In everyday life, carrying the head upright is no small task! The head is completely supported by the neck-which also serves as the head's lifeline to the rest of the body

The uppermost part of the spine pro- vides the skeletal support for the neck. These seven small bones, or vertebrae, are called the cervical spine. Attached to and between the vertebrae are pads of cartilage called discs, which act as cushions or shock absorbers as the spinal bones move. The skull sits on top of the atlas-the uppermost bone of the cervical spine. The atlas is appropriately named after the Greek god who supported the weight of the world on his shoulders.

A “whiplash” injury may occur if the head is forced to move violently away from the body because of a sudden and powerful impact. The neck moves out of its normal range of movement, resulting in overstretched tendons, muscles, and ligaments. Tendons are tissues by which muscles attach to bone. Tendons are flexible, fibrous and tough. Like ligaments, tendons are tough flexible cords. Ligaments go from bone-to-bone while tendons go from muscle-to-bone. Although tendons and ligaments are tough, they are known as soft tissue, because they are usually compared to bone or cartilage.

Jaw Joint Damage from Whiplash

The muscles which control your jaw are also affected. Those muscles which attach the jaw to the front of the neck do not have time to relax. They end up anchoring the jaw by holding it still so that the mouth opens too wide while the head snaps back. This excessive opening of the mouth while the head snaps backward may cause the jaw joints to dislocate. They are often rammed up against the back of the delicate part of the skull bone which encases these joints. As with the spinal column, this may compress and damage the disc which typically cushions each jaw joint from these delicate areas.

Causes

An impact from a sudden force can cause the head and neck to be forced into hyperextended (backward) position as the seat pushes the person's torso forward - and the unrestrained head and neck fall backwards. After a short delay the head and neck then recover and are thrown into a hyper flexed (forward) position. Whiplash injury may also be sustained in various ways, such as from falling off a bicycle or a horse.

More recent studies investigating high-speed cameras and sophisticated crash dummies have determined that after the rear impact, the lower cervical vertebrae (lower bones in the neck) are forced into a position of hyperextension while the upper cervical vertebrae (upper bones in the neck) are in a hyper flexed position. This leads to an abnormal S-shape in the cervical spine after the rear impact that is different from the normal motion. It is thought that this abnormal motion causes damage to the soft tissues that holds the cervical vertebrae together (ligaments, facet capsules, muscles). So when the neck is forced to go beyond their normal range of motion, like a whiplash, muscles and ligaments stretch and tear. The discs that cushion and protect the vertebrae of the neck can also be damaged.

Symptoms

The symptoms may not be felt until hours or months after the injury. 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; however, they can be very painful and quite persistent.

Whiplash injuries can present with a broad variety of symptoms, with the most predominant being:

1. Neck pain: The most common symptom 2. Headaches: The second most common symptom, usually occurring on one side of the head. Beginning at the base of the skull (occiput) and often radiating to the top of the head and frontal regions. 3. Nerve entrapment syndromes. 4. Arm pain: Caused by nerve compression or referred pain from the facet joint or disc. 5. Back and Shoulder pain or stiffness 6. Temporomandibular Joint Disorders symptoms like Facial pain (either direct or referred), Limited mouth opening or locking (opened or closed), Difficulty closing teeth together, Clicking, popping, or pain in jaw joint, Unexplained teeth pain, Difficulty swallowing.

Whiplash injuries may also cause:

1. Balance problems (often related to upper cervical issues). 2. Ear pain, fullness or stuffiness, ringing or even loss of hearing. 3. Tinnitus (ringing, buzzing, whistling, or other noises heard in one or both ears). 4. Dizziness/Balance problems. 5. Pain behind the eyes or unexplained eye disorder. 6. Visual disturbances (sensitivity to light – this can be stress induced, or due to adrenal stress). 7. Unusual fatigue or lack of energy. 8. Weakness. 9. Lower back pain. 10. Poor concentration. 11. Difficulty sleeping. 12. Loss of memory. 13. Psychological changes, such as depression.

Because patients and providers of health care often do not suspect the jaw joints and muscles may be damaged, this aspect is often overlooked. When not recognized and treated, it can become the dominant medical problem. A reason why symptoms may persist is because in many cases of whiplash, the jaw joints and the muscles which support the jaw are damaged as well. The accident may trigger a condition in which these muscles go into spasm and become very painful. Specific clues as to whether this damage occurred include:

• Pain in or around the jaw joints • Clicking or popping of the jaw joints • Locking or limited opening of your mouth • Difficulty with bringing your teeth together

Prevention

• Prevention of accidents: personal responsibility when driving, safe roads, avoiding alcohol before driving. • Headrests which are properly fitted play a major role in preventing or reducing the severity of whiplash injuries. • Laser-initiated braking systems can prevent collisions and intelligent seat design can halve the rate of neck injury if an accident occurs.[2] • Prevention of sports injuries, particularly contact sports. • Prevention of falls in the elderly.

Diagnosis

In most cases, injuries are too soft tissues such as the discs, muscles and ligaments cannot be seen on standard X- rays. Specialized imaging tests, such as CT scans or magnetic resonance imaging (MRI) may be required to diagnose whiplash not only for the neck (cervical spine) but for the Temporomandibular Joints.

Treatment

Treatments for whiplash vary based on the symptoms presented and the severity of the injury. Whiplash injuries are complex, involving much more than just one set of structures.

This type of injury often involves joints, muscles, ligaments, tendons, connective tissue, and a wide array of other neurological structures. Besides the immediate pain and suffering felt from the initial incident, this type of injury can often lead to degenerative osteoarthritis ten or twenty years later.

When a person has suffered a trauma and has pain and dysfunction even though the onset of that is delayed, injury to the temporomandibular joint must become a part of the differential diagnosis. Appropriate work-up should be done before an individual is written off as suffering from "functional overlay." TMJ disorder can be extremely painful and devastating to both victims and their loved ones.

At Torres Dental Group, we can help in proper diagnosis and treatment of patients who have suffered a whiplash incident and have jaw pain. In such patients it is crucial that diagnosis and treatment begin at an early stage to avoid the development of chronic pain and anatomical degenerative consequences.

If you, a friend, or a relative are suffering from the persistent symptoms of whiplash and suspect that your jaw joints and surrounding muscles might have been damaged, contact us. We will conduct a thorough evaluation of the joint area.

If the jaw muscles or joints were damaged, treatment will involve fitting an orthotic device, or “splint”, between your upper and lower teeth. This will limit the movement of the injured joints and properly support the jaw so that pain is reduced and healing can occur. It will also prevent further damage to the TMJ area.

Take the time to understand your health. Your health is your most valuable possession. It's worth the investment!

Dr. María Claudia Torres FAACP, DABDSM

78-11 35th Avenue, Suite 1-E Jackson Heights, NY 11372 (718) 899-3840