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Shaw Chiropractic Lithuania III: The Saga Continues Temporomanibular Joint (TMJ) disorders have been an area of controversy for many years within the dental industry. This has resulted in even greater controversy in the medical legal community with regard to it’s causal relationship in motor vehicle collisions. A recent paper published in the June 1999 issue of the Journal of Oral Surgery, Oral Medicine and Oral Pathology completes the "Lithuania" trilogy. For those of you who have missed my previous newsletters on the "Lithuania" studies let me recap. The first two studies from these same researchers have gained momentum in the defense community from their conclusions which are generally negative regarding the potential for injury in motor vehicle accidents. The previous studies have been highly controversial in the medical community and have been dissected by the scientific community for flaws in research design, subject selection and data analysis. In analyzing the recent study I have identified some interesting areas which both plaintiff and defense attorneys should be familiar. I have listed them below: 1. The present study has been performed by the same researchers based upon the same sample population. In other words, all the identified flaws in subject selection from their prior papers have been carried over into this paper. 2. Interestingly, the authors chose to eliminate those accident victims who had sustained blunt trauma to the jaw, face or head. I would suspect that if those victims who had direct trauma to the area been included it would have been more valuable to determine the prevalence of TMJ in motor vehicle collisions (MVC). 3. The final number of subjects included in the study was 165. Of these, only 26 were female and 139 were male. It is well documented in the scientific literature that females have a far greater (4:1) propensity to sustain injuries in MVC. 4. The authors report an average speed of collision of 40 km/hr (SD 19km/hr). Two points need to be made regarding the collision speed. First, the collision speeds are based upon reports of the victims which is hardly an accurate or scientific method. Second, if in fact the collision speeds were of that magnitude they could not be classified as low velocity and one would expect a far greater incidence of TMJ and other findings. In fact, impacts of that magnitude are often associated with fatalities. 5. The authors identify no significant demographic difference between the subject groups. This certainly reduces the between variance of the groups. Unfortunately, it does little in the way of assisting in relating the data to western countries which have much different demographic considerations not the least of which are the socioeconomic and political influences. 6. The respondents of the survey were those involved in the MVC. However, it is well established that only a small population of MVC victims require medical care. A better subject selection criteria would have been only those subjects who reported to doctors versus their inclusion of all subjects who sustained accidents based upon police report. 7. The authors found that the control group had between 66% and 100% greater reported pain than the accident victims. The control group included those subjects without prior TMJ complaints or trauma. At the very least, one would suspect that there would be no difference between the control and test group. This finding defies logic. Using this logic, one would recommend MVC for those people who wish to reduce the potential of developing TMJ disorders. As with the previous studies the utility
of the findings is negligible. The data
seems so flawed that any application of
the data would be without foundation.
The real threat from the study is misapplication
of the data in the medical legal arena.
Having dealt with "Lithuania I and
II" in the past I am sure that this
new study will continue to add to the
armament of the defense minded community.
Perhaps, with the data above both defense
and plaintiff interests can be leveled.
Your familiarity and objectivity when
using this study will add to the just
and reasonable resolution of TMJ issues. |
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