce the memory effect. Examinations could yield single, multiple or no diagnosis. Kappa statistics were calculated to estimate reliability. Results: There was substantial overall agreement between the CEP-TMD and the RDC/TMD (kappa = 0.70). Intra-examination agreements were substantial in both RDC/TMD (kappa = 0.70) and CEP-TMD (kappa = 0.90). For examination and diagnosis, the CEP-TMD was almost 3 min faster than the RDC/TMD (p < 0.05). Conclusions: It was concluded that the CEP-TMD's diagnosis is comparable to the RDC/TMD thus providing a convenient and intuitive approach for dentists to physically diagnose TMD in clinical practice. The well-established RDC/TMD remains the gold standard for research diagnosis of TMD. (C) 2009 Elsevier Ltd. All rights reserved.