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
Primary Image
TMJ Scale
Populations
Key Descriptions
- 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
97
Equipment Required
- Pen/pencil and paper with a printed form or computer with online access
Time to Administer
15-20 minutes
Required Training
Reading an Article/ManualInstrument Reviewers
Initially reviewed by Jamie Bayliss, PT, MPT in 3/2015
ICF Domain
Body StructureBody 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.
-
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Non-Specific Patient Population
back to PopulationsCut-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