In Beit Lowenstein, the rehabilitation process for patients with head injuries was so long and complicated that I never stopped thinking about the Cranio-Mandibular complex. As a physiotherapist, I have always focused on the patient’s functional goals, which change depending on the patient’s functional and cognitive progress. After taking a vestibular rehab course, I was also able to treat patients who complained of dizziness because of the collision they had. Nevertheless, back then, I didn’t know how to treat headaches (Which were part of their complaints above many others) other than mobilising and exercising the upper neck.
Epstein et al in 2011 established the level of the evidence base for general outcomes by taking clinical studies, systematic reviews, and meta-analyses from 1995-2009 that have dealt with the connection between whiplash due to motor collision and Temporomandibular disorder. Epstein states that clearly TMD is documented to follow motor vehicle occlusion. He established that the presence of TMDs is found in a subset of whiplash-associated disorders patients, or as an independent finding in some patients. A TMD diagnosis may or may not be made at the time of the initial examination due to the development of symptoms later on or later recognition of ongoing dysfunction. TMDS, whether independent or associated with whiplash-associated disorders, tends to affect females and is often accompanied by widespread or regional pain, which may be caused by central, systemic, or psychological causes.
As a result of these findings, Epstein concluded that oral health care providers need to consider all the factors involved in using a bio-psycho-social approach when managing patients who experience orofacial signs and symptoms following motor vehicle collisions and require multidisciplinary management.
Today, I know how to identify a TMD patient (according to the new DC/TMD) and to treat his headaches in a different way than before.
Yifat Bassist-Abilitee
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