Syfte Syftet med litteraturöversikten var att beskriva förekomst av whiplashtrauma hos TMD patienter. Metod En systematisk litteratursökning av PubMed, CochraneLibrary och Bandolier databaser genomfördes för artiklar publicerade från 1 januari 1966 till 11 november 2011. Den systematiska sökningen identifierade121 artiklar. Efter borttagning av brev till redaktion och författarinlägg, utfördes en initial screening av abstract på 108 artiklar. Efter den initiala screeningen lästes 32 artiklar i fulltext med tillämpning av inklusions- och exklusionskriterier. Två av författarna utvärderade den metodologiska kvaliteten på de inkluderade studierna. Resultat Sex studier mötte inklusionskriterierna och inkluderades i rapporten. Den rapporterade förekomsten av whiplashtrauma hos TMD populationerna varierade mellan 8,4 % och 70 % (median 35 %). Förekomst av whiplashtrauma hos kontrollgrupperna varierade mellan 1,7 % och 18 %. TMD patienter med historik av whiplashtrauma rapporterade gravare TMD symptom och mer smärta jämfört med TMD patienter utan nackskada.Konklusion Resultaten från denna litteraturöversikt visar en högre förekomst av whiplashtrauma hos TMD patienter vilket tyder på att whiplashtrauma kan vara en riskfaktor för TMD. Stora variationer sågs mellan de olika inkluderade studierna och i samtliga studier fanns också brister gällande diagnoskriterier. Sammantaget så gör dessa begränsningar det svårt att bedöma traumaförekomst hos TMD patienter och i vilken utsträckning whiplashskada kan bidra till utvecklingen av TMD. Fler väldesignade studier som använder tydligt definierade diagnostiska kriterier med hög reliabilitet och validitet som t.ex RDC/TMD behövs för att kunna dra en säkrare slutsats om TMD vid whiplashtrauma. / Aim The aim ofthis systemic literature review was to describe the prevalence of whiplash trauma in TMD populations. Method A systemic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 11 November 2011. This systemic search identified 121 articles. After exclusion of letters to editor and author replies, an initial screening of the abstracts of 108 articles was carried out. After the initial screening 32 articles were read in full text applying the inclusion and exclusion criteria. Two of the authors evaluated the methodological quality of the included studies. Result Six studies matched the inclusion criteria and were included in the review. The reported prevalence of whiplash trauma in the TMD populations varied from 8.4% to 70% (median 35%). The prevalence of whiplash trauma in the control groups varied from1.7% to 18%.TMD patients with a history of whiplash trauma reported more TMD symptom and more pain compared to TMD patient without a neck injury.Conclusion The results from this literature review show a higher prevalence of whiplash trauma in TMD patients which indicate that whiplash trauma could be risk factor for TMD. A large variation could be seen between the included studies and there were also weaknesses with regard to the diagnostic criteria. In summery we suggest that these limitations make it difficult to assess the prevalence of neck trauma in TMD patients and to which extent a whiplash injury can contribute to the development of TMD. More well designed studies using the RDC/TMD criteria and well-defined criteria with high reliability and validity for whiplash trauma are needed in order to make a more reliable conclusion.

Background: Temporomandibular disorder (TMD) is a common and costly problem often leading to chronic pain. There exists moderate evidence for physical therapy (PT) interventions in the management of TMD. A known relationship between TMD and the cervical spine exists with some evidence to support cervical intervention treatments. Cervical spine thrust joint manipulation (TJM) is an effective PT intervention explored in a limited fashion for this population. Objectives: To determine the immediate and short term (1 and 4 week) effects of cervical TJM on pain, dysfunction, and perception of change in individuals with a primary complaint of TMD. Methods: In this single blind randomized clinical trial, individuals with TMD (n=50) were randomly assigned to receive cervical TJM or sham manipulation in 4 PT visits over 4-weeks. All participants also received behavioral education, a home exercise program, and soft tissue mobilization. Primary outcomes included jaw range of motion (ROM), Numeric Pain Rating Scale (NPRS), TMD Disability Index, Jaw Functional Limitation Scale (JFLS), Tampa Scale of Kinesiophobia (TSK-TMD), and Global Rating of Change (GROC). Self-report and objective measurements (with blinded assessor) were taken at baseline, immediately after baseline treatment, 1-week, and 4-weeks. A 2 x 4 mixed model ANOVA was used with treatment group as the between-subjects factor and time as the within-subjects factor. Separate ANOVAs were performed for dependent variables and the hypothesis of interest was the group by time interaction. Results: Statistically significant 2-way interactions were noted in JFLS (p = .026) and TSK-TMD (p = .008), favoring the thrust manipulation group. Both groups showed statistically significant main effects in all measures over time. GROC and PASS favored the thrust manipulation group with statistically significant differences in successful outcomes noted immediately after baseline treatment (NNT = 5) and at 4-weeks (NNT = 4). Conclusion: Both groups received identical multi-modal treatments with the addition of the randomized intervention: cervical TJM or sham manipulation. Differences between groups were small, however, improvements favored the TJM on all measures. Cervical TJM may be beneficial in the treatment of TMD.