Thank you for publishing a very well-organized August JADA study, "Delayed Temporomandibular Joint Pain and Dysfunction Induced by Whiplash Trauma: A Controlled Prospective Study," by Drs. Hannah Salé and Annika Isberg (
JADA 2007;138[8]:1084–91[Abstract/Free Full Text]
). The study shows that temporomandibular joint (TMJ) symptoms with pathological physical changes in the TMJ can occur following an accident causing whiplash trauma.
The prospective study was important and an improvement over previous research because of the timeliness of the initial examinations following trauma, the use of both trauma and control subjects who represented population groups corresponding to the general population, the reasonable posttrauma time for analysis, and the limitation of the study to TMJ symptoms.
Although the study did not intend to suggest treatment, the results indicate that preventive or therapeutic procedures should start in the emergency department or at a general or pediatric dental office as soon as possible with the use of anti-inflammatory medications and a water-filled splint.
The one important aspect of the study that was not discussed adequately was the use of magnetic resonance imaging (MRI). MRI was done at the inceptive examination, but the data were not analyzed. Also, there was no mention of MRI studies done at the end of the study. It would be interesting to know the anatomical status of the joints initially, and whether any pathologies were maintained, had progressed or were reduced at follow-up.
