One of the most common jaw complaints is clicking and locking, often associated with pain in the jaw, face, head and down the neck. This can often be caused by an anterior disc displacement, something we see frequently in the clinic.

But what is an anterior disc displacement and what can we do about it? Before we dive into that question, let’s back it up and talk about the anatomy of the temporo-mandibular joint.

The Anatomy of the TMJ

The temporo-mandibular joint (aka the TMJ) is what attaches the mandible (aka the jaw bone) to the skull. It is located just in front of the ear and, if you place your hands on either side of your face just in front of your ears, you can feel that jaw moving forward and back as you open and close your jaw.

The TMJ is a synovial joint between the temporal bone of the skull and the condyle of the mandible. Between the condyle and the temporal bone is a donut-shaped fibrous disc that is essential for proper opening and closing of the jaw. This disc is partially held in place by the retro-discal tissue, a network of loose connective tissue, blood vessels and nerves attaching the back of the disc to the bone behind it, just in front of the ear canal.

Anterior Disc Displacements

One of the most common causes of temporo-mandibular dysfunction (aka TMD) is when the disc becomes displaced, typically anterior in the joint and away from the ear canal. When this occurs, the retro-discal tissue in the back gets stretched and is unable to hold the disc back in its normal position.

Common symptoms of anterior disc displacements include:

pain in the TMJ with chewing, yawning & talking
pain in and around the ear
headaches
a reproducible click in the TMJ, with or without pain
decreased range of motion with opening

When a disc moves anteriorly in the joint, it may click or block jaw movements but this isn’t guaranteed. Every person’s anatomy is different: jaw condyle shapes, depth of the socket, size of the disc, amount of retro-discal tissue and all the other factors that make a person unique can play into their TMD and experience of pain.

Treating a Disc Displacement

A few things to know first:

One third of asymptomatic people have at least one displaced TMJ disc. It’s really common to have a disc issue and not be bothered by it at all!
Discs will not (typically) relocate back to where they were. Instead, your body heals and creates a “pseudo-disc” from the now-stretched retro-discal tissue to act as the original disc.
When that disc moves forward, it can often block the opening of the TMJ. Over time, the disc remodels to be less donut-shaped and more wedge-shaped so the condyle of the jaw can easily slide over it.

Acute Disc Displacements

Remember how I said just up there that discs won’t relocate?

If the injury has occurred in the past 3 days, we can sometimes (and I stress SOMETIMES) get the disc to relocate. It has to be before the retro-discal tissue has stretched too much. Our therapists who treat TMD can attempt a specific maneuver to try and get that disc back to where it was.

Outside this 72 hour window, we are looking at healing and remodeling the disc.

Chronic Disc Displacements

We have a whole tool-box of therapy techniques to help with disc displacements in the TMJ. These include:

Manual therapy of the TMJ - we use specific techniques to increase the range of motion of the jaw and help the disc remodel into the wedge shape we’re looking for.
Soft tissue techniques (including IMS and massage) of the surrounding muscles - with a disc displacement, these muscles (for instance, the temporalis and masseter) are often clenching or working hard to compensate for the TMD, leading to increased pain and headaches.
Neck assessment & treatment - when the TMJ is irritated, up to 70% of people also have neck pain. As a part of TMD treatment, the neck needs to be evaluated and treated accordingly.
Exercises - the right exercise for you and your TMD is so important. The right exercise helps discs remodel, muscles relax and pain reduce. We spend a lot of time with you to make sure you are doing the correct exercise with the correct technique.

Top Five Tips in Dealing with a Disc Displacement

Finally, we live by these principles of managing disc displacements:

Don’t test it!! You will be tempted - does it still click? Is it still stuck? - but we beg you to resist this temptation. Let your disc heal. The more you poke it, the longer it’ll take to heal.
Avoid hard/crunchy/chewy foods for the first 6-8 weeks after a disc displacement. We promise you can eat your favourite food soon but avoid those types of foods initially.
Support your jaw when yawning. If you have the urge to yawn and really open your jaw, place a hand under your chin so you have something to push against and limit how much your jaw actually opens.
Sleep is so important for healing & pain control. We know that under 6.5 hours of sleep per night increases your experience of pain. We also know that you heal when you sleep. So make sure you’re getting enough sleep, with a good pillow supporting your head!
Posture also play a huge role. Make sure your computer is set up properly so you aren’t sitting in a head forward posture, putting more inappropriate muscular forces through your jaw. (Need some tips on computer set up? Read our blog!)

If you are dealing with a disc displacement, TMD or headaches, book with one of our TMJ therapists online, by email or calling us at (778) 630-8800.

That pesky jaw joint (better known as the temporomandibular joint or TMJ).

So many of us - 35%! - have issues with it yet only 5-10% of us actually seek treatment. Temporomandibular joint dysfunction (TMD for short) tends to hit in people ages 20-40, affecting women more than men.

Despite TMD being so common, not many people know what it is or what to do about it. Here are the top 5 things I want you to understand about the temporomandibular joint and dysfunction:

Top Five Fun Facts About TMJ/D

1. The TMJ moves out of its socket and has a disc

The TMJ is not your average joint! When you open your mouth fully, the first half of that movement is the jaw rotating in the socket. In the second half, the jaw bone comes out of the joint and moves forward.

The disc is a little piece of tissue that sits on top of the condyle like a hat. It helps the jaw slide nicely out of the socket, holding the jaw in place when the mouth is fully open and returning it to its closed position. Thanks, little disc!

To feel the movement of your jaw, place your hands flat on your cheeks, just in front of your ears. Slowly open your jaw and feel the condyle pop forward into your hand about halfway through opening.

2. Discs can slip forward and that’s okay!

One of the most common causes of TMD is the disc can be displaced anteriorly - in other words, the disc can slip forward in the joint. This may result in clicking or locking of the jaw or it may not - in fact, 9-31% of people moving about their lives have an anteriorly displaced disc and absolutely no symptoms!

The biggest thing to remember with disc displacements is that discs remodel and heal. If you have a symptomatic disc issue, the name of the game is to lessen the irritation of the tissues for a little while to allow the disc to remodel and the TMJ to heal. We do that through manual therapy and specific exercises.

3. Sounds are totally fine, as long as they aren’t painful

Most jaw sounds are related to the discs and if it doesn’t hurt, don’t worry about it. Popping, clicking and snapping are all common sounds in people with no TMJ-related pain.

These sounds are also not predictive of more problems down the road, so ignore them as best you can. It’s hard - the jaw is right beside your ear and the noises can be LOUD! Be armed with the knowledge that these sounds typically decrease over time and everything will be just fine.

4. Your jaw has a resting position and you should be in it most of the time

Check in with your jaw right now - are your teeth together? Are your jaw muscles clenched, tensed or relaxed? Where is your tongue - is it flopped against your bottom teeth or resting on your palate?

Your jaw should be at rest most of the time. In fact, your teeth should only be in contact for 8-15 minutes per day!

Here’s what you need to look for in a resting jaw:

Teeth slightly apart - your teeth shouldn’t be touching anywhere and be about 1mm apart
Tongue against the roof of your mouth - your tongue should be resting comfortably against your palate. It should be a few millimetres away from your teeth at the front.
Relaxed muscles - the chewing muscles in your cheek and on the sides of your skull should be nice and relaxed.

This resting posture is also heavily dependent on good posture throughout your whole body. For tips on this, visit our previous blog posts on posture Your Head Is A Bowling Ball & Ergonomics: The At Home Edition.

5. All those chewing habits can lead to TMD

We’re talking clenching, nail biting, cheek biting, lip pursing… all those mindless mouth habits so many of us are guilty of doing on a daily basis. All that added muscle activation can lead to overuse of the jaw muscles, causing anything from headaches, pain in and around the face and ear, tooth pain and tinnitus.

Since 45% of TMD is muscular in origin, it’s really important to identify and stop these habits. Changing these habits, like all habits, is really hard to do but it can mean the difference between pain and being pain-free.

If you are dealing with TMD, book with one of our therapists with advanced training in TMD. Book online, through email or call us at (778) 630-8800.

My Jaw Locks & Clicks! What's Going On?