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ACCIDENTAL INJURIES.

Previously on this web site, we have been discussing the diagnosis and treatment of patients who are experiencing chronic pain. Unfortunately, some of our patients come to us following motor vehicle accidents or on-the job injuries. These people are usually suffering from acute TMD pain... that is, pain of sudden onset, usually trauma related.

Recent published studies seem to confirm that as many as 80% to 85% of the persons involved in rear-end or side collision auto accidents suffer an injury to the TM Joint mechanism. Then, add to that number the many persons who are injured on-the-job. Unfortunately, often these injuries go unnoticed and untreated for months following the accident. Finally, as the other injury symptoms are eliminated, the headache, facial, neck and ear pain associated with TMD injury becomes more obvious. Too bad... because often that delay complicates the treatment and slows the complete recovery of the patient.

Another very interesting fact has recently been confirmed by at least two published studies. Direct impact of the face and jaw IS NOT necessary to dislocate and injure your jaw in a car wreck. Studies published by Garcia and Arrington and a second one by Pressman both found positive MRI evidence of injury to the TM Joints following a motor vehicle accident in which there was no direct trauma to the face and jaws of the patient. So... if your insurance company is attempting to deny you coverage because you "did not hit your jaw or face", we now have scientific evidence that they should not disallow coverage based on that presumption.

Physicians who initially evaluate injured victims in the office or emergency room should be aware of the strong possibility of injury to the temporomandibular joints and make appropriate referrals for evaluation at the time of initial examination. Attorney's representing injured clients should also be alert to the following list of complaints :

* A "new" popping or grinding sound when the jaw is moved.
* Persistent headaches, neck and shoulder pain.
* Ear pain, ringing in the ears, dizziness and blurred vision.
* Chewing pain or a dramatic change in the "bite"
* Reduced ability to open the mouth.
* Numbness of the hands or fingers.
* Tenderness over the TM Joints.

Remember... many of these symptoms are reported by the patient initially, but they are passed over as the "normal" expected pain associated with the accident. The patient will always confirm that the onset of the symptom is directly related to the time of the injury. At the time of accidental injury, patients are usually placed on medication and told that they should give it some time. But... when these complaints do not resolve as expected, a consultation with a dentist TMD expert should be considered. These injuries could well represent permanent damage, loss of function, altered function, and a permanently altered lifestyle which should be objectively documented for the patient and reported to the appropriate sources.

Fortunately, many of these severe pain symptoms can be controlled with proper management. If the injury report is negative for fractures in the emergency room examination, then surgery is usually only necessary in a small percentage of cases. Most of the pain conditions and lifestyle changes can be managed in a conservative, non-invasive fashion.

In the legal setting, knowledge of Impairment Rating is another important issue. By definition, Permanent Impairment measures the un-resolved symptoms after appropriate treatment has been provided for an appropriate period of time. In this practice, I usually rate Impairment using the two most accepted methods... the rating system of the AMA Guides, fourth edition, and the method developed and published in the Journal of Craniomandibular Practice (CRANIO) by Phillips, et al. Again, by definition, any Impairment Rating must await the outcome of treatment and the comparison of objective testing prior to and following that course of treatment.