The relationship of whiplash injury and temporomandibular disorders: a narrative literature review

Abstract

Objective: The purpose of this article is to offer a narrative review and discuss the possible relationship between temporomandibular disorders (TMDs) and whiplash injuries. Methods: Databases from 1966 to present were searched including PubMed; Manual, Alternative, and Natural Therapy Index System; and Cumulative Index for Nursing and Allied Health Literature. Search terms used included whiplash injury, temporomandibular disorders and craniomandibular disorders. Inclusion criteria consisted of studies on orofacial pain of a musculoskeletal origin addressing the following topics: posttraumatic temporomandibular disorder (pTMD) incidence and prevalence, mechanism of injury, clinical findings and characteristics, prognosis (including psychologic factors). Excluded were studies of orofacial pain from nontraumatic origin, as well as nonmusculoskeletal causes including neurologic, vascular, neoplastic, or infectious disease. Results: Thirty-two studies describing the effects of whiplash on TMD were reviewed based on inclusion/exclusion criteria. The best evidence from prospective studies indicates a low to moderate incidence and prevalence. Only 3 studies addressed mechanism of injury theories. Most studies focusing on clinical findings and characteristics suggest significant differences when comparing pTMD to idiopathic/nontraumatic patients. Regarding prognosis, most studies suggest a significant difference when comparing pTMD to idiopathic/nontraumatic TMD patients, with pTMD having a poorer prognosis. Conclusions: There is conflicting evidence regarding the effects of whiplash on the development of TMD. Furthermore, because of lack of homogeneity in the study populations and lack of standardization of data collection procedures and outcomes measured, this review cannot conclusively resolve the controversies that exist concerning this relationship. This review of the literature is provided to clarify the issues and to provide useful clinical information for health care providers managing TMD such as doctors of chiropractic, physical therapists, dentists, and medical doctors.

Magnetic Resonance Imaging-Based Prediction of the Relationship between Whiplash Injury and Temporomandibular Disorders

“…Unexpected macrotrauma to the jaw can lead to disk displacement ( 3 ). The most common type of indirect macrotrauma is associated with whiplash injury ( 2 , 29 ). Although the literature does report that whiplash injury is associated with TMD symptoms, data regarding the precise nature of this relationship are still lacking.…”

“…Whiplash injury results from an acceleration–deceleration mechanism of energy transfer to the neck predominantly in motor vehicle accidents ( 1 ). Whiplash is associated with a wide variety of clinical manifestations, including neck pain, neck stiffness, problems with psychological distress, and temporomandibular disorders (TMDs) (Figure 1 ) ( 2 , 3 ). Previous reports using magnetic resonance imaging (MRI) have reported that a high percentage of TMD patients have abnormal effusion, disk displacement, and alterations in the thickness of the lateral pterygoid muscle (LPM) ( 4 , 5 ).…”

Sex‐related differences in symptoms of temporomandibular disorders and structural changes in the lateral pterygoid muscle after whiplash injury

“…Such a condition is caused by a rear‐end or side‐impact collision, mainly in motor vehicle accidents . Moreover, it is accompanied by a variety of clinical manifestations, including neck pain and stiffness, headache, psychological distress and temporomandibular disorder (TMD) . Up to 40% of individuals experiencing whiplash injury report persistent pain and chronic disabilities, and the symptoms are more prominent in women than in men .…”

Whiplash is Likely to be Associated with Temporomandibular Disorder Symptoms, but the Magnitude of this Association is not Known

“…Another literature review found ''conflicting'' evidence. 5 The authors reported that methodological problems such as study population heterogeneity, lack of standardization of data collection, and outcome measurement were frequently present in reviewed studies about the whiplash-TMD relationship. Their ''review cannot conclusively resolve the controversies that exist concerning this relationship.''…”