Motor Vehicle Accidents and TMD
Few published studies have investigated the effect of temporomandibular joint disorders (TMD) and motor vehicle accidents. Since a correlation between the etiology of TMDs and trauma from vehicle accidents is controversial and undetermined, the researchers evaluated 50 files of patients with post-vehicle accident TMD. Evaluating the signs and symptoms, diagnoses, and outcomes, they found evidence explaining the possible effects of the two.
76% of the group identified TMD-related symptoms within one week or less of accident. Symptoms included TMJ or limited jaw opening, headache, neck and back pain. Since almost the entire sample experienced a rear-end or front-end collision, the researchers compared these two predominant groups.
The front-end collision patients reported jaw locking more frequently, and direct injuries to facial and dental areas; but the group required a fewer number of treatment types and experienced less tenderness over time.
Patients in the rear-end collision group were the opposite: they received more treatment types and reported masticatory tenderness during the final examination. Similarly, although the patients involved in severe vehicle accidents experienced more head, facial, and dental injuries, patients involved in minimal damage accidents reported more treatment visits and had higher rates of tenderness than with severe damage.
After assessing the accident and impact factors, the researchers found a slower recovery in those collisions with: minimal vehicle damage, lack of headrest use, poor driver position, and settlement of claim. This last finding is particularly interesting, as litigation is usually believe to prolong symptoms: "...insurance claim settlement at the time of the initial visit did not seem to suggest a better prognosis for patients with post-MVA TMDs..."
While discussing the onset of symptoms, the researchers concluded:
"We find it troubling that TMJ symptoms were identified by the patients themselves (rather than by health care providers) for over 80% of the study patients. Nondental health care workers must heighten their awareness of the possibility of TMD-related problems occurring in the MVA patient..."Kolbinson DA, Epstein JB, Senthilselvan A, Burgess JA. Effect of impact and injury characteristics on post-motor vehicle accident temporomandibular disorders. Oral surgery, Oral Medicine, Oral Pathology 1998; 85(6):665-673.