Subtype-specific screening for temporomandibular disorders: Diagnostic performance and cut-point optimization of the 6Ts-4D Tool.

STATEMENT OF PROBLEM: Effective screeners for temporomandibular disorders (TMDs) should be concise, inexpensive, straightforward to complete, diagnostically accurate, and ideally self-administered. Existing instruments have notable limitations, underscoring the need for a multidimensional screener that addresses these gaps.

PURPOSE: This study evaluated the reliability, diagnostic accuracy, and cut-point optimization of the multidimensional 6Ts-4D screener for identifying pain-related (PT) and intra-articular (IT) TMDs and assessed its clinical utility across specific TMD subtypes.

MATERIAL AND

METHODS

A case-control study was conducted with 344 adults recruited from a university-based dental hospital. Participants completed the 6Ts-4D screener, followed by standardized Diagnostic Criteria for TMD (DC/TMD) interviews and clinical examinations, supplemented with diagnostic imaging to establish reference standards. Reliability was assessed using the Cronbach alpha and intraclass correlation coefficients. Diagnostic performance was evaluated with area under the receiver operating characteristic curve (AUC) analysis and conventional accuracy metrics. Optimal cut-points were determined using the Youden Index.

RESULTS

The 6Ts-4D demonstrated acceptable reliability (Cronbach alpha 0.67) and excellent diagnostic performance for all TMDs (AUC 0.97; sensitivity 86.8%; specificity 100%). Subscale analyses showed good accuracy for PT (AUC 0.83) and IT (AUC 0.81). Item-level screening yielded moderate-to-good AUCs for myalgia (0.80), arthralgia (0.82), disc displacement with reduction (0.77), disc displacement without reduction with limited opening (0.82), and TMJ subluxation (0.79).

CONCLUSIONS

The 6Ts-4D screener was found to be a brief, reliable, and subtype-sensitive tool for TMD triage, with robust diagnostic metrics supporting its use in clinical, telehealth, and research settings.