Validation and internal consistency of a questionnaire to assess dental surgeons' knowledge about temporomandibular disorders

Aguiar-Filho, Nereu Barreira de; Ferro, Antônio Henrique Borges; Lima, Maria Amélia Oliveira Soares de; Tomaz, Rosilene Dias; Moraes, Rerison Roger Pereira; Rodrigues, Luciane Lacerda Franco Rocha; Guimarães, António Sérgio

doi:10.63231/2595-0118.20250041-pt

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ORIGINAL ARTICLE • BrJP 8 • 2025 • https://doi.org/10.63231/2595-0118.20250041-en linkcopy

Validation and internal consistency of a questionnaire to assess dental surgeons' knowledge about temporomandibular disorders

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES Temporomandibular Disorder (TMD), despite being an increasingly common condition, is still a complex topic for many dentists. This study aims to validate and verify the internal consistency of an instrument developed to assess the knowledge of dentists on the main issues related to TMD.

METHODS This is research divided into three stages: observational, transversal and quantitative. Initially, a total of 10 expert/judges dental surgeons (DS) in the area of TMD and orofacial pain were invited to participate to evaluate the form and content of the instrument. In the second stage, a total of 5 DS who were also specialists validated the answers considered correct. In the third stage, internal consistency was checked in a sample of 188 DS who responded to the same questionnaire on two occasions to compare and calculate internal consistency.

RESULTS In the first stage of validation, the individual and total CVI was 1, suggesting the consistency of the instrument. In the experts' assessment, cohesion was found in the structure of the instrument, which presented a total Cronbach's alpha of 0.766, that is, substantial consistency, with the first domain, on pain and behavior, the greatest consistency with 𝞪 of 0.815. The internal consistency of the instrument carried out by 188 dental surgeons showed almost perfect consistency (𝞪 of 0.820).

CONCLUSION The general consistency of the instrument developed to assess knowledge about TMD was considered substantial. When internal consistency was verified in a sample of dental surgeons, it varied from moderate to almost perfect.

Keywords:
Dental surgeon; Instruments; Knowledge; Validation; Temporomandibular dysfunction

HIGHLIGHTS

Validated instrument shows substantial consistency in assessing dental surgeons' knowledge of TMD

The study reveals high levels of content validity and reliability in TMD questionnaire

The domain of pain and behavioral aspects showed the highest internal consistency, standing out among the evaluated topics

Items				Agreement										CVI
Items				Strongly Disagree f(%)		Disagree f(%)		Neutral f(%)		Agree f(%)		Strongly agree f(%)		CVI
Objectives
1		Includes the proposed theme.		0		0		0		0		100		1
2		Suitable for the evaluation process		0		0		0		10		90		1
Structure and presentation
3		Language appropriate to the target audience.		0		0		0		10		90		1
4		Objective information		0		0		0		30		70		1
5		Required information		0		0		0		10		90		1
6		Logical sequence of ideas		0		0		0		10		90		1
7		Current theme		0		0		0		0		100		1
8		Appropriate text size		0		0		0		20		80		1
Relevance
9	Stimulates learning		0		0		0		10		90		1
10	Contributes to knowledge in the area		0		0		0		20		80		1
11	Arouses interest in the topic		0		0		0		20		80		1
	CVI total												1

		PREDOMINANT RESPONSE	CRONBACH'S ALPHA
	COMPLETE INSTRUMENT		0.766 Substantial consistency
	CHRONIC PAIN AND BEHAVIORAL PAIN		0.815 Almost perfect consistency
1	Chronic pain is somatic in a behavioral and social problem	Strongly agree
2	Sleep disturbances are common in patients with chronic orofacial pain	Agree
3	Depression may be an important etiological factor in chronic orofacial pain	Strongly agree
	ETIOLOGY		0.595 Moderate consistency
4	Oral parafunctional habits are significant in the development of TMD	Agree
5	Stress is a very important factor in the development of TMD	Strongly agree
6	Headache is commonly related to psychological or social factors	Agree
7	Patients with rheumatoid arthritis should be asked about the appearance of TMJ symptoms	Strongly agree
	DIAGNOSIS AND CLASSIFICATION		0.733 Substantial consistency
8	Pain in TMJ disorders is often associated with a clicking sound and/or restriction in the mouth opening	Strongly agree
9	TMD pain is aggravated/relieved by jaw movements	Agree
10	Reduced mouth opening capacity is almost never caused by TMJ arthritis	Agree
11	Tenderness to palpation in the masticatory system and/or TMJ is the most important clinical sign of TMD	Agree
	TREATMENT AND PROGNOSIS		0.70 Substantial consistency
12	Orthodontic treatment can treat TMD	Strongly disagree
13	Anti-inflammatories are effective in treating acute arthralgias	Agree
14	The use of occlusal splints is a good therapy for patients with TMD	Agree
15	Counseling and behavioral therapy are the first line of treatment in patients with TMD	Strongly agree

		CRONBACH'S ALPHA FOR EACH ITEM	FULL DOMAIN CRONBACH'S ALPHA
	COMPLETE INSTRUMENT		.820 Almost perfect consistency
	CHRONIC PAIN AND BEHAVIORAL PAIN		.540 Moderate consistency
1	Chronic pain is somatic in a behavioral and social problem	.834
2	Sleep disturbances are common in patients with chronic orofacial pain	.827
3	Depression may be an important etiological factor in chronic orofacial pain	.822
	ETIOLOGY		.676 Substantial consistency
4	Oral parafunctional habits are significant in the development of TMD	.815
5	Stress is a very important factor in the development of TMD	.817
6	Headache is commonly related to psychological or social factors	.807
7	Patients with rheumatoid arthritis should be asked about the appearance of TMJ symptoms	.807
	DIAGNOSIS AND CLASSIFICATION		.681 Substantial consistency
8	Pain in TMJ disorders is often associated with a clicking sound and/or restriction in the mouth opening	.801
9	TMD pain is aggravated/relieved by jaw movements	.798	:
10	Reduced mouth opening capacity is almost never caused by TMJ arthritis	.813
11	Tenderness to palpation in the masticatory system and/or TMJ is the most important clinical sign of TMD	.802
	TREATMENT AND PROGNOSIS		.789 Substantial consistency
12	Orthodontic treatment can treat TMD	.810
13	Anti-inflammatories are effective in treating acute arthralgias	.795
14	The use of occlusal splints is a good therapy for patients with TMD	.797
15	Counseling and behavioral therapy are the first line of treatment in patients with TMD	.793

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[1] f = absolute frequency; % = relative frequency; CVI = Content Validity Index per item.