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Temporomandibular joint sequelae after whiplash trauma.: Long-term, prospective, controlled study
Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Whiplash-related injuries and manifestations, typically neck pain, following car collisions are known to potentially disable individuals with a high and increasing cost to society. There is limited knowledge regarding the temporomandibular joint (TMJ) sequelae following whiplash trauma. Previous studies are typically based on retrospective data and few follow-ups are prospective and controlled in design. Furthermore, previous follow-ups have not included magnetic resonance (MR) imaging, which is a prerequisite for verification of TMJ status.

The aims of this prospective long-term study were (i) to determine frequency of inaccurate recall of TMJ symptoms in patients with a history of whiplash trauma, and (ii) to evaluate incidence, prevalence and progression of TMJ pathology, verified with MR imaging, and TMJ symptoms in patients after whiplash trauma, compared with the natural course in matched volunteers.

We studied 60 consecutive patients who had neck symptoms following a rear-end car collision and were seen at a hospital emergency department. Bilateral TMJ MR imaging and clinical examination were performed at inception and at follow-up on average 15 years later. A self-administered questionnaire regarding TMJ symptoms (pain, dysfunction, or both) and a subsequent interview were performed at inception, at the one-year, and 15-year follow-up. Fifty-seven patients (95%) participated in all three examinations (85% for MR imaging examinations). Concurrently, 53 volunteers matched by age and sex followed the same protocol. Fifty volunteers (94%) participated in all three examinations (89% for MR imaging examinations). Ethics approval of the study protocol and informed consent from all participants was obtained.

The calculated agreement between each patient’s inceptive and retrospective reports on TMJ symptoms yielded a kappa value of 0.41 (95% CI 0.18-0.64). Sixteen patients (40%) had inaccurate recall one year after whiplash trauma. There was no statistically significant difference in TMJ symptoms reported by the patients to be present before whiplash trauma compared with matched volunteers at inception. Prevalence of TMJ symptoms increased significantly with whiplash trauma and the increase remained stable throughout the 15-year study period, which contrasted to the natural course in volunteers. After one year the difference in prevalence between patients and volunteers was 54% versus 21% (p=0.0003) and after 15 years 49% versus 18% (p=0.0017). There was no statistically significant difference between patients and volunteers in prevalence of TMJ disc displacement either at inception (63% versus 53%) or at 15-year follow-up (63% versus 55%). TMJ disc displacement was significantly more prevalent in symptomatic volunteers compared with asymptomatic volunteers (89% versus 31%, p=0.0002). Incidence or progression of MR imaging verified TMJ pathology did not differ between patients and volunteers.

This prospective 15-year follow-up concludes

- that future studies on TMJ sequelae following whiplash trauma should be prospective in study design with examinations conducted in close proximity to whiplash trauma. This allows for reliable baseline status and potential bias of inaccurate recall of symptoms is minimized.

- that future controlled studies on TMJ pathology in patients should include control groups of not only asymptomatic but also symptomatic volunteers in order to avoid potentially biased conclusions.

- that one of three patients exposed to whiplash trauma can be expected to develop TMJ symptoms beyond that which corresponds to the natural course in volunteers. This finding and previously reported impairment of jaw function in patients with symptoms after whiplash trauma points to the need for including TMJs and related muscles in routine medical examinations of patients with symptoms following whiplash trauma.

- that adult individuals presenting with no or mild TMJ symptoms seldom show development or aggravation of TMJ pathology and there is no or little indication for TMJ treatment of these adult individuals. This is in contrast to the higher progression of TMJ pathology previously reported for adult patients with TMJ symptoms, which requires treatment.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2011. , 54 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 118
Keyword [en]
Whiplash trauma, Magnetic resonance imaging, temporomandibular joint
National Category
Dentistry
Identifiers
URN: urn:nbn:se:umu:diva-48155ISBN: 978-91-7459-265-8 (print)OAI: oai:DiVA.org:umu-48155DiVA: diva2:446868
Public defence
2011-11-11, sal D, 9 tr, Tandläkarhögskolan, By 1D, Umeå universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-10-14 Created: 2011-10-10 Last updated: 2011-10-31Bibliographically approved
List of papers
1. Accuracy of patients' recall of temporomandibular joint pain and dysfunction after experiencing whiplash trauma: a prospective study
Open this publication in new window or tab >>Accuracy of patients' recall of temporomandibular joint pain and dysfunction after experiencing whiplash trauma: a prospective study
2010 (English)In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 141, no 7, 879-886 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Researchers have conducted studies regarding whiplash-induced temporomandibular joint (TMJ) pain and dysfunction mainly under the presumption that patients' memory of symptoms remains accurate across time. In this prospective study, the authors aimed to determine the frequency of patients' inaccurate retrospective reports of TMJ pain and dysfunction after whiplash trauma.

METHODS: The authors assessed TMJ pain and dysfunction in 60 patients consecutively seen in a hospital emergency department directly after the patients experienced whiplash trauma in rear-end automobile accidents. They followed up with 59 patients one year later. The participants completed a self-administered questionnaire followed by a comprehensive interview during both examinations. The study group consisted of the 40 patients who reported previous or current TMJ pain, dysfunction or both at either examination or at both examinations.

RESULTS: The agreement between each patient's inceptive and retrospective reports of TMJ pain and dysfunction yielded a kappa value of 0.41 (95 percent confidence interval [CI] 0.18-0.64). Sixteen patients (40 percent, 95 percent CI 25-57 percent) had inaccurate recall. Recollection errors were addition, omission, and forward and backward telescoping. Seven patients incorrectly referred symptom onset to the accident.

CONCLUSIONS: The high frequency of inaccurate recall of TMJ pain and dysfunction one year after whiplash trauma implies that clinicians and researchers should interpret with caution the results of previous studies that relied on retrospective data regarding whiplash-induced TMJ pain and dysfunction.

CLINICAL IMPLICATIONS: To achieve valid long-term evaluations in clinical research, the patient's TMJ status should be established at the time of an accident.

Place, publisher, year, edition, pages
American dental association, 2010
Keyword
temporomandibular joint, memory, whiplash injuries, prospective studies
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-35193 (URN)10.14219/jada.archive.2010.0287 (DOI)000279842600019 ()20592409 (PubMedID)
Available from: 2010-08-09 Created: 2010-08-09 Last updated: 2017-12-12Bibliographically approved
2. Delayed temporomandibular joint pain and dysfunction induced by whiplash trauma: a controlled prospective study
Open this publication in new window or tab >>Delayed temporomandibular joint pain and dysfunction induced by whiplash trauma: a controlled prospective study
2007 (English)In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 138, no 8, 1084-1091 p.Article in journal (Refereed) Published
Abstract [en]

Background. The Quebec Task Force on Whiplash-Associated Disorders urged for controlled, prognostic studies of symptoms after whiplash trauma. The authors conducted a study that met the design requirements to enhance knowledge about short-term and long-term temporomandibular joint (TMJ) pain, dysfunction or both induced by whiplash trauma.

Methods. The authors studied 60 consecutive patients who had neck symptoms after whiplash trauma and were seen at a hospital emergency department. They followed up 59 subjects one full year later. At the inceptive examination and at follow-up, each subject completed a self-administered questionnaire, followed by a comprehensive interview. Fifty-three frequency-matched control subjects followed the same protocol concurrently.

Results. The incidence of new symptoms of TMJ pain, dysfunction or both between the inceptive examination and follow-up was five times higher in subjects (34 percent) than in control subjects (7 percent). The frequency of TMJ pain increased significantly in female subjects, as did the frequency of TMJ symptoms that were reported to be the main complaint. At the follow-up, 20 percent of all subjects reported that TMJ symptoms were their main complaint.

Conclusions. Our results suggest that one in three people who are exposed to whiplash trauma is at risk of developing delayed TMJ symptoms that may require clinical management.

Clinical Implications. Awareness of a significant risk for delayed onset of TMJ symptoms after whiplash trauma is crucial for making adequate diagnoses, prognoses and medicolegal decisions.

Place, publisher, year, edition, pages
Chicago: American dental association, 2007
Keyword
Prospective, temporomandibular joint, whiplash trauma, asymptomatic, pain, dysfunction
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-17845 (URN)000248775900013 ()
Available from: 2007-11-21 Created: 2007-11-21 Last updated: 2017-12-14Bibliographically approved
3. 15-year natural course of temporomandibular joints in asymptomatic and symptomatic non-patient volunteers: a prospective clinical and MR imaging study
Open this publication in new window or tab >>15-year natural course of temporomandibular joints in asymptomatic and symptomatic non-patient volunteers: a prospective clinical and MR imaging study
2013 (English)In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 267, no 1, 183-194 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To determine the incidence, prevalence, and progression of temporomandibular joint (TMJ) magnetic resonance (MR) imaging findings and symptoms during 15 years in adult asymptomatic and symptomatic volunteers (nonpatients).

Materials and Methods: A regional committee for medical research ethics approved the study, and informed volunteer consent was obtained. Fifty-three volunteers were examined at study inception. For clinical assessment, a self-administered questionnaire was given, followed by an interview with each volunteer at study inception, at 1 year later, and at 15 years later. Bilateral TMJ MR imaging and clinical examination were performed at inception and at 15-year follow-up. The MR images were assessed for disk position, bone status, and joint fluid. All 53 volunteers participated at 1-year follow-up, and 50 of 53 volunteers participated at 15-year follow-up; of these 50 volunteers, 47 underwent MR imaging. The Fisher exact test was used to determine differences between groups, and the Wilcoxon signed-rank test was used to determine differences in prevalence of TMJ symptoms among the three examination times.

Results: At study inception, TMJ disk displacement was observed in 31% of asymptomatic volunteers (nine of 29) compared with 89% of symptomatic volunteers (16 of 18, P < .001). Inceptive TMJ status was maintained after 15 years in 91% (43 of 47). Unilateral progression was observed in four volunteers (9%); one was symptomatic and three were asymptomatic. Progression involved development of new disk displacement (n = 1), development of new bone changes (n = 2), and aggravation from reducing to non-reducing disk displacement (n = 1). Prevalence of TMJ symptoms did not change significantly between examination times (P = .77). TMJ clicking was the most common clinical symptom.

Conclusion: Volunteers with mild symptoms had a prevalence of disk displacement of the same magnitude as that reported in patients, although most volunteers, symptomatic as well as asymptomatic, maintained their TMJ status during 15 years.

Place, publisher, year, edition, pages
Radiological Society of North America, 2013
Keyword
Temporomandibular joint, Magnetic resonance imaging, natural course, volunteers
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-48153 (URN)10.1148/radiol.12112243 (DOI)
Note

Originally pulished in thesis in manuscript form.

Available from: 2011-10-10 Created: 2011-10-10 Last updated: 2017-12-08Bibliographically approved
4. A 15-year follow-up of temporomandibular joint symptoms and magnetic resonance imaging findings in whiplash patients: a prospective, controlled study
Open this publication in new window or tab >>A 15-year follow-up of temporomandibular joint symptoms and magnetic resonance imaging findings in whiplash patients: a prospective, controlled study
2014 (English)In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, Vol. 117, no 4, 522-532 p.Article in journal (Other academic) Published
Keyword
Whiplash trauma, Temporomandibular joint, Magnetic resonance imaging, follow-up, controlled, prospective
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-48154 (URN)10.1016/j.oooo.2014.01.020 (DOI)000333410000023 ()
Note

Originally published in thesis in manuscript form.

Available from: 2011-10-10 Created: 2011-10-10 Last updated: 2014-05-15Bibliographically approved

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