TMJ Scale

Last Updated

September 04, 2015

Purpose

A subjective measure designed to evaluate physical and physiological symptoms associated with temporomandibular dysfunction (TMD) and Craniofacial pain and its association with dysfunction.

Acronym TMJ

Cost

Free

Cost Description

This measure can be obtained online at no cost, however, a cost is associated with scoring of the outcome tool by the Pain Resource Center: $21 for single outcome measure scoring or $15 for scoring of each outcome measure with a minimum of 100 outcome measure scorings; Per the Pain Resource Center it is not possible for the test to be scored outside the Pain Resource Center secondary to copyright.

Non-Specific Patient Population

Self-report assessment of symptoms that screen for TMD.

Measured on a 5-point scale from 0-4.

10 Sections: Pain Report (PR), Palpation Pain (PP), Perceived Malocclusion (MO), Joint Dysfunction (JD), Range of Motion Limitation (RL), Psychological Factor (PF), Stress (ST), Chronicity (CN), Global Scale (GS), and Non-TMD Disorder (NT).

Measures of overall and individual symptoms intensity, self-report of facial, head, and neck pain, symptoms change, and treatment outcomes.

Indicates whether or not a TMJ disorder is likely to be present, the severity of the TMJ disorder (if present), the types and severity of physical problems involved, whether or not a Non-TMJ problem is likely to be present, whether or not psychological factors and stress are significant, and the probability of whether or not the problem is, or may become, a chronic (long term) problem.

Scores above the cut off scores indicate a higher degree of dysfunction, disability, and psychological factors.

Requires a reading level of 8th grade.

Number of Items

Pen/pencil and paper with a printed form or computer with online access

15-20 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Jamie Bayliss, PT, MPT in 3/2015

ICF Domain

Body Structure
Body Function
Activity

Considerations

(Lundeen et al, 1986)

Women have a higher prevalence of each symptom category than men and are more likely to be seen for treatment for TMD (pain report p = .011, palpation pain p = .003, joint dysfunction p = .020, and range of motion limitation p = .012).
In persons <30 years old and >50 years old:
- Prevalence of TMD is increased (p = .028)
- ROM limitation decreased (p = .035)
- Non-TMJ disorder increased (p = .027)
- Psychological factors increased (p = .046)
- Chronicity increased
  - <30 to 30 to 50 years (p = .013)
  - <30 and >50 years (p = .017)
- Malocclusion and stress did not reach statistically significant changes.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Cut-Off Scores

Orthodontic patients with TMD: (Yamaguchi et al, 2002 n = 80, Japanese orthodontic patients with TMD compared to those of the same age without symptoms; mean age = 21 years for both groups)

	Female	Male
Pain Report (PR)	63	62
Palpation Pain (PP)	58	59
Perceived Malocclusion (MO)	61	60
Joint Dysfunction (JD)	61	65
Range of Motion Limitation (RL)	69	67
Non-TMD Dysfunction (NT)	63	63
Psychological Factors (PF)	59	55
Stress (ST)	62	54
Chronicity (CN)	55	57
Global Scale (GS)	65	62

*Table replicated from Yamaguchi et al, 2002

Adults with TMD (Lundeen et al, 1988; 3 case studies: 23 year old female with myofascial pain, 36 year old female with post-traumatic myofascial dysfunction and tension headaches, 74 year old female with TM degenerative joint disease and myofascial pain dysfunction)

	Female	Male
Pain Report (PR)	63	62
Palpation Pain (PP)	58	59
Perceived Malocclusion (MO)	61	60
Joint Dysfunction (JD)	61	65
Range of Motion Limitation (RL)	69	67
Non-TMD Dysfunction (NT)	63	63
Psychological Factors (PF)	59	55
Stress (ST)	62	54
Chronicity (CN)	55	57
Global Scale (GS)	65	62

*Table replicated from data presented in Lundeen et al, 1988

*If a patient’s score is at or above the cutoff, the patient may have a clinically significant problem in the symptoms area.

Normative Data

Adults with TMD (Lundeen et al, 1986; n=274; 121 non-TMJ dental patients and 153 symptomatic TMJ patients; mean ages not provided, however, outcomes were categorized based on three age ranges: <30 years of age, 30-50 years of age, and >50 years of age)

Prevalence of symptoms (%)

	Female	Male	Age <30	Age 30-50	Age >50
Palpation Report	60.0	41.6	58.4	56.8	47.8
Palpation Pain	55.8	33.3	53.4	53.4	40.0
Malocclusion	49.7	44.6	46.9	50.9	45.2
Joint Dysfunction	45.0	28.3	48.0	40.3	29.1
ROM Limitation	36.2	18.1	38.2	31.3	20.4
Non-TMJ Disorder	42.2	33.3	31.9	46.8	41.8
Psychological Factors	37.0	27.1	27.5	40.5	36.9
Stress	36.1	25.4	27.0	37.6	38.0
Chronicity	29.4	23.5	17.6	34.0	38.7
Global Scale	52.7	46.0	52.3	53.1	42.4

Test/Retest Reliability

Adults with TMD (Lundeen et al, 1986)

Excellent test-retest reliability (ICC = .82)

(Levitt et al, 1988; n=25 for individuals with TMJ disorders; mean age not provided; results based on a mean of 5 days from initial test to retest)

Scale	Correlation (ICC)	Significance	Interpretation of ICC
Pain report	.94	<.001	Excellent
Palpation report	.87	<.001	Excellent
Malocclusion	.90	<.001	Excellent
Joint dysfunction	.88	<.001	Excellent
Range-of-motion limitation	.90	<.001	Excellent
Non-TMJ disorder	.55	.004	Adequate
Psychologic factors	.70	<.001	Adequate
Stress	.83	<.001	Excellent
Chronicity	.84	<.001	Excellent
Global scale	.95	<.001	Excellent

*Table replicated from Levitt et al, 1988

Interrater/Intrarater Reliability

Adults with TMD (Lundeen et al, 1988, n= 22 adults with TM disorders, no mean age reported)

Scale	Correlation Coefficient (ICC)	P Value	Interpretation of ICC
Pain report	.77	<0.001	Excellent
Palpation report	.79	<0.001	Excellent
Malocclusion	.88	<0.001	Excellent
Joint dysfunction	.77	<0.001	Excellent
Range-of-motion limitation	.69	.002	Adequate
Non-TMJ disorder	.56	.010	Adequate
Psychologic factors	.62	.006	Adequate
Stress	.53	.015	Adequate
Chronicity	.30	.168	Poor

*Table replicated from Lundeen et al, 1987

Internal Consistency

Adults with TMD: (Lundeen et al, 1986)

Excellent internal consistency (alpha = .80)

(Levitt et al, 1988; n=153 individuals with TMJ disorders; mean age of participants not reported)

Scale	Cronbach’s Alpha	Interpretation of Cronbach’s Alpha
Pain report	.89	Excellent
Palpation report	.88	Excellent
Malocclusion	.82	Excellent
Joint dysfunction	.81	Excellent
Range-of-motion limitation	.89	Excellent
Non-TMJ disorder	.91	Excellent
Psychologic factors	.83	Excellent
Stress	.82	Excellent
Chronicity	.84	Excellent
Global scale	.95	Excellent

*Table replicated from Levitt et al, 1988

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:

Adults with TMD

(Lundeen et al, 1986)

Scale	Pearson Correlation Coefficient Between Clinician Ratings of Patient Clinical Presentation and TMJ Scale Scores	P Value	Interpretation of r
Pain report	0.69	<0.001	Excellent
Palpation report	0.63	<0.001	Excellent
Malocclusion	0.34	<0.001	Adequate
Joint dysfunction	0.67	<0.001	Excellent
Range-of-motion limitation	0.64	<0.001	Excellent
Non-TMJ disorder	0.45	<0.001	Adequate
Psychologic factors	0.47	<0.001	Adequate
Stress	0.42	<0.001	Adequate
Chronicity	0.50	<0.001	Adequate

*Table replicated from Lundeen et al, 1986

(Levitt et al, 1988)

Item-scale correlations corrected for overlap in TMJ patient samples

Scale	Pearson Correlation Coefficient	SD	Interpretation of Pearson Correlation Coefficient
Pain report	.62	.06	Adequate
Palpation report	.66	.07	Adequate
Malocclusion	.55	.12	Adequate
Joint dysfunction	.52	.14	Adequate
Range-of-motion limitation	.61	.14	Adequate
Non-TMJ Disorder	.52	.08	Adequate
Psychologic factors	.55	.11	Adequate
Stress	.55	.14	Adequate
Chronicity	.53	.11	Adequate
Global Scale	.51	.16	Adequate
All scales	.56	.05	Adequate

*Table replicated from Levitt et al, 1988

Predictive validity:

Adults with TMD

(Levitt, 1991; n=1000 patients from a dentist’s office, 900 patients identified as being healthy adults and 100 with TMD symptoms)

Adequate Sensitivity Global Scale (84%) for predicting TM disorders
Adequate Specificity Global Scale (80%) for predicting TM disorders
Poor (+) Predictive value = .43
Excellent (-) Predictive value = .97

(Levitt et al, 1990; n=1000 patients from a dentist’s office, population not identified as being healthy adults or having TMD symptoms)

Use of predictive values of the Psychological scale, Stress scale, and Non-TMD scale to confirm or exclude psychological problems, stress and non-TM disorders in a patient with myofascial pain dysfunction

Scale	Clinician’s Estimate (%)	(+) Predictive value (%)	(-) Predictive value (%)	Change (%)
Psychological factors	50	74		+24
Stress	70	86		+16
Non-TM disorder	10		95	+5

*Table replicated from Levitt et al, 1990

(Levitt et al, 1990, excerpt from Lundeen et al, 1987, n= 742 TM patients and 473 non-TM dental patients)

Scale	Sensitivity	Specificity	Overall % Correct Classification
Pain report	83.4	73.2	82.4
Palpation report	82.0	70.8	80.1
Malocclusion	60.1	61.3	60.3
Joint dysfunction	76.3	73.1	75.5
Range-of-motion limitation	70.7	66.4	68.4
Non-TMJ disorder	66.7	63.4	65.1
Psychologic factors	75.6	74.3	74.6
Stress	73.7	71.1	71.6
Chronicity	67.3	63.4	66.6
Global scale	84.2	80.3	82.7

*Table replicated from Levitt et al, 1990 and original publication of data from Lundeen et al, 1987

(Levitt et al, 1990)

Sensitivity and specificity of the physical symptom scales of the TMJ Scale

Scale	No. Present	No. Absent	Sensitivity (%)	Specificity (%)
Pain report	735	82	83	73
Palpation pain	671	137	82	71
Perceived malocclusion	669	137	60	61
Joint dysfunction	600	208	76	73
ROM limitation	375	440	71	66

*Table replicated from Levitt et al, 1990

(Levitt et al, 1990)

Sensitivity and specificity of psychological problems and non-TM disorders

Scale	Sensitivity (%)	Specificity (%)
Psychological factors	76	74
Stress	74	71
Non-TM disorder	67	63

Construct Validity

Discriminant Validity:

Adults with TMD: (Levitt et al, 1988)

t-Tests of TMJ Scale scores for each scale construct present vs. absent as determined by clinician ratings on TMJ patients

Scale	Scale Construct Absent	Scale Construct Absent	Scale Construct Present	Scale Construct Present	t-Test Signific-ance
	Mean	SD	Mean	SD
Pain report	.23	.41	1.26	.67	<.001
Palpation report	.13	.22	.79	.65	<.001
Malocclusion	.89	.71	1.20	.79	.050
Joint dysfunction	.63	.46	1.44	.66	<.001
Range-of-motion limitation	1.23	.69	2.01	.65	<.001
Non-TMJ disorder	.37	.30	.70	.48	<.001
Psychologic factors	.59	.42	.93	.52	<.001
Stress	.64	.48	1.07	.62	<.001
Chronicity	.13	.28	.29	.40	<.001
Global scale	.48	.32	1.02	.55	<.001

* Table replicated from Levitt et al, 1988

Bibliography

Yamaguchi D, Motegi E, Nomura M, Narimya Y, Katsumura S, Miyazaki H, Kaji H, Watanabe K, Yamaguchi H. Evaluation of psychological factors in orthodontic patients with TMD as applied to the “TMJ Scale”. Bull. Tokyo dent. Coll. 2002; 43:83-87.

Lundeen T, Levitt S, McKinney M. Clinical applications of the TMJ Scale. J Cranio Mandib Prac. 1988; 6:339-345

Levitt s, Lundeen T, McKinney M. Initial studies of a new assessment method for temporomandibular joint disorders. J Prosthet Dent. 1988; 59:490-495

Levitt S. Predictive value: A model for dentists to evaluate the accuracy of diagnostic tests for temporomandibular disorders as applied to a TMJ scale. J Prosthet Dent. 1991;66:385-90

Lundeen T, Levitt S, McKinney M. Discriminative ability of the TMJ Scale: Age and gender differences. J Prosthet Dent. 1986; 56:84-92

Lundeen T, Levitt S, McKinney M. Evaluation of TMJ disorders by clinician ratings. J Prosthet Dent. 1988;59:202-211

Levitt S. Predictive value of the TMJ Scale in detecting clinically significant symptoms of temporomandibular disorders. J Craniomandib Disord Facial Oral. 1990; 4:177-185

Levitt S. Predictive value of the TMJ Scale in detecting psychological problems and non-TM disorders in patients with temporomandibular disorders. J Craniomandib Pract. 1990; 8:225-233

Spiegel E, Levitt S. Measuring symptom severity with the TMJ scale. J Clin Orthod. 1991; 25:21-26

Last Updated

Purpose

Cost

Cost Description

Number of Items

Required Training

Instrument Reviewers

ICF Domain

Considerations

Cut-Off Scores

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Internal Consistency

Criterion Validity (Predictive/Concurrent)

Construct Validity

Bibliography

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