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It appears to be a very little known fact that people who have sustained whiplash injuries are dramatically more likely than not to have also sustained a TMJ injury, which is nearly always overlooked by the medical profession. This is quite understandable, because naturally the physician will be most concerned with neck trauma, cranial injury and stability of the airway in the case of an individual hospitalized as a result of a car wreck. In one of the very few (if only) known studies on the subjects done by Dr. Barry Pressman of Cedars-Sinai Hospital (excerpt below)*, it was determined that of the patients admitted with whiplash injuries (vehicles or otherwise) imaging revealed that fully 66% of the TMJ's showed signs of acute injury.

Dr. Nichols' experience with whiplash patients is that none has professed to being evaluated for a TMJ injury after a whiplash, let alone had joint-specific MRI's taken. Chances are that there is a large population with undiagnosed, untreated, and subsequently degenerating TMJ injuries who are experiencing unnecessary pain.

There are three types of whiplash injury scenarios:

  • Flexion-extension whiplash, typically experienced in a head-on collision
  • Extension-flexion whiplash (most likely to cause injury to the TMJ) in the case of rear-end collision while sitting still or driving slowly
  • Asymmetric whiplash, typically occurring when the patient was either "t-boned" in an accident or had their head turned sideways at the moment of impact.

There is a particular type of injury to the TMJ, namely a stretch injury to diskal ligaments and retro-diskal attachment as a result of impact that is most common to see in these scenarios. The exact mechanics of the accident are important to understand in each individual's case to better understand the likelihood of injury, and the type of injury likely to have been sustained.

If you have ever had a whiplash injury, recall as best you can if:

  • Your bite changed at all immediately after the accident, especially if some or all of your back teeth didn't connect when you closed your mouth all the way; or
  • You experienced any joint specific pain in the TMJ (achiness, tenderness, or sharp radiating pain).

You've probably sustained injury to your TMJ if you experienced these symptoms. Dr. Nichols would be very likely to prescribe an MRI to get accurate images of the exact condition of the joints. Even in the absence of pain or symptoms, a history of traumatic injury to the TMJ is a fairly mandatory indication for MRI of the joint. The reason for this is simple. In human physiology, all pathologies (disease processes) tend to exist for an extended period of time before they reach the threshold of actually causing pain. Trauma has the added complication of pain being masked by another injury to another independent structure (i.e. a neck injury severe enough to make a TMJ injury imperceptible at the time).

Combining these two facts of disease and trauma, pain does not become a basis upon which Dr. Nichols could make a decision about whether to image the joint or not. Rather, it is the presence of evidence indicating joint injury upon which that decision is made.

As a rule in any endeavor, it is always best to know all the facts before making a decision. Especially considering the likelihood (66%) of TMJ injury subsequent to whiplash, we always want to know the whole story before assessing a judgment on the condition of the joint. That's why MRI's are so important. They tell us the exact condition of the joint right now, with no need to guess what's going on. Accurate diagnosis equals better treatment!



* Article: MR Imaging Of Temporomandibular Joint Abnormalities Associated With Cervical Hyper extension/hyper flexion (whiplash) Injuries.
Date: October 1992
Journal: Journal Of Magnetic Resonance Imaging: JMRI
Patients often have temporomandibular joint (TMJ) dysfunction-related symptoms after cervical hyper extension/hyper flexion injuries (whiplash) caused by rear-end motor-vehicle collisions. To determine abnormalities of the TMJ associated with these injuries, 33 consecutive symptomatic patients (66 joints) with no direct trauma to the jaw, mouth, head, or face due to the accident and no prior history of TMJ dysfunction underwent magnetic resonance (MR) imaging, and the images were retrospectively analyzed. Overall, 29 (88%) patients had some type of TMJ abnormality related to whiplash injury. Displacement of the disk was seen in 37 (56%) of the TMJ's as follows: 21 (32%) had anterior displacement with reduction, nine (14%) had anterior displacement without reduction, six (9%) had lateral or medial displacement, and one (2%) had posterior displacement.

If you sustained an TMJ injury and are seeking relief, please contact Apexx Dental Care – serving Littleton, Colorado for an appointment.

"... considering the likelihood (66%) of TMJ injury subsequent to whiplash, we always want to know the whole story before assessing a judgment on the condition of the joint."
Dr. Richard Nichols

The following illustration shows how the neck is injured in cases of flexion-extension and extension-flexion injuries.

Diagrams courtesy of
Dr. Mark Piper, MD, DMD
© Piper I: Comprehensive
TMJ Science.