Trauma, a physical injury or wound or a psychological shock, will be experienced by 50-70% of the UK’s population at some point in their life.i There can be many sources: traffic accidents, being a victim of a crime or witnessing one, playing sports or an accident in the workplace are just some of the common causes of trauma.
Temporomandibular disorder (TMD) is strongly associated with trauma to the orofacial region. As a musculoskeletal complication that affects the temporomandibular region, TMD leads to discomfort in the masticatory muscles and can ultimately inhibit eating and breathing. Trauma may cause TMD, but the psychological impact of experiencing trauma can cause further damage, making it essential that TMD patients are quickly treated.ii
In cases of blunt force trauma, the mandible is the most frequently fractured facial bone.iii This can cause the temporomandibular joint to break, crack or become unhinged from the skull, effecting quality of life. Assault and road traffic accidents are the most common causes for mandibular trauma, with the latter having been better controlled in recent decades by seatbelts, airbags, drink driving education and better public transport.iii A fist or blunt object is more likely to deliver an angle fracture from a lateral blow to the temporomandibular region compared to a traffic accident, which will instead more frequently impact the front and centre of the mandible, jolting the entire bone.iii
In traffic accidents such as a head-on collision, whiplash can be expected, and this is something to monitor even if patients who have been in a crash emerge with no immediate wound or injury to their jaw. Whiplash trauma can impair mastication as it may disturb the jaw-neck sensory motor function – this has been found to occur within a month of the initial trauma.iv However, whilst accidents and injuries can present physical damage, a multi-disciplinary approach is required because of the psychological impact a facial trauma can have.
Patients with trauma-induced TMD may struggle psychologically, with facial wounds reducing self-confidence and leading to a withdrawal from social interactions, particularly if speech is impacted.ii Depression and post-traumatic stress disorder (PTSD) are noted as the two most prevalent psychological disorders among patients with orofacial pain.v Stressed individuals are at a greater risk of worsening TMD, owing to the association with bruxism and rapid jaw movements.v Indeed, someone with TMD is more likely to have undergone a traumatic life event than someone without TMD, whilst nearly half the patients with chronic TMD have had at least one traumatic experience.v
PTSD develops following the exposure to an extreme traumatic stressor; around 10% of Brits will experience PTSD – over 6.5 million people.i Being assaulted and serious accident/injury are two of the likely experiences to cause PTSD, with a chance of developing it at 31.9% and 16.8% from those two events, respectively.i Assault and a serious accident/injury are also two incidents that may directly cause TMD, creating an overlap that warrants early intervention for patients recently impacted by either.
Individuals with PTSD may be more effected by TMD due to a lower pain threshold caused by neurotransmitter disturbances.v The relationship between PTSD and TMD is bi-directional: orofacial pain is increased in intensity and duration by PTSD and PTSD can induce the bruxism that worsens TMD.v Identifying patients who may have been in a traumatic event is difficult, as it is likely they will find it hard to discuss. But noticing patients with TMD and having appropriate posters or brochures about the impact PTSD and other psychological disorders have on bruxism can foster a supportive environment.
For TMD patients needing an effective rehabilitation system, the OraStretch® Press Jaw Rehab System from Total TMJ is recommended. User-operated, the device opens the mouth to stretch the orofacial tissues and animate the temporomandibular joint, promoting mobility and preventing and treating trismus. With a simple squeeze of the handles, patients can extend their jaw to strengthen the muscles and restore masticatory function. The OraStretch® Press is a simple yet reliable solution that patients can use on their recovery journey to eating, sleeping and living without TMD.
The impact of facial trauma can be both physical and psychological, with both able to increase the damage of TMD. By adopting a multi-disciplinary approach that assesses the two impacts, practitioners will be better able to help treat patients.
For more details about Total TMJ and the products available, please visit https://totaltmj.co.uk/products/orastretch/
i PTSD UK (2023). PTSD Stats – PTSD UK. [online] PTSD UK. Available at: https://www.ptsduk.org/ptsd-stats/.
ii Sahni, V. (2017). Psychological Impact of Facial Trauma. Craniomaxillofacial Trauma & Reconstruction, 11(01), pp.015–020. doi:https://doi.org/10.1055/s-0037-1603464.
iii Goots, A., Isa, M.I., Fenton, T.W. and Wei, F. (2022). Blunt force trauma in the human mandible: An experimental investigation. Forensic Science International: Reports, [online] 5, p.100252. doi:https://doi.org/10.1016/j.fsir.2021.100252.
iv Lampa, E., A. Wänman, E. Nordh and B. Häggman‐Henrikson (2017). Effects on jaw function shortly after whiplash trauma. Journal of Oral Rehabilitation, 44(12), pp.941–947. doi:https://doi.org/10.1111/joor.12571.
v Al-Khudhairy, M.W., Al-Mutairi, A., Al Mazyad, B., Al Yousef, S. and Hatab Alanazi, S. (2022). The Association Between Post-Traumatic Stress Disorder and Temporomandibular Disorders: A Systematic Review. Cureus. doi:https://doi.org/10.7759/cureus.31896.