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Pain and Disability in the Jaw and Neck Region following Whiplash Trauma
Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.
Umeå University, Faculty of Medicine, Department of Odontology.
Umeå University, Faculty of Medicine, Department of Odontology.
Umeå University, Faculty of Medicine, Department of Odontology.
2016 (English)In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 95, no 10, p. 1155-1160Article in journal (Refereed) Published
Abstract [en]

The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain.

Place, publisher, year, edition, pages
2016. Vol. 95, no 10, p. 1155-1160
Keywords [en]
myofascial pain, neurophysiology, neuroscience/neurobiology, orofacial pain/TMD, risk factor(s), mporomandibular disorders/TMD
National Category
Dentistry
Identifiers
URN: urn:nbn:se:umu:diva-126320DOI: 10.1177/0022034516653598ISI: 000382310400011PubMedID: 27307051OAI: oai:DiVA.org:umu-126320DiVA, id: diva2:1044157
Available from: 2016-11-02 Created: 2016-10-03 Last updated: 2018-11-08Bibliographically approved
In thesis
1. Pain and disability in the jaw and neck regions after whiplash trauma: a short- and long-term perspective
Open this publication in new window or tab >>Pain and disability in the jaw and neck regions after whiplash trauma: a short- and long-term perspective
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Smärta och dysfunktion i käk- och nackregionerna efter whiplashtrauma : ett kort- och långtidsperspektiv
Abstract [en]

Whiplash trauma, a hyperextension-flexion trauma to the neck that is often related to a car accident, affects tens of thousands in Sweden every year. A significant proportion will develop long-term symptoms including neck pain and dysfunction – this is embraced as Whiplash associated disorders (WAD). Some individuals also develop pain and dysfunction in the orofacial region that is denoted as Temporomandibular disorder (TMD). TMD is common in the population with a prevalence of about 10% but the relation to whiplash trauma is still unclear. The limited number of prospective studies on TMD after whiplash trauma show diverging results, but it has been suggested that TMD develops over time and not in close proximity to the trauma. Prospective studies are needed to determine the course of jaw pain and disability after whiplash trauma.

The general aim of this thesis was to evaluate the presence and course of pain and disability in the jaw and neck regions at the acute and chronic stages after whiplash trauma.

This prospective cohort study included at baseline 176 cases with a recent whiplash trauma, and 116 age and gender matched controls without a history of neck trauma that were recruited from the general population. The cases had visited the emergency department at Umeå university hospital, Sweden, with neck pain within 72 hours following a car accident and had been diagnosed with neck distortion by a physician. The cases were examined within one month after the trauma (December 2010 to January 2016) and at a 2-year followup (December 2012 to January 2018). All participants completed questionnaires regarding pain and disability in the jaw and neck regions, physical symptoms (pain and non-pain items), and depression. At baseline, 80 of the cases and 80 of the controls also completed a 5-minute chewing capacity test. At the 2- year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined with the same questionnaires.

Compared to controls, within one month after a whiplash trauma cases reported significantly more pain in the jaw and neck regions with a positive correlation between the intensity of pain in these regions (Paper I). In the acute stage after trauma, cases, compared to controls, showed a reduced chewing capacity, and this was related to the severity of neck disability (Paper II). For cases, jaw and neck pain correlated positively to each other, to non-specific physical symptoms, and to depression at both the acute (Paper III) and chronic stages (Paper IV). About one third (34%) of the cases reported orofacial pain at baseline, and for a majority of these, the pain persisted at the 2-year follow-up (Paper IV).

The presence of orofacial pain early after a whiplash trauma indicates involvement of central sensitization and spread of pain between the jaw and neck regions. The positive correlations between pain in the jaw and neck regions, and to psychosocial factors, underline the integration of these regions and the importance of a biopsychosocial perspective. The impaired jaw function shortly after a neck trauma further underlines the close sensorimotor relationship between the trigeminal and cervical regions. The finding that orofacial pain is common shortly after whiplash trauma, and often persists into the chronic stage, indicates that assessment in the acute stage should include both the neck and jaw regions. From this, it follows that multidisciplinary teams that entail both medical professions and dentists specialised in orofacial pain can be beneficial in the early assessment after whiplash trauma.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2018. p. 68
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 141
Keywords
Jaw pain, Neck Pain, Neck disability, Orofacial pain, Psychosocial factors, Temporomandibular disorders, TMD, Temporomandibular joint, TMJ, Whiplash injury
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-153181 (URN)978-91-7601-953-5 (ISBN)
Public defence
2018-11-30, Sal B, 9 tr, byggnad 1D, Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-11-09 Created: 2018-11-08 Last updated: 2018-11-09Bibliographically approved

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Häggman-Henrikson, BirgittaLampa, EwaMarklund, SusannaWänman, Anders

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