Temporomandibular disorders and whiplash injury: a narrative review

Differences in physical examination findings between those who present with or without headache soon after a whiplash injury: a cross-sectional study

AIM

To determine differences in physical examination findings between people with acute whiplash-associated disorders (WAD) with and without headache.

METHODS

In this cross-sectional study, participants with acute WAD were evaluated to assess differences in the presence of physical impairments. The following were assessed: pain intensity on manual palpation the over spinous process of C1-C3, zygapophyseal joints of C0-C4, and trapezius, sternocleidomastoid, suboccipitalis, masseter and temporalis muscles; cervical range of motion (ROM); flexion-rotation test (FRT); forward head posture; cranio-cervical flexion test (CCFT); neck flexor and extensor endurance; pressure-pain thresholds (PPT) over neural structures and upper limb neural tests (ULNT) in addition to median UNLT + CCF. Correlation analyses were performed to assess the association between examination findings and headache intensity. Logistic regression and discriminant analyses were also performed.

RESULTS

Forty-seven participants (26 men and 21 women; mean age = 38.9 years old) were included in the study. 60% of the participants presented with headache. Several examination findings were significantly different between groups. A group of examination findings composed of neck endurance, manual palpation over cervical and muscular structures, PPT, CCFT, ROM and FRT could discriminate between groups with a sensitivity of 86.7% and specificity of 90%.

CONCLUSIONS

Several neuromusculoskeletal features are different between people with acute WAD with or without headache. A combination of features could distinguish between groups with high levels of sensitivity and specificity.

Higher Neck Pain Intensity and the Presence of Psychosocial Factors Are More Likely When Headache is Present after a Whiplash Injury: A Case-Control Study

BACKGROUND

Several factors such as neck pain intensity, disability, anxiety, depression, female sex, or a previous history of headache are associated with post-whiplash headache. However, the possible role of psychosocial factors contributing to the presence of headache or worsening of headache after a whiplash trauma remains unclear. To address this gap in knowledge, there is the need to assess psychosocial factors concerning headache shortly after a whiplash injury.

OBJECTIVE

To evaluate psychological features, pain and disability in people with acute whiplash associated disorders (WAD) and compare these features between those with and without headache.

DESIGN

Case-control study.

SETTING

A secondary care traumatology center.

METHODS

Forty-seven people with acute WAD were recruited; 28 with headache, and 19 without. All participants completed self-reported questionnaires including Visual Analogue Scale (VAS) for neck pain intensity, the Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale Kinesiophobia-11 (TSK-11), and State-Trait Anxiety Inventory.

RESULTS

Neck pain intensity (P < .001), neck disability (P < 0.001), pain catastrophizing (P < .001), kinesiophobia (P < .001), and anxiety state (P = .007) and trait (P = .05) were higher in those with headache when compared to those without. In addition, high levels of neck pain (P = .025), moderate levels of neck disability (P < .001), moderate levels of pain catastrophizing (P = .015), and moderate (P = .002) and severe (P = .016) levels of kinesiophobia were related to the presence of headache.

CONCLUSIONS

The level of neck pain intensity and disability, kinesiophobia, catastrophizing, and anxiety were all greater in people with acute WAD who presented with a headache compared to those without headache.

Temporomandibular joint trauma and disability assessment - A longitudinal exploratory study

BACKGROUND

Orofacial trauma can encompass, isolated or not, several anatomical regions, namely facial, dental and temporomandibular joint (TMJ), one of the most complex joints in the human body. Evidence-based knowledge in the field of TMJ trauma and in temporomandibular joint disorders (TMD) diagnosis and treatment, provides the necessary data for medico-legal assessment.

OBJECTIVE

The aim of this study is to bring up epidemiological data referring to TMJ injuries and sequelae, in order to present a medico-legal approach of TMJ disability.

METHODS

An observational longitudinal exploratory study was performed in the database of the National Institute of Legal Medicine and Forensic Sciences, Portugal, between 2000 and 2017, regarding inclusion and exclusion criteria.Statistical significance was set as P‹0.05, Fisher's exact test, Binomial test and Goodman and Kruskal's test were used.

RESULTS

Post-traumatic orofacial reports (n = 2622) included 234 TMJ-injury and 149 TMJ-sequelae.Epidemiological data was presented regarding age,gender, professional status and etiology. There was a statistically significant association between TMJ injury and TMJ sequela, despite a weak relation (ƛ = 0.170). No statistically significant association was identified between TMJ-injury/TMJ-sequelae and the professional status, etiology.

CONCLUSION

The TMJ sequela group is smaller than the TMJ-injury, reflecting that 2/3 of the injuries have been cured without a monetary compensation value and without Health costs. The association between TMJ injury and TMJ sequelae reinforces the necessity of preventive measures in TMJ trauma, namely in physical violence context and in medico-legal impairment.

Retrospective analysis of trauma incidence in patients with temporomandibular disorders

BACKGROUND/AIM

The relationships between direct trauma, whiplash injuries, and temporomandibular disorders (TMD) have not been well established. The aim of this study was to evaluate the percentage of direct and/or whiplash trauma in patients with TMDs.

MATERIAL AND METHODS

The clinical records of 237 patients with temporomandibular disorders who had sought treatment at the Orofacial Pain Clinic were reviewed. Clinical data for age and gender of the patients, history of trauma, temporomandibular joint (TMJ) sounds, and TMD diagnosis were extracted from the medical records of all included patients. The presence of TMJ sounds and TMD diagnosis had been determined based on the Research Diagnostic Criteria for TMDs.

RESULTS

The mean age of patients with osteoarthritis was significantly higher than that of patients with disk displacement with reduction (P = .001, P ˂ .05). There was no statistically significant gender-based difference in diagnosis, clicking, crepitus, and trauma frequency (P > .05). A history of direct and whiplash trauma was observed in 18.6% and 14.8% of patients, respectively. Statistical analysis for the relationship between clicking and crepitus, and trauma showed no significant correlation (P > .05).

CONCLUSION

Direct and/or whiplash trauma in patients with temporomandibular disorders were not associated with the diagnostic records and temporomandibular joint sounds.

Self-Perceived Dentists' Knowledge of Temporomandibular Disorders in Krakow: A Pilot Study

Introduction

The most common nondental orofacial pain conditions are temporomandibular disorders (TMDs). TMD basic examination and clinical management are included in a curriculum of each dentistry programme taught in Poland, but it is not clear how the dentists cope with diagnosis and possible treatment in their routine dental practices. The objective of the present study was to assess a level of self-perceived knowledge of TMD amongst dentists in Poland. Materials and methods. The participants, of whom all studied and graduated from a Polish university, were randomly selected from dental offices in Krakow (Poland). The selected dentists were administered an anonymous questionnaire, which contained questions measuring self-assessment of knowledge of TMD diagnosis and therapy and assessing knowledge of ethology and TMD symptoms.

Results

Only 6.5% of the participants identified their TMD knowledge as very good, 32.3% assessed it as good, 39.3% thought it was sufficient, 20.4% as insufficient, and 1.49% considered it as poor. 9.4% of all participants have attempted to diagnose and treat TMD patients very often, 26.4% declared performing it often, 45.8% rarely, and 18.4% had never made such an attempt. There was a significant relationship between the dentists' knowledge and their attempts at diagnosing and treating TMD patients (p < 0.05).

Conclusion

The level of TMD knowledge amongst the Polish dentists is still insufficient. Raising its level would considerably help the dentists to refer their patients to right specialists for a diagnosis and TMD treatment and/or interdisciplinary management of TMD patients.

Differences between palpation and static/dynamic tests to diagnose painful temporomandibular disorders in patients with Lyme disease

OBJECTIVES

The aim was to determine the frequency of Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD)-based pain diagnoses and dynamic/static tests-based pain diagnoses, and to assess the agreement of palpation tests with static/dynamic tests.

MATERIALS AND METHODS

Eighty-six (N = 86) adult patients with Lyme disease (mean age 57.0 ± 14.3 years; male/female ratio was 42/44) were examined according to techniques described in the RDC/TMD. Additionally, dynamic/static tests were performed. For RDC/TMD-based pain diagnoses and dynamic/static tests-based pain diagnoses, descriptive frequencies were calculated. Differences between the frequency of palpation-based diagnoses and of dynamic/static-based diagnoses as well as the agreement between pain diagnoses established with the two diagnostic approaches were assessed.

RESULTS

RDC/TMD-based pain diagnoses were made in 61 patients for myofascial pain and in 11 patients for arthralgia and/or osteoarthritis. Based on dynamic/static tests, mainly myogenous pain was diagnosed in 6 patients, and a mainly arthrogenous pain in 5. The agreement of palpation tests with static/dynamic tests in Lyme disease population was poor.

CONCLUSION

A high prevalence of TMD symptoms was found in patients with Lyme disease. The results suggest that using palpation tests alone could overestimate primary TMDs when comorbid conditions are present.

CLINICAL RELEVANCE

Dynamic/static tests should be used as part of the routine TMD assessment. In case of Lyme disease as the actual cause of the facial pain, while the dentist might be suspecting TMD when dynamic/static TMD tests are negative, referral to an appropriate specialist for the diagnosis and treatment of Lyme disease needs to be made.

Driver head locations: Considerations for head restraint design

OBJECTIVE

U.S. FMVSS 202a requires that a vehicle head restraint lie within a specified distance (55 mm) from the physical headform on the head restraint measurement device (HRMD). Smaller values of this distance, known as backset, are frequently associated with improved protection against neck injury in rear impact. In some vehicles, small backsets are also associated with complaints of head restraint interference with drivers' preferred head positions. The objective of this study is to examine head/head restraint distances using data from a lab study of driving posture to provide guidance for safe and comfortable head restraint design.

METHODS

Head positions were measured for 88 U.S. drivers in a laboratory mockup using a seat from a mid-size sedan. The head restraint was removed to allow measurement of drivers' preferred head locations without interference from the head restraint. Rates of disaccommodation, defined as interference between predicted possible head restraint locations and drivers' preferred head locations, were analyzed at HRMD-referenced backsets of 25, 50, 75, and 100 mm measured at 22° and 25° seat back angles.

RESULTS

With HRMD-referenced backsets of 25 mm and 50 mm measured at 25°, the head restraint intersected the preferred head locations of 17.9 and 5.2% of the drivers, respectively. An HRMD-referenced backset measured at 22° produced larger accommodation rates than the same backset measured at 25°.

CONCLUSIONS

The reported distribution of occupant head positions and the resulting restrictions on comfortable head restraint position at various HRMD-referenced backsets and seat back angles help provide guidance for head restraint design. Knowing the actual mean driver-selected seat back angle for a particular vehicle seat and the model presented in this work, a manufacturer can choose a head restraint location that will have a high likelihood of complying with FMVSS backset requirements while also achieving minimal disaccommodation. The findings in this study support the flexibility in the current FMVSS 202a that permits testing at more upright seat back angles than the 25° originally proposed.