Advances in Dental Research, Vol 7, 127-136, Copyright © 1993 by International & American Associations for Dental Research
Temporomandibular disorders: assessment of psychological factors
J. D. Rugh, B. J. Woods and L. Dahlstrom
University of Texas Health Science Center, Department of Orthodontics, San Antonio 78284.
Factors such as psychological stress, anxiety, depression, oral habits, and
chronic pain behaviors have been found in subgroups of Temporomandibular
Disorders (TMD) patients. This paper reviews the current status of
diagnostic methods and instruments designed to identify various
psychological factors. The authors offer the following general conclusions:
Although the DSM-III-R has significant limitations, it is currently the
most common gold standard with which other psychological instruments are
compared. There are several specific assessment instruments, such as the
Beck Depression Inventory and the Zung Self-Rating Depression Scale, which
have been found to have acceptable sensitivity and specificity scores. In
addition, certain simple screening questions may be cost-effective for the
identification of psychological factors. Because of studies indicating that
the dentists' recognition of psychological factors is inaccurate, a brief
screening questionnaire may be useful in TMD patients. The literature does
not support the routine use of the MMPI. A major conclusion of this review
is that there are several psychological instruments available which have
demonstrated reasonable validity through a blind comparison with a gold
standard. There is need for further development and testing of brief
screening instruments using clinical decision methods.
