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
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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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Mixed Conditions
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