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Perspectives on concurrent jaw and neck pain: function, development and perceptions
Umeå University, Faculty of Medicine, Department of Odontology.ORCID iD: 0000-0002-1932-9610
2024 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Samtidig käk- och nacksmärta : funktion, utveckling och upplevelser (Swedish)
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.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. , p. 71
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 151
Keywords [en]
cohort studies, facial pain, longitudinal studies, motor acitivity, movement, musculoskeletal pain, neck pain, temporomandibular disorders, qualitative research, whiplash injuries
National Category
Dentistry
Research subject
Medicine; Odontology; Odontology
Identifiers
URN: urn:nbn:se:umu:diva-230935ISBN: 978-91-8070-441-0 (print)ISBN: 978-91-8070-442-7 (electronic)OAI: oai:DiVA.org:umu-230935DiVA, id: diva2:1908209
Public defence
2024-11-29, Sal B, Byggnad 1D, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
The Kempe FoundationsRegion Västerbotten, RV-909851; RV990480; VLL-324631Umeå UniversityPersonskadeförbundet RTP
Note

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

Available from: 2024-11-08 Created: 2024-10-25 Last updated: 2024-11-11Bibliographically approved
List of papers
1. Jaw–neck motor strategy during jaw‐opening with resistance load
Open this publication in new window or tab >>Jaw–neck motor strategy during jaw‐opening with resistance load
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2022 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 49, no 5, p. 514-521Article in journal (Refereed) Published
Abstract [en]

Background:  The jaw and neck motor systems have a close functional integration but the effect of resistance load to the mandible during jaw opening on the jaw-neck integration is not known.

Objectives:  To evaluate the effect of resistance load compared to no load on integrated jaw and neck motor function in individuals free from pain and dysfunction in the jaw and neck regions.

Methods:  Jaw and head movements during continuous jaw opening were recorded with an optoelectronic system (MacReflex® ) in 26 pain-free individuals (14 women, 12 men, mean age 22 years). Jaw opening was performed with and without resistance load (1600 g) to the mandible. The relationship between jaw movement amplitude, head movement amplitude, head/jaw ratio (quotient of head and jaw movement amplitude) and resistance load were modelled using linear mixed-model analysis. A p-value <.05 was considered statistically significant.

Results:  The expected head/jaw ratio mean was increased by 0.05 (95% CI: 0.03, 0.08, p < .001) with resistance load as compared to no load. This corresponds to an increase in expected mean by 55.6%. With resistance load, expected mean head movement amplitude increased by 1.4 mm (95% CI: 0.2, 2.5, p = .018), and expected mean jaw movement amplitude decreased by 3.7 mm (95% CI: -7.0, -0.5, p = .025).

Conclusion:  There is a compensation and adaptation of integrated jaw-neck motor function with an altered jaw-neck motor strategy during jaw opening with resistance load compared to no load. The head/jaw ratio demonstrates increased proportional involvement of the neck during increased load on the jaw system.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
exercise, jaw, motor activity, motor skills, movement, neck
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-190626 (URN)10.1111/joor.13291 (DOI)000731492000001 ()34878690 (PubMedID)2-s2.0-85121471921 (Scopus ID)
Funder
Region Västerbotten, 7003768
Available from: 2021-12-20 Created: 2021-12-20 Last updated: 2024-10-25Bibliographically approved
2. Clinical signs in the jaw and neck region following whiplash trauma: A 2-year follow-up
Open this publication in new window or tab >>Clinical signs in the jaw and neck region following whiplash trauma: A 2-year follow-up
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2023 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 27, no 6, p. 699-709Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-205666 (URN)10.1002/ejp.2099 (DOI)000945366500001 ()36806817 (PubMedID)2-s2.0-85150413156 (Scopus ID)
Funder
Region Västerbotten, RV-909851Region Västerbotten, VLL-324631
Available from: 2023-03-13 Created: 2023-03-13 Last updated: 2024-10-25Bibliographically approved
3. Whiplash trauma did not predict jaw pain after 2 years: an explorative study
Open this publication in new window or tab >>Whiplash trauma did not predict jaw pain after 2 years: an explorative study
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2024 (English)In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 28, article id 165Article in journal (Refereed) Published
Abstract [en]

Objectives: To explore predictive factors for the development and maintenance of jaw pain over a 2-year period.

Methods: One hundred nineteen cases (73 women) and 104 controls (59 women), mean age 34.9 years (SD 13.9), attended baseline and 2-year follow-up examinations. The whiplash cases visited the emergency department at Umeå University Hospital, Sweden, with neck pain within 72 h following a car accident, and baseline questionnaires were answered within a month after trauma. Controls were recruited via advertising. Inclusion criteria were age 18–70 years, living in Umeå municipality and Swedish speaking. The exclusion criterion was neck fracture for cases and a previous neck trauma for controls. Validated questionnaires recommended in the standardized Research Diagnostic Criteria for temporomandibular disorders were used. Jaw pain was assessed by two validated screening questions answered with “yes” or “no.” A logistic regression analysis was used to predict the outcome variable jaw pain (yes/no) after 2 years.

Results: Whiplash trauma did not increase the odds of development of jaw pain over a 2-year period (OR 1.97, 95% CI 0.53–7.38). However, non-specific physical symptoms (OR 8.56, 95% CI 1.08–67.67) and female gender (OR 4.89, 95% CI 1.09–22.02) did increase the odds for jaw pain after 2 years.

Conclusion: The development and maintenance of jaw pain after whiplash trauma are primarily not related to the trauma itself, but more associated with physical symptoms.

Clinical relevance: The development of jaw pain in connection with a whiplash trauma needs to be seen in a biopsychosocial perspective, and early assessment is recommended.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
Temporomandibular disorders, Whiplash injuries, Facial pain, Jaw pain, Neck pain
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-221419 (URN)10.1007/s00784-024-05555-z (DOI)38383824 (PubMedID)2-s2.0-85185695499 (Scopus ID)
Funder
Region Västerbotten, RV-909851Region Västerbotten, VLL-324631
Available from: 2024-02-22 Created: 2024-02-22 Last updated: 2024-10-25Bibliographically approved
4. Sense-making and symptom location guides in challenging healthcare navigation
Open this publication in new window or tab >>Sense-making and symptom location guides in challenging healthcare navigation
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(English)Manuscript (preprint) (Other academic)
National Category
Dentistry
Research subject
Odontology; Medicine
Identifiers
urn:nbn:se:umu:diva-230933 (URN)
Available from: 2024-10-25 Created: 2024-10-25 Last updated: 2024-11-01

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