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Clinical signs in the jaw and neck region following whiplash trauma: A 2-year follow-up
Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.ORCID-id: 0000-0002-1932-9610
Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.ORCID-id: 0000-0001-6088-3739
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.ORCID-id: 0000-0002-2916-0628
Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.ORCID-id: 0000-0002-8346-5289
Visa övriga samt affilieringar
2023 (Engelska)Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 27, nr 6, s. 699-709Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Pain in the orofacial region is often reported after whiplash trauma. However, prospective studies evaluating clinical signs related to orofacial pain and disability in whiplash populations are rare. The aim of the present study was to evaluate clinical signs related to pain and dysfunction in orofacial and neck regions after whiplash trauma, in a short- and long-term perspective.

Methods: In total, 84 cases (48 women) diagnosed with neck distortion after a car accident and 116 controls (68 women) were examined within 1 month, and 49 cases (27 women) and 71 controls (41 women) were re-examined 2 years later. Outcome measures were pain on palpation of jaw and neck muscles and maximal jaw opening. Analysis was performed using mixed-models.

Results: Cases and women were at higher risk for pain on palpation of jaw muscles (OR:7.7; p < 0.001 and OR:3.2; p = 0.010 respectively) and neck muscles (OR:12.7; p < 0.001 and OR:2.9; p = 0.020 respectively) but with no significant effect of time. Cases and women also had lower maximal jaw opening (−3.1; p = 0.001 and −3.3; p = 0.001 respectively). There was no significant time effect, but a significant interaction between cases and time (2.2; p = 0.004).

Conclusion: Individuals with a whiplash trauma present a higher risk for pain on palpation in jaw and neck muscles both in a short- and long-term perspective, but show normal jaw movements. No time effect suggests that cases do not spontaneously improve nor get worse. Investigating pain on palpation in the jaw and neck muscles after whiplash trauma can identify individuals at risk for developing long-term orofacial pain and dysfunction.

Significance: Orofacial pain is often reported after whiplash trauma but most previous studies concerning orofacial pain in whiplash populations have been questionnaire studies. Cases with a previous whiplash trauma and women, in general, had higher risk for pain on palpation in the jaw and neck region. Investigating pain on palpation after a whiplash trauma can help to identify individuals at risk of developing long-lasting pain in the orofacial region.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2023. Vol. 27, nr 6, s. 699-709
Nationell ämneskategori
Odontologi
Forskningsämne
odontologi
Identifikatorer
URN: urn:nbn:se:umu:diva-205666DOI: 10.1002/ejp.2099ISI: 000945366500001PubMedID: 36806817Scopus ID: 2-s2.0-85150413156OAI: oai:DiVA.org:umu-205666DiVA, id: diva2:1743023
Forskningsfinansiär
Region Västerbotten, RV-909851Region Västerbotten, VLL-324631Tillgänglig från: 2023-03-13 Skapad: 2023-03-13 Senast uppdaterad: 2024-10-25Bibliografiskt granskad
Ingår i avhandling
1. Perspectives on concurrent jaw and neck pain: function, development and perceptions
Öppna denna publikation i ny flik eller fönster >>Perspectives on concurrent jaw and neck pain: function, development and perceptions
2024 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Samtidig käk- och nacksmärta : funktion, utveckling och upplevelser
Abstract [en]

Background: Jaw and neck pain are prevalent and are often concurrent. Despite this, jaw and neck pain are often assessed and managed separately. Jaw pain is mainly treated within dentistry, whereas pain elsewhere in the body is treated within healthcare. Patients with jaw pain have expressed a struggle with finding the right care. Moreover, early identification and treatment are important factors in pain management in terms of the longterm prognosis for the affected individual. This results in suffering over a prolonged time and increased costs for the health care system. The prevalence of jaw pain is twice as high in connection with a whiplash trauma. However, previous studies on the relationship between orofacial pain and whiplash trauma have mainly been cross-sectional. The main purpose of this thesis was to evaluate and explore function, development and perceptions of concurrent jaw and neck pain.

Methods: The thesis is based on four studies, all with different study designs. The studies were conducted at the Department of Odontology, Umeå University, Sweden, in collaboration with Umeå University Hospital, Sweden. In Study I, with an experimental design, the effect of resistance load on jaw and head movements were evaluated among 26 pain-free individuals. Studies II and III were based on a cohort consisting of 292 individuals that entailed 176 whiplash cases and 116 controls at baseline. All individuals answered questionnaires, and 200 of the 292 had a clinical examination at baseline (one month after the trauma). After two years, 223 individuals repeated the questionnaires and 120 of 223 individuals had a second clinical examination. In study II, clinical signs were evaluated, whereas in study III, predictive factors for jaw pain after two years were explored. In study IV, patients' perspectives on the development of concurrent jaw and neck pain in relation to navigating the health care system were explored. Sixteen individuals with concurrent jaw and neck were interviewed using individual semi-structured interviews.

Results: In the experimental study, the ratio between jaw and head movements was increased when resistance load was applied to the lower jaw, which indicates that the neck involvement increased. In the study regarding clinical signs, cases and women presented more pain on palpation at baseline and at the two-year follow-up. In the explorative study, whiplash trauma did not increase the odds for jaw pain over a two-year period. The development and maintenance of further jaw pain after whiplash trauma was not related to the trauma itself but more associated with non-specific physical symptoms or female gender. In the qualitative study, participants expressed that navigating the health care system was perceived as difficult, and they had a holistic approach regarding their pain and mental status.

Conclusions: Within this thesis we have demonstrated that function and pain in the jaw and neck regions are connected. In addition, navigating the health care system was perceived as difficult, and sufferers wanted to receive confirmation from their health care providers. Therefore, dentistry and healthcare should be aware of the connection between jaw and neck pain. Moreover, an increased collaboration is needed between dentistry and healthcare in terms of multidisciplinary management using a biopsychosocial perspective.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2024. s. 71
Serie
Umeå University odontological dissertations, ISSN 0345-7532 ; 151
Nyckelord
cohort studies, facial pain, longitudinal studies, motor acitivity, movement, musculoskeletal pain, neck pain, temporomandibular disorders, qualitative research, whiplash injuries
Nationell ämneskategori
Odontologi
Forskningsämne
medicin; odontologi; odontologi
Identifikatorer
urn:nbn:se:umu:diva-230935 (URN)978-91-8070-441-0 (ISBN)978-91-8070-442-7 (ISBN)
Disputation
2024-11-29, Sal B, Byggnad 1D, Norrlands Universitetssjukhus, Umeå, 09:00 (Engelska)
Opponent
Handledare
Forskningsfinansiär
KempestiftelsernaRegion Västerbotten, RV-909851; RV990480; VLL-324631Umeå universitetPersonskadeförbundet RTP
Anmärkning

Forskningsfinansiärer: Svenska Tandläkare-Sällskapet, Folksam Forskningsstiftelse och SOL, Riksföreningen för Tandläkare inom Forskning, Utbildning och Specialisttandvård.

Tillgänglig från: 2024-11-08 Skapad: 2024-10-25 Senast uppdaterad: 2024-11-11Bibliografiskt granskad

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Böthun, AliciaHäggman-Henrikson, BirgittaStålnacke, Britt-MarieWänman, AndersNordh, ErikLampa, EwaHellström, Fredrik

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Böthun, AliciaHäggman-Henrikson, BirgittaStålnacke, Britt-MarieWänman, AndersNordh, ErikLampa, EwaHellström, Fredrik
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