Change search
ReferencesLink to record
Permanent link

Direct link
15-year natural course of temporomandibular joints in asymptomatic and symptomatic non-patient volunteers: a prospective clinical and MR imaging study
Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
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. Vol. 267, no 1, 183-194 p.
Keyword [en]
Temporomandibular joint, Magnetic resonance imaging, natural course, volunteers
National Category
URN: urn:nbn:se:umu:diva-48153DOI: 10.1148/radiol.12112243OAI: diva2:446854

Originally pulished in thesis in manuscript form.

Available from: 2011-10-10 Created: 2011-10-10 Last updated: 2013-04-25Bibliographically approved
In thesis
1. Temporomandibular joint sequelae after whiplash trauma.: Long-term, prospective, controlled study
Open this publication in new window or tab >>Temporomandibular joint sequelae after whiplash trauma.: Long-term, prospective, controlled study
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.
Umeå University odontological dissertations, ISSN 0345-7532 ; 118
Whiplash trauma, Magnetic resonance imaging, temporomandibular joint
National Category
urn:nbn:se:umu:diva-48155 (URN)978-91-7459-265-8 (ISBN)
Public defence
2011-11-11, sal D, 9 tr, Tandläkarhögskolan, By 1D, Umeå universitet, Umeå, 13:00 (Swedish)
Available from: 2011-10-14 Created: 2011-10-10 Last updated: 2011-10-31Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Salé, HannaBryndahl, FredrikIsberg, Annika
By organisation
Oral and Maxillofacial Radiology
In the same journal

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 157 hits
ReferencesLink to record
Permanent link

Direct link