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Examining the Sensitivity and Specificity of two screening instruments: odontogenic or temporomandibular disorder pain?

Lookup NU author(s): Professor Justin DurhamORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


Introduction: Two orofacial pains that are clinically important to distinguish are odontogenic pain and temporomandibular disorders (TMD) pain. The aim of this study was to determine the sensitivity and specificity of two screening instruments in distinguishing between patients with these types of pain. Methods: A convenience sample of patients seeking care at an Endodontic clinic and an Orofacial Pain clinic were recruited. The 14-item Dental Pain Questionnaire (DePaQ) was used to screen for odontogenic pain and the 6-item TMD-screener was used to screen for TMD pain. Sensitivity and specificity calculations, with 95% confidence intervals (CI), were performed for both instruments and thresholds/acceptability/performance was assessed using published guidelines. Results: Thirty-four patients with odontogenic pain and 37 patients with TMD pain were included in this study. The sensitivity of the DePaQ was 0.85 (95%CI: 0.69-0.95) and specificity was 0.11 (95%CI: 0.03-0.25). The sensitivity of the TMD screener was 0.92 (95%CI: 0.78-0.98) and specificity was 0.59 (95%CI: 0.41-0.75). The point estimates, a single value used to estimate the population parameter, for both the DePaQ and TMD screener were “acceptable” in identifying patients who had the pain condition in question (i.e., sensitivity), while the point estimate for appropriately identifying patients who did not have the pain condition when they did not have it (i.e., specificity) was “non-acceptable” for both. Conclusion: The DePaQ and the TMD Screener lack diagnostic accuracy for differentiating TMD from odontogenic tooth pain without adjunctive (clinical) investigation(s) or examination. The TMD screener, however, has high sensitivity for identifying true positives i.e. TMD pain, and would therefore be useful as a screening instrument when one can exclude odontogenic pain definitively on clinical and radiographical grounds for instance in endodontic practices. In this study the negative predictive value was also high in the TMD screener and therefore we can trust a negative result: that is when the TMD screener is negative we can be fairly certain the pain diagnosis is not TMD and rule out TMD.

Publication metadata

Author(s): Alonso BF, Nixdorf DR, Shueb SS, John MT, Law AS, Durham J

Publication type: Article

Publication status: Published

Journal: Journal of Endodontics

Year: 2017

Volume: 43

Issue: 1

Pages: 36-45

Print publication date: 01/01/2017

Online publication date: 14/12/2016

Acceptance date: 05/10/2016

Date deposited: 10/10/2016

ISSN (print): 0099-2399

ISSN (electronic): 1878-3554

Publisher: Elsevier


DOI: 10.1016/j.joen.2016.10.001


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