title: Examining the Sensitivity and Specificity of 2 Screening Instruments: Odontogenic or Temporomandibular Disorder Pain?
abstract: BACKGROUND
  Two groups of patients with orofacial pains that are clinically important to distinguish from each other are patients with odontogenic pain and temporomandibular disorder (TMD) pain. The aim of this study was to determine the sensitivity and specificity of 2 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 (CIs) 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 (ie, sensitivity), whereas the point estimate for appropriately identifying patients who did not have the pain condition when they did not have it (ie, specificity) was "nonacceptable" for both.
  
  
  CONCLUSIONS
  The DePaQ and the TMD screener lack diagnostic accuracy for differentiating TMD from odontogenic tooth pain without adjunctive (clinical) investigation(s) or examination. However, the TMD screener has high sensitivity for identifying true positives (ie, TMD pain) and would therefore be useful as a screening instrument when one can definitively exclude odontogenic etiology for pain on clinical and radiographic 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 (ie, when the TMD screener is negative, we can be fairly certain the pain diagnosis is not TMD and rule out TMD).
authors.affiliation: School of Dentistry, University Complutense of Madrid, Madrid, Spain; Private Practice, Madrid, Spain.
authors.forename: Barbara
authors.initials: B
authors.lastname: Fonseca Alonso
authors.affiliation: School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Health Partners Institute of Education and Research, Bloomington, Minnesota. Electronic address: nixdorf@umn.edu.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Nixdorf
authors.affiliation: School of Dentistry, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Shueb
authors.affiliation: School of Dentistry, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Mike T
authors.initials: MT
authors.lastname: John
authors.affiliation: School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Private Practice, Lake Elmo, Minnesota.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Law
authors.affiliation: Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Justin
authors.initials: J
authors.lastname: Durham
mesh_terms: D005157:Facial Pain / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis*; D014098:Toothache / Q000175:diagnosis*
keywords: Dental pain; dental pain questionnaire; screening instruments; temporomandibular disorders; temporomandibular pain; temporomandibular screener