I had an MRI done of my TMJ and it showed anterior displacement. What does this mean for treatment?

Patient Question

Ryan Miller 🇨🇦: Dr. Samuel, I’ve been having jaw pain, clicking, and occasional locking for several months. My doctor ordered an MRI of my TMJ, and the report says I have “anterior displacement of the disc” on my right side. What exactly does this mean? Is this a serious condition? Will I need surgery, or are there other treatment options? I’m confused about what steps to take next and how concerned I should be about this finding.

Dr. Rockson Samuel’s Response

Dr. Rockson Samuel: Thank you for your question, Ryan. MRI findings of the TMJ can certainly be confusing, and I’m happy to help clarify what anterior disc displacement means and what it implies for your treatment options.

Understanding Anterior Disc Displacement

Let’s start with understanding the normal anatomy and what this finding means:

Normal TMJ Anatomy

• Your temporomandibular joint (TMJ) has a disc made of fibrocartilage that sits between the condyle (the rounded end of your lower jaw) and the temporal bone of your skull
• This disc acts as a cushion and facilitates smooth movement
• In normal function, the disc remains positioned directly between these bony components during all jaw movements

What Anterior Displacement Means

• “Anterior displacement” means the disc has shifted forward from its optimal position
• This is the most common type of disc displacement in the TMJ
• The report likely specified one of two types:
  1. Anterior disc displacement with reduction: The displaced disc returns to its normal position when you open your mouth (typically causing a clicking sound)
  2. Anterior disc displacement without reduction: The disc remains displaced even when you open your mouth (often associated with limited opening and potential locking)

Your MRI report should have specified which type you have, as this distinction significantly influences treatment approaches.

How Common Is This Finding?

It’s important to understand that:

• Disc displacement is extremely common in the general population
• Studies show 30-40% of asymptomatic individuals (without any jaw pain) have disc displacement visible on MRI
• There isn’t always a direct correlation between imaging findings and symptoms

Treatment Implications Based on Clinical Presentation

The appropriate treatment approach depends not just on the MRI finding, but on your specific symptoms and clinical examination. Here’s how we typically approach treatment:

If You Have Anterior Displacement with Reduction (Clicking but Good Function)

If your jaw opens normally with perhaps a click and minimal to moderate pain:

1. Conservative Management:

   • Physical therapy focusing on:
     • Proper jaw movement patterns
     • Muscle relaxation techniques
     • Posture training
   • Home exercises and stretches
   • Heat application for muscle relaxation
   • Soft diet during flare-ups

2. Behavioral Modifications:

   • Avoiding extreme jaw movements (wide yawning, vigorous chewing)
   • Stress management (as tension often exacerbates TMJ symptoms)
   • Breaking parafunctional habits like clenching, nail biting, etc.

3. Oral Appliances:

   • Stabilization splints primarily for nighttime use
   • These redistribute forces and reduce muscle activity
   • Not intended to permanently reposition the disc, but to reduce symptoms

If You Have Anterior Displacement without Reduction (Limited Opening or Locking)

If you’re experiencing restricted opening, locking episodes, or more significant pain:

1. All of the Above Conservative Approaches

2. Potentially More Specific Physical Therapy:

   • Manual mobilization techniques
   • Targeted exercises to improve range of motion
   • Training in self-mobilization during locking episodes

3. Pharmacological Management:

   • Anti-inflammatory medications
   • Muscle relaxants for acute muscle spasm
   • Occasionally, short-term low-dose pain management

4. Minimally Invasive Procedures (if conservative treatment is insufficient):

   • Arthrocentesis (joint washing)
   • Intra-articular injections of corticosteroids or hyaluronic acid
   • These procedures are outpatient, minimally invasive, and can provide significant relief

Surgical Intervention

Surgery is rarely needed for disc displacement and is only considered when:

• Severe, persistent pain is present despite 6+ months of conservative care
• Significant functional limitation affects quality of life
• Clear structural problems exist that cannot be managed conservatively

Surgical options include:

• Arthroscopic surgery (minimally invasive)
• Open joint surgery (much less common)
• The specific technique would depend on your unique situation

Prognosis and Long-term Outlook

The good news is that:

• 80-90% of patients with TMJ disorders improve with conservative management
• Many people adapt to disc displacement naturally over time
• The condition often stabilizes rather than progressively worsens
• Even when the disc remains displaced, symptoms often resolve with appropriate management

My Recommendation for Your Next Steps

Based on your description, I would suggest:

1. Clarify Your Specific Diagnosis:

   • Confirm whether you have displacement with or without reduction
   • Discuss with your doctor how your clinical symptoms correlate with the imaging

2. Begin Conservative Treatment:

   • Consult with a TMJ specialist or orofacial pain dentist
   • Consider physical therapy with someone experienced in TMJ disorders
   • Discuss whether an oral appliance would be beneficial in your case

3. Establish a Monitoring Protocol:

   • Regular follow-up to track progress
   • Clear timelines for when to consider additional interventions if needed

4. Avoid Premature Intervention:

   • Be cautious about rushing to invasive procedures
   • Many practitioners now recognize that aggressive treatment for disc displacement can sometimes create more problems than it solves

Addressing Your Specific Concerns

You asked if this is serious and how concerned you should be. In most cases, anterior disc displacement is not a serious condition requiring urgent intervention. It’s a common finding that can often be managed effectively with appropriate care.

Your level of concern should match your symptoms:

• If you have mild clicking with minimal pain and good function, minimal concern is warranted
• If you have significant pain, locking, or functional limitations, more active management is appropriate

Would you like more information about any specific aspect of TMJ management? I’m happy to provide more detailed guidance based on your particular symptoms and concerns.

Further Reading and Resources

For more information on related topics, you might find these resources helpful:

• Understanding TMJ Disorders: Beyond the Click
• Self-Management Strategies for TMJ Pain
• Physical Therapy for TMJ Disorders: What to Expect
• TMJ Oral Appliances: Types and Benefits