The Gazette 1993

GAZETTE

Whiplash and its Effects on the Temporo Mandibular Joint

Whiplash can often cause damage to the jaw joints and muscles, which if unrecognised and untreated, can later become a dominant medical problem, writes Dr. Meurig Devonald* "Whiplash" is the common term for neck injury which often occurs when riding in a car which is involved in a road accident. Typically, the passen- ger's head forcibly snaps backward as the body is thrown forward. The head may then snap forward in a recoil motion. This severe backward and forward motion damages the neck muscles and especially the soft tissues (muscles and ligaments) supporting the neck, head, and jaw. It is easy to see why this damage ! happens, when you consider that the head itself weighs up to 15 pounds (the weight of an average bowling ball). When this "bowling ball" snaps backward, it creates 500 to 600 lbs. of ! force on the neck! Women are even more vulnerable to whiplash injuries than men because their neck muscles are smaller in relation to head weight. | Persistent Symptoms of Whiplash Since injuries to soft tissues do not show up on x-rays, it is difficult to see immediately whether or not these injuries have occurred as symptoms may not be felt until hours or days after the accident. Once symptoms do appear, however, they can be very painful and quite persistent. j Whiplash symptoms include: • neck pain, stiffness, and decreased range of motion, ! • headaches, [ • numbness of the head and face, i • blurring of vision and pain behind the i eyes,

J between 87% and 94 % of people who j had suffered a whiplash injury without j direct trauma showed damage and dislocation of jaw tissue associated | with the headaches, spasms and general pain experienced with having ! their heads whipped backwards and then forwards suddenly. The Preventive Dental Research Group ] studied 500 people injured in motor vehicle accidents whose cases had been settled, but were still suffering from I injuries traced back to the accident I itself. This study revealed that the residual ! symptoms were: i These are all typical symptoms of a ' temporo mandibular joint (TMJ) | injury but were undiagnosed at the time. In motor vehicle accidents, particularly in rear end collisions, the suddenness • headaches, • neckaches, • backaches, • earaches, • ringing in the ear, • clicking noise when opening and closing the mouth, • difficulty when swallowing, • hearing loss, • pain in chewing, • pain in the face and jaws, • dizziness.

Dr. Meurig Devonald.

One reason why symptoms may persist is because in many cases of whiplash, the jaw joint and the muscles which support the jaw are damaged as well. The accident may trigger a condition in which these muscles go into spasm and become very painful. Specific clues as to whether this damage occurred include: • pain in or around the jaw joints, • clicking or popping of the jaw joints, • locking or limited opening the mouth, • difficulty with bringing your teeth together. Because both patients and health care providers often do not suspect that the jaw joints and muscles may have been damaged, this aspect often goes unrecognised. When not recognised and untreated it can become the dominant medical problem.

Two recent studies using magnetic resonance imaging have shown that

• problems with balance, j • difficulty swallowing, : • ringing in the ears, •jaw pain.

Figure 1 - Anterior Neck Muscles Anchor the Mandible Resulting in a Dislocation.