Dentistry’s Role in Whiplash Injuries and car accident cases

UNDERSTANDING TMJ and Craniofacial Pain Dysfunction

The mandible or jaw is articulated to the skull by two joints on both sides of the head, in front of the ears. These joints are called the Temporomandibular joints (TMJ) and have a small disk (or cartilage) which sits in between  each joint like a shock absorber that allows for smooth movement of the jaw. TM joints are the most used joints in the entire body and has the uniqueness of being the  only joint in the body that is bilateral; the rest of the joints do not involve one bone for the left and right side of the body like the mandible does.

Jaw movements are controlled by a complex balance of many muscles, bones and nerves. They allow the mouth to open and close when talking, chewing, breathing, singing, shouting and yawning. It’s easy to see why the role of joints, muscles and teeth are so important.

Trauma may be the result of an automobile accident,  occupational injury or physical assault. Such accidents may trigger a condition in which the muscles spasm and become very painful. The discs which cushion and protect the neck, vertebrae and TM joints may also be damaged or displaced causing inflammation that can lead to acute and chronic pain and dysfunction.

HOW THE INJURY OCCURS          
Whiplash, the most common trauma, occurs when the muscles which attach to the front of the neck and chest do not have time to relax. Consequently, these muscles anchor the jaw by holding it still,  but not the head so that the mouth opens too wide while the head snaps back. The TMJ joints dislocate when they are pulled out of the socket and forcefully pushed against the back of the socket when the head whips forward.

Since the head and neck are forced to move beyond their normal range of motion, the muscles, ligaments and discs are damaged with an injury. The key thing to note is that most of the time there is a TMJ injury when there has been a Whiplash injury but symptoms may not be felt until hours or months after the injury and in some cases years after the accident.

SYMPTOMS

Since soft tissue (discs, ligaments, and muscles) damage does not show up well on screening x-rays, it is difficult to immediately see structural damage. Common medical observation does not provide a conclusive diagnosis. Many times the patients nor the health care providers suspect damage to the jaw joints, muscles and ligaments. When this condition is not recognized and properly treated it can become the dominant medical problem causing various disabilities and legal issues. When this type of injury occurs, the symptoms can include some of the following:

• Headaches
• Face or jaw pain
• Ear pain, sounds or stuffiness, ringing
• Pain behind the eyes
• Dizziness/Balance problems
• Limited mouth opening or locking
• Difficulty closing teeth together
• Unexplained teeth pain
• Clicking, popping, or pain in jaw joint
• Difficulty swallowing, chewing or speaking
• Unusual fatigue or lack of energy
• Neck, shoulder, back pain or stiffness
• Burning sensation of neck, shoulders, face Headaches-usually in temples and back of head and neck

Dr. Betancur has special TMJ training, Qualifications and over 20 years of experience treating TMJ and Craniofacial pain Dysfunction.  Dr. Betancur's involvement can be highly important in early settlement of many cases.

COMPENSATION

Insurance coverage has often been denied for patients suffering from TMD problems. This is due to the lack of understanding and accepting that these problems exist. More states are continuing to gain passage of legislation which grants that medical coverage is the same as that for treatment to any other joint in the body and shall apply if the treatment is administered or prescribed by a physician or dentist. Too often patients are forced to have surgery as the only recourse simply because it is covered by medical insurance. Conservative treatment (non-surgical) such as an orthopedic appliance, counseling, and/or physical therapy is rarely covered by traditional health insurance.

This places a tremendous financial burden on the patient, which can force sufferers into litigation to obtain proper compensation. Unfortunately, more than 60% of whiplash victims never fully recover – this could be due to unrecognized damage to the jaw joints and muscles, allowing the problem to become chronic. It is important to note that when the condition is properly diagnosed and treated early, the majority of patients experience resolution of symptoms. However, some long term damage to the craniomandibular structures are common after an accident

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