TMJ, Whiplash and Lithuania

Over the last few years, a number of studies have been published by a group of researchers from Norway that have tried to refute the existence of whiplash injuries. The most recent article from this group is focused on the issue of TMJ pain after whiplash.¹

The vast majority of medical literature on the topic of TMJ pain and trauma show that a significant percentage—10 to 15%, depending on the study—of whiplash patients report some kind of jaw pain after their accident.

This recent article questioned 165 individuals who had been involved in an accident in regard to TMJ symptoms an average of 27 months after the collision.
The authors reported that only 2.4% of the accident victims reported TMJ symptoms, while 3.3% of accident-free controls did. They conclude that there is no relationship between TMJ pain and rear end collisions, and that the TMJ issue reported in other studies is "a function of cultural and medical fashions." The authors discuss further how they imagine TMJ pain is really caused:

"...headache, jaw clicking, dizziness, and auditory complaints are common in the general population in many Western societies. Presumably, even if the victim had not been in an accident, he or she would carry some risk of developing such symptoms, inasmuch as they are quite prevalent in the general population. As an accident victim, and especially as a claimant, the whiplash patient is in circumstances in which excessive and detailed symptom recording is compelled. Previously unintrusive symptoms (largely ignored in daily life) become far more intrusive after an accident, and the presumably physical (biologic) sources of the symptoms, which are not due to accident injury, may act as a substrate for the effects of psychosocial factors in the generation of an apparent TMD after whiplash. Also to be added are the effects that anxiety, anger, resentment, and battling with one's insurance company have on symptom reporting. Finally, the possibility cannot be ignored that to the extent that TMD symptoms after whiplash are widely publicized, insurance fraud also increasingly plays a role."

(The authors do not provide any citations for the statement that TMD symptoms are "widely publicized" and we are not aware of any such publicity. In fact, most whiplash patients first see a medical doctor for care after a whiplash, and it is seems somewhat unlikely that MDs are planting the suggestion of TMJ pain in the minds of whiplash patients.)
There are a number of problems with this study.

1. First, and foremost, the entire study methodology is the same used in the other studies by the same authors, and is severely flawed, as elucidated by Freeman et al² and others. The individuals studied in this article were not "whiplash victims," as suggested by the authors, but persons involved in automobile collisions. To truly study the relationship between TMJ symptoms and whiplash, one would need to study those individuals who actually suffered a whiplash injury.
2. Second, most of the individuals (84%) studied were men. The medical literature consistently reports that women are more likely to suffer whiplash injuries and are more likely to suffer from TMJ pain. To obtain meaningful statistics, many more women would need to be studied.
3. The study completely disregards the current engineering literature showing objective evidence of abnormal spinal mechanics in low speed rear end collisions that may result in spinal and jaw pain. In fact, the authors discount the possibility that there are any physical injuries at all.

There is no doubt that the issue of TMJ pain and whiplash is a difficult and controversial problem. Unfortunately, studies such as these serve only to confuse the issue. Hopefully, further research will help clarify this issue and help develop techniques to prevent these types of injuries.

1. Ferrari R, Schrader H, Obelieniene D, et al. Prevalence of temporomandibular disorders associated with whiplash injury in Lithuania. Oral Surgery, Oral Medicine, Oral Pathology 1999;87:653-657.
2. Freeman MD, Croft AC, Rossignol AM, et al. A review and methodologic critique of the literature refuting whiplash syndrome. Spine 1999;24(1):86-98.