Assessment of Dental Students’ Diagnostic and Management Decision‐Making Skills in Temporomandibular Disorders Through Virtual Scenarios

PURPOSE: Temporomandibular disorders (TMDs) affect the temporomandibular joint and masticatory muscles, causing pain and dysfunction. Despite the Commission of Dental Accreditation (CODA) mandates for TMD integration into predoctoral curricula, educational delivery remains variable. This study assessed dental students' clinical decision-making in myofascial pain (MFP) and disc displacement with reduction (DDwR) cases using standardized virtual patient scenarios. METHODS: Dental students completing the Orofacial Pain and Oral Medicine rotation at Herman Ostrow School of Dentistry engaged with five virtual patient scenarios between October 2024 and August 2025. Data from 149 MFP and 80 DDwR cases were analyzed. Student selections for diagnostic tests, diagnoses, and treatment plans were coded based on expert consensus. Correlation and regression analyses examined relationships between test selection, diagnostic accuracy, and overall performance. RESULTS: Among 238 students, pass rates were 81.9% for MFP and 58.8% for DDwR. Diagnostic accuracy strongly predicted success; students selecting correct diagnoses were significantly more likely to pass (MFP: OR = 19.8; DDwR: OR > 100). Time spent showed no correlation with performance. Critical errors differed by case type: MFP cases showed diagnostic failures (66.7%) and excessive testing (51.9%), while DDwR cases revealed over-selection across multiple categories (81.8%), indicating distinct cognitive challenges. CONCLUSIONS: Virtual patient scenarios provide safe, flexible environments to assess and develop diagnostic reasoning in TMDs, revealing persistent gaps in test prioritization and treatment planning. These findings support simulation-based education for dental curricula and emphasize integrated teaching strategies to enhance clinical reasoning and decision-making skills.