Posts Tagged ‘referred pain’

Cervical Whiplash and TMJ

Wednesday, February 3rd, 2010

It is a matter of common sense that a direct impact to the lower jaw, temple, or temporomandibular joint can result in injury to the TM joint.  A lesser-known mechanism of injury is the TM joint injury resulting from trauma to structures, which directly or indirectly provide attachment to or are functionally related to jaw biomechanics.  Neck whiplash injuries are a common cause of late onset symptoms of jaw dysfunctions.  Several scientific studies have looked at this specific relationship.  The most recent study by Sale and Isberg, published in the Journal of American Dental Association in 2007, reported the incidence of new TM disorder symptoms was 5 times higher in the whiplash injury group as compared to the control group.  In the whiplash group, 2 out of 3 patients reported onset of symptoms within 12 months and 20% of the whiplash group stated TMD as their major complaint.  Our clients often present with TMD complaints months or years following their whiplash injury without ever having been evaluated for TMD prior to settlement for medical cost of treating the whiplash injury to their neck.  TMD treatment then becomes an out of pocket expense and cost alone may prevent the injured person from receiving effective TMD treatment.

The important points to remember are

1)      Cervical whiplash alone without direct impact to the temporomandibular structures results in the development of significant TMD complaints in 2 out of 3 whiplash injuries

2)      If yourself, a friend or a loved-one suffer a neck whiplash injury from a fall or motor vehicle accident, monitor closely for at least 12 months for the development of possible TMD related symptoms

TMJ and Ear Pain

Wednesday, January 27th, 2010

Patients frequently present with mysterious pain or other symptoms in the head and jaws, which they do not associate with jaw dysfunction (TMJ-TMD).  Recently a woman presented with the primary complaint of ear pain.  Thinking she had an ear infection, she sought care from her primary physician and an ENT (ear, nose, and throat physician).  Both assured her there was no evidence of infection but they did not have an explanation for the pain and gave no recommendation for treatment.  She explained to me that although her jaw joints clicked and popped, she did not experience jaw joint pain or limitation of movement.  She had come to see me on recommendation of a friend and was uncertain how a dentist could help her ear pain.

The explanation of the mysterious ear pain is actually well understood.  The ear pain was what we call “referred pain” resulting from pinching of a branch of the auriculotemporal nerve as it passes thru the temporomandibular joint on its way to the inner ear.  Treatment of the underlying jaw dysfunction resulted in relief of her chronic ear pain.

One of the challenges to effective treatment of chronic head and jaw pain is proper diagnosis of the cause, which is often not immediately apparent.