RehabMeasures Instrument
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  2. TMJ Scale

TMJ Scale

Last Updated

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

Cost

Free

Cost Description

This measure can be obtained online at no cost, however, a cost is associated with scoring of the outcome tool by the Pain Resource Center: $21 for single outcome measure scoring or $15 for scoring of each outcome measure with a minimum of 100 outcome measure scorings; Per the Pain Resource Center it is not possible for the test to be scored outside the Pain Resource Center secondary to copyright.

Populations

Non-Specific Patient Population

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/Manual

Instrument Reviewers

Initially reviewed by Jamie Bayliss, PT, MPT in 3/2015

ICF Domain

Body Structure
Body 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.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us! 

Non-Specific Patient Population

back to Populations

Cut-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

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