Symptoms of Whiplash
TMJ Disorder Whiplash and temporomandibular (TMJ) joint disorder
TMJ Disorder Diagnosis and Treatment
The findings of a Swedish study show that there is a link between whiplash injury and the development of delayed jaw pain and dysfunction. The study involved 60 patients who had been involved in collisions to the rear of their vehicles. It was found that a year after the accident they were 5 times more likely to display new symptoms of jaw pain and dysfunction than the control group of uninjured subjects.
The damage is caused when the temporomandibular joint (TMJ) is stretched as the head is whipped upwards and forwards during a collision. This stretching can prevent the muscles, ligaments, discs and bones from working together as they should and can lead to the jaw clicking or locking and make eating or even talking painful and difficult.
Short and long-term temporomandibular (TMJ) dysfunction is a painful condition which can take some time to manifest itself and is a little known side effect of whiplash injury. However, it is becoming better understood in medico-legal circles and the medical and legal professions are working together to prove to motor insurers that it is a legitimate condition.
Some of the symptoms of TMJ disorder, such as headache, neck pain, shoulder pain, dizziness and tinnitus, mimic those of cervical injury and it is important that doctors are aware of the link between TMJ pain and dysfunction, and whiplash. Early recognition of the condition will help to prevent incorrect treatment and medico-legal disputes as well as reducing the pain and suffering it causes.
In order to provide effective treatment it is necessary to establish accurately what the particular problems are, as the term “TMJ disorder” covers a wide range of diseases, dysfunctions and derangements to the articulating parts of the jaw joints.
Diagnosis of TMJ disorder is carried out in two parts. The first part is exploring the history of the patient and conducting a clinical examination and the second is by diagnostic study. There are a number of different diagnostic studies which can be carried out individually or in combination and most medical professionals tend to have ones which they favour.
The diagnostic studies available for TMJ diagnosis, in general are:
- x-rays of the temporomandibular joints and skull
- Magnetic Resonance Imaging (MRI)
- Electromyography – for study of muscle function
- Joint Vibration Analysis – a form of ultra-sound
- Casts of the mandible and maxilla
- Dental x-rays
There are two types of treatment for TMJ disorders, surgical and non-surgical but the surgical option is undertaken only as a last resort when medical treatment has failed.
The medical treatment for acute TMJ can include any of the following in isolation or in combination depending upon the particular problem.
Avoiding chewy, hard or crunchy foods that require the jaw to move excessively and foods that require the mouth to be opened wide such as burgers etc may give the joints time to rest and recover. It may seem a strange thing to advise but even swallowing exerts about 25 pounds pressure on the teeth which is then transferred to the temporomandibular joint. Recognising when the teeth are clenching or grinding and stopping them from doing so will also reduce pressure on the joint.
Application of Heat and Ice
Putting hot or cold packs on the area can assist in reducing muscle tension and spasm. Cold applications are best following an injury and can be useful in reducing inflammation and pain.
Anti-inflammatory, muscle relaxant medication and cortisone injections into the TMJ may be administered as applicable to the case.
Physical Therapy Treatment
An exercise programme, gentle massage, ultra-sound and electrical stimulation may reduce the pain and help to increase the range of movement as well as strengthening the joint.
Referral for stress management or psychological counseling may help to reduce muscle tension. Biofeedback treatment technique can assist with relaxation and pain management.
An acrylic appliance can be custom made to fit over the teeth to balance the bite and reduce or eliminate grinding or clenching of the teeth (bruxism). This is usually only used during the night but may be required through the day in some cases.
Correcting Bite Abnormalities
Dental restorations can create a more stable bite, adjusting crowns or bridges can realign teeth and Orthodontics may be required to correct an abnormal bite.
Surgery is undertaken as a last resort if medical treatment has failed. In the most severe cases TMJ arthroscopy, ligament tightening, restructuring or replacement of the TMJ may be considered.