TMJ Pain and the Cervical Spine
Pain and dysfunction of the temporomandibular joint (TMJ) are common after auto collisions. Some studies show that as many as 25% of whiplash patients may report TMJ pain or symptoms.
The authors of this current study decided to examine if the existence of TMJ dysfunction was also associated with cervical spine disorders. This is not a new theory, as other studies have found a link between the jaw and the neck:
"Aetiological connections between diseases of the temporomandibular system and of the cervical spine have often been discussed in the past. An examination of the anatomy, physiology and biomechanics of the two systems clearly shows their close topographical and functional relationship. For example, it has been shown that the position of the cervical spine influences that of the lower jaw. Conversely, a change in the position of the lower jaw with an increase in the interocclusal distance can lead to craniovertebral extension. Earlier retrospective studies have already indicated that patients with temporo-mandibular disorders (TMD) often show cervical spine disorders."
In this current study, the authors wanted to see if there were signs of cervical spine disorder in TMJ patients. They tested the theory by examining 30 patients with TMJ symptoms who had no subjective neck pain; they compared the TMJ patients with 30 age- and gender-controlled subjects with no TMJ pain.
All study participants were examined for TMJ symptoms and cervical spine symptoms. The examining physician was blinded to the group membership of each patient.
The study found significant differences between the two groups, as the following chart illustrates:
Patient Group Control Group Neck rotation (left and right) 79.8° 86.3° Lateral flexion (left and right) 39.6° 47.5° Neck extension 45.3° 56.8° Number of spinal joints with dysfunction 6.0 3.4 Number of sites with neck and shoulder tenderness 2.6 0.1 The authors found that the TMJ patients had noticeable dysfunction of the cervical spine as compared to the non-TMJ control subjects. The authors put forth a number of reasons for such a relationship:
- Neurological Convergence The nerves that innervate the jaw and the neck both converge in one part of the brainstem. It is possible that the signals from the jaw, for instance, might interfere with the nerves from the cervical spine, causing muscle tension and decreased range of motion. "This neurophysiological and structural convergence could cause development of 'silent' functional disorders of the cervical spine in patients with internal derangement of the TMJ before these patients develop the neck complaints which are typical of CSD."
- Muscular Interactions The muscles of the jaw and the cervical spine are closely interrelated. The muscular reactions of the jaw "may involve the neck muscles because of the kinetic chain of motion between the temporomandibular system and the cervical area. Our findings support this view, showing that there is also significant restriction in the lateroflexion, extension and rotation of the cervical spine in patients with internal derangements of the TMJ but without subjective complaints related to the cervical spine."
Treatment
The authors make the following recommendations regarding treatment of TMJ disorders:
"The present study shows that asymptomatic 'silent' functional disorders of the cervical spine occur more frequently in patients with internal derangement of the TMJ than in the control group. It follows that, when in daily practice the signs and symptoms of internal derangement are present, a specific investigation of the cervical and shoulder girdle area with muscle palpation and passive motion tests should routinely be carried out, to detect asymptomatic cervical disorder. The present results allow the conclusion that 'silent' disorders of the cervical region are particularly to be expected in TMD patients with a myogenic component from the temporomandibular muscles. As functional disorders of the cervical spine may tend to extend the duration of temporomandibular dysfunction, it seems reasonable to treat cervical spine disorders as part of the interdisciplinary collaboration with Physical Medicine."
Stiesch-Scholz M, Fink M, Tschernitschek H. Comorbidity of internal derangement of the temporomandibular joint and silent dysfunction of the cervical spine. Journal of Oral Rehabilitation 2003;30:386-391.
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