TMJ Disc Displacements: Difference between revisions

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== Introduction  ==
== Introduction  ==


[[TMJ Anatomy|Temperomandibular joint]] displacement, also known as internal disc derangement, is an abnormal relationship between the articular disc, the mandibular condyle and the mandibular fossa. It  is understood that the posterior band of the disc generally lies in front of the condyle and that the condyle functions on the posterior attachment.  
[[TMJ Anatomy|Temperomandibular joint]] displacement, also known as internal disc derangement, is an abnormal relationship between the articular disc, the mandibular condyle and the mandibular fossa<ref name=":2">Young AL. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762294/ Internal derangements of the temporomandibular joint: A review of the anatomy, diagnosis, and management.] The Journal of the Indian Prosthodontic Society. 2015 Jan;15(1):2.</ref>. The most frequent displacement of the disc is anterior to the mandibular condyle however, in rare cases it can be posteriorly. The prognosis for these conditions is good and normally recover with minimal intervention or conservative management.<ref name=":2" />[[File:TMJ palpation.jpg|thumb|340x340px|Limited TMJ opening<ref>Wright EF, North SL. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813497/ Management and treatment of temporomandibular disorders: a clinical perspective.] Journal of Manual & Manipulative Therapy. 2009 Dec 1;17(4):247-54.</ref>]]Imaging studies have demonstrated that a more anterior disc position is relatively common in the asymptomatic population.<ref>Kircos LT, Ortendahl DA, Mark AS, Arakawa M. [https://pubmed.ncbi.nlm.nih.gov/3477621/ Magnetic resonance imaging of the TMJ disc in asymptomatic volunteers]. Journal of oral and maxillofacial surgery. 1987 Oct 1;45(10):852-4.</ref> It is also thought that in the majority of people the TMJ adapts to the disc position and rarely produces pain from being in a different position. <ref>Poluha RL, Canales GD, Costa YM, Grossmann E, Bonjardim LR, Conti PC. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382319/ Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation.] Journal of Applied Oral Science. 2019;27.</ref>
 
Imaging studies have demonstrated that a more anterior disc position are relatively common in the asymptomatic population.<ref>Kircos LT, Ortendahl DA, Mark AS, Arakawa M. [https://pubmed.ncbi.nlm.nih.gov/3477621/ Magnetic resonance imaging of the TMJ disc in asymptomatic volunteers]. Journal of oral and maxillofacial surgery. 1987 Oct 1;45(10):852-4.</ref> It is also thought that in the majority of people the TMJ adapts to the disc position and rarely produces pain from being in a different position. <ref>Poluha RL, Canales GD, Costa YM, Grossmann E, Bonjardim LR, Conti PC. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382319/ Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation.] Journal of Applied Oral Science. 2019;27.</ref>
 
{{#ev:youtube|mB468Jh9aAY}}
 
== Clinically Relevant Anatomy ==
== Clinically Relevant Anatomy ==
See [[TMJ Anatomy|TMJ anatomy]]
See [[TMJ Anatomy|TMJ anatomy]]
Also see [[Muscles of Mastication|muscles of mastication]]
== Clinical Presentation  ==
== Clinical Presentation  ==


=== Symptoms<ref>Canales GD, Guarda-Nardini L, Rizzatti-Barbosa CM, Conti PC, Manfredini D. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322638/ Distribution of depression, somatization and pain-related impairment in patients with chronic temporomandibular disorders.] Journal of Applied Oral Science. 2019;27.</ref> ===
=== Symptoms ===
* Pain or discomfort associated with anyone or combination of: chewing, yawning, talking, bruxism
* Pain or discomfort associated with anyone or combination of: chewing, yawning, talking, bruxism<ref>Canales GD, Guarda-Nardini L, Rizzatti-Barbosa CM, Conti PC, Manfredini D. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322638/ Distribution of depression, somatization and pain-related impairment in patients with chronic temporomandibular disorders.] Journal of Applied Oral Science. 2019;27.</ref>  
* Headaches  
* Headaches  
* Ear pain  
* Ear pain  
Line 35: Line 32:
# Constant pain unrelated to jaw movement
# Constant pain unrelated to jaw movement


== Stages of TMJ disc displacement<ref name=":0">Moffett BC. Definitions of TMJ Derangements. IN: Diagnosis of internal derangements of the TMJ, Vol.1, Double contrast Arthrography and Clinical considerations. BC Moffett and PL Westesson eds. Proceedings of a Continuing Dental Symposium, Seattle 1984.</ref> ==
== Types of TMJ disc displacement ==
{{#ev:youtube|v=IHl6WNeSXIk}}<ref>The Dentist! TMJ disc displacement. Available from: https://www.youtube.com/watch?v=IHl6WNeSXIk [last accessed: 11/8/2017]</ref>
# '''Disc displacement with reduction (DDWR)'''<ref name=":2" /><ref name=":4">Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4478082/ Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group.] Journal of oral & facial pain and headache. 2014;28(1):6.</ref>: The articular disc displaces anteriorly to the condylar head, when the mouth is opened the disc relocates on the the condylar head.  
#* Hearing and palpating joint noises during opening and closing
#* Protrusive opening and closings stops the reciprocal click
#* There is unlikely to be any restriction in ROM due to the disc relocating when the mouth opens
#'''Disc displacement with reduction with intermittent locking'''<ref name=":2" /><ref name=":4" />: identical to DDWR with the additional symptom of intermittent limited jaw opening. This occurs when the disc does not reduce.
#'''Disc displacement without reduction (DDwoR) with limited opening''':<ref name=":2" /><ref name=":1">Al-Baghdadi M, Durham J, Araujo-Soares V, Robalino S, Errington L, Steele J. [https://journals.sagepub.com/doi/full/10.1177/0022034514528333# TMJ disc displacement without reduction management: a systematic review.] Journal of dental research. 2014 Jul;93(7_suppl):37S-51S.</ref> the articular disc displaces but does not reduce.
#*TMJ pain
#*Limited jaw range of movement <40mm
#*Clicking and popping 4. '''Disc displacement without reduction without limited opening:''' identical to DDwoR without limited ROM, although limited ROM must have occurred at some point.


=== Stage I ===
These stages are under review and a new classification system is being trialled however at present it has only been trialled in adolescents.<ref name=":0">Shen P, Xie Q, Ma Z, Abdelrehem A, Zhang S, Yang C. [https://www.nature.com/articles/s41598-019-42081-5 Yang’s Classification of Juvenile TMJ Anterior Disc Displacement Contributing to Treatment protocols]. Scientific reports. 2019 Apr 4;9(1):1-8.</ref> This classification reports five stages of disc displacement based on MRI results.
Disc displacement with reduction (DDWR):  
* Hearing and palpating joint noises during opening and closing


* Protrusive opening and closings stops the reciprocal click
=== Yang’s Classification of Juvenile TMJ Anterior Disc Displacement ===
{| class="wikitable"
!stage
!Disc
!Condyle
!Marrow
|-
|Stage 0
|Basic shape
|Normal condylar shape and height
|Normal volume and quality
|-
|Stage 1
|Basic shape
|Mild and local condylar resorption, but normal condylar height
|Partially reduced on the top
|-
|Stage 2
|Basic shape
|Moderate condylar resorption, reduced condylar height.
|Mildly reduced
|-
|Stage 3
|Basic shape or distorted
|Severe condylar resorption
|Moderately reduced
|-
|3A
|Basic shape remains, or mildly distorted and shortened
|Small, but basic shape is present
|Moderately reduced
|-
|3B
|Severely distorted and shortened
|Small, but basic shape is present
|Moderately reduced
|-
|Stage 4
|Basic shape or distorted
|Severe condylar resorption
|Moderately reduced with inflammatory changes, or severe reduced, or absent
|-
|4A
|Basic shape remains or distorted. Perforation is common
|Severe resorption, loss of integrity of cortical bone.
|Moderately reduced with severe inflammatory changes
|-
|4B
|Basic shape remains or distorted. Perforation is common
|Severe resorption, or complete resorption
|Severe reduced, or absent
|}
<ref name=":0" />


=== Stage II ===
== Diagnostic Procedures  ==
Disc displacement without reduction (DDWoR)  
Assessment of disc displacement can be done via subjective assessment, objective assessment and radiography.<ref name=":3">Wright EF, North SL. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813497/ Management and treatment of temporomandibular disorders: a clinical perspective]. Journal of Manual & Manipulative Therapy. 2009 Dec 1;17(4):247-54.</ref>
* History of clicking and popping
* With or without intermittent locking
* Limited jaw range of movement


=== Stage III ===
=== Subjective assessment ===
Chronic disc displacement without reduction
The patient may have the history of:
* Hearing multiple noises during opening and closing (crepitus),
* Insidious or traumatic onset
* Normal or near normal mandibular dynamics<ref>Eriksson L and Westesson PL. [https://pubmed.ncbi.nlm.nih.gov/6576492/ Clinical and radiological study of patients with Anterior disc displacement of the temporomandibular joint]. Swed Dent J. 1983; 7:55.</ref>
* Difficulty chewing food
* Reduced mouth opening
* Subjective clicking and popping


== Diagnostic Procedures  ==
=== Objective Assessment ===
* Clearing the TMJ could be done with the following imaging: Radiography (normal x-ray and panoramic radiography), Tomogram, Computerized tomography (CT scan), MRI, Arthrography.<ref>Kraus S. (1994). Clinics in Physical Therapy: Temporomandibular Disorders (2nd edition). Churchill Livingstone: New York.</ref><ref>Helms CA, Kaplan R. Diagnostic imaging of the temporomandibular joint: recommendations for use of the various techniques. AM J Roentgenol. 1990: 154;319.</ref><ref>Pharoah M. The prescription of diagnostic images for temporomandibular joint disorders. J of Orofascial Pain. 1999; 13(4): 251-254.</ref><ref>Trumpy I, Erickson J, Lyberg T. Internal derangement of the temporomandibular joint: Correlation of arthrographic imaging with surgical findings. Int J Oral Maxillofac Surg. 1997; 26:327-330.</ref><ref>Watt-Smith S, Sadler A, Baddeley H, et al. Comparison of arthrotomographic and magnetic resonance images of 50 temporomandibular joints with operative finds. Br J Oral Maxillofac Surg. 1993; 31:139-143.</ref>
* Pain on TMJ palpation<ref>Ali HM. [https://www.sciencedirect.com/science/article/abs/pii/S0031940605612680 Diagnostic Criteria for Temporomandibular joint Disorders: A physiotherapist's perspective.] Physiotherapy. 2002 Jul 1;88(7):421-6.</ref>
* Measurements of maximal mouth opening using a standard ruler have demonstrated an intra-rater reliability of .99 (ICC) and an inter-rater reliability of .94<ref>Walker N, Bohannon RW, Cameron D. Discriminant validity of temporomandibular joint range of motion measurements obtained with a ruler. J Orthop Sports Phys Ther. 2000 August;30(8): 484-92.</ref>
* Potential clicking on jaw opening
* Auscultation During Active Movement: To identify presence of OA on the TMJ. Positive test if crepitus heard by examiner. Sn= .45-.67, Sp= .84-.86, -LR=.38-.65, +LR= 2.8-4.8<ref>Flynn TW, Cleland JA, Whitman JM. User’s Guide to the Musculoskeletal Examination: Fundamentals for an Evidence-based Clinician. EIM. 2008:180.</ref>
* Reduced TMJ range of movement
* Associated muscular tightness of cervical and facial muscles such as [[sternocleidomastoid]], upper [[trapezius]] and masseter.  
 
=== Radiography ===
* XR<ref>Razek AA, Al Belasy FA, Ahmed WM, Haggag MA. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504863/ Assessment of articular disc displacement of temporomandibular joint with ultrasound.] Journal of ultrasound. 2015 Jun 1;18(2):159-63.</ref>
* Ultrasound can be useful in assessing the extent of disc derangement
* MRI is considered gold standard


== Management/Intervention  ==
== Management/Intervention  ==


=== Disc displacement with reduction without pain ===
=== Disc displacement without reduction ===
# Explain to the patient what it is they are experiencing that popping may continue indefinitely, they may experience occasional brief moments of locking.  
The best treatment plan for disc displacement without reduction is still under discussion and requires more evidence as treatment is usually based on experience rather than evidence.<ref>Haketa T, Kino K, Sugisaki M, Takaoka M, Ohta T. [https://journals.sagepub.com/doi/abs/10.1177/0022034510378424 Randomized clinical trial of treatment for TMJ disc displacement.] Journal of dental research. 2010 Nov;89(11):1259-63.</ref><ref name=":1" />
# Reassure the patient that what they have is very common, their condition rarely deteriorates to the level of having persistent pain and loss of oral function.  
 
Interventions can range from conservative management to surgical intervention. Although primary management for disc displacement should always be conservative.<ref>Schiffman EL, Look JO, Hodges JS, Swift JQ, Decker KL, Hathaway KM, Templeton RB, Fricton JR. [https://pubmed.ncbi.nlm.nih.gov/17189464/ Randomized effectiveness study of four therapeutic strategies for TMJ closed lock.] Journal of dental research. 2007 Jan;86(1):58-63.</ref>


=== Disc displacement without reduction<ref>Haketa T, Kino K, Sugisaki M, Takaoka M, Ohta T. [https://journals.sagepub.com/doi/abs/10.1177/0022034510378424 Randomized clinical trial of treatment for TMJ disc displacement.] Journal of dental research. 2010 Nov;89(11):1259-63.</ref> ===
==== Conservative management (primarily physiotherapy) ====
# Physiotherapy and therapeutic exercise
# Education and self-management<ref name=":1" />
# Splinting  
# Splinting  
# Therapeutic exercise
# Joint mobilisation of the TMJ and cervical spine  
# Joint mobilisation of the TMJ and cervical spine  
# TMJ active exercises  
# Active jaw exercises and strengthening
# Treat other sources of symptoms that may be unrelated to the DDwR such as: joint inflammation (physical therapy/anti-inflammatory meds), masticatory muscle pain (physical therapy/oral appliance), and referred pain from cervical spine (physical therapy)<ref>Moses JJ, Topper DC. A functional approach to the treatment of temporomandibular joint internal derangement. J Craniomandib Disor Facial &amp; Oral Pain. 1991; 519-27.</ref>
# [[Cognitive Behavioural Therapy|Cognitive behavioural therapy]]
Treatment of DDwR with locking episodes (patient experiences sudden episodes of limited mouth opening, which returns to normal with spontaneous resolution or resolution in response to force exerted by the patient):
# NSAIDs and analgesia
# Reposition the disc into the condyle
 
# Decrease frequency and duration of locking episodes
==== Surgical intervention ====
# Progress DDwR to a functional non-reducing disc.<ref>Yoda T, Sakamoto I, Imai H, et al. Response of temporomandibular joint intermittent closed lock to different treatment modalities: A multicenter Survey. J Craniomadndib Practice. 2006; 24(2): 130-6.</ref>
# Arthrocentesis<ref>Monje-Gil F, Nitzan D, González-Garcia R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476018/#:~:text=TMJ%20arthrocentesis%20represents%20a%20form,drug%20or%20other%20therapeutic%20substance. Temporomandibular joint arthrocentesis. Review of the literature.] Medicina oral, patologia oral y cirugia bucal. 2012 Jul;17(4):e575.</ref>
Since cervical spine disorders coexist 70% of the time with TMD it is very important to screen and treat the cervical spine as necessary<ref>Ciancaglini R, Testa M, Radaelli G. Association of neck pain with symptoms of TMD in the general adult population. Scand J Rehab Med. 1999; 31:17-22.</ref><ref>Sjaastad O, Saunte C, Hovdal H, et al. “Cervicogenic” headache. An hypothesis. Cephalalgia. 1983; 3:249-256.</ref><ref>Kuttila S, Kuttila M, Le Bell Y, et al. Characteristics of subjects with secondary otalgia. Journal of Orofacial Pain. 2004; 18(3):226-234.</ref>  
# Arthroscopy
# Open joint intervenetion
On analysis of the surgical interventions there was no change in outcomes (pain and TMJ range of movement) when compared with each other. <ref name=":1" />


== Clinical bottom line ==
Regardless of intervention disc displacement without reduction has shown to improve over time, therefore the optimum treatment would be the least invasive and most cost effective i.e. education, self-management and early TMJ manipulation.<ref name=":1" /> In some extreme cases surgical intervention may be required but should be treated as a last choice.
== Differential Diagnosis  ==
== Differential Diagnosis  ==
* Pseudo-hypomobilities: muscle spasm, acute surgical, intra and extracapsular irritations, neoplasm, inflammatory diseases, and trauma
* [[Neck Pain: Clinical Practice Guidelines|Cervical spine disorders]] coexist 70% of the time with TMJ disorders therefore it is important to screen and treat the cervical spine routinely<ref name=":3" />
* True hypomobilities: chronic post-surgical, arthritic, fibrosis adhesions
* TMJ [[osteoarthritis]]
* See [[Temporomandibular Disorders|TMD]]
== References  ==
== References  ==


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[[Category:EIM_Residency_Project]]  
[[Category:EIM_Residency_Project]]  
[[Category:Musculoskeletal/Orthopaedics]]  
[[Category:Musculoskeletal/Orthopaedics]]  
[[Category:TMJ]]
[[Category: Head - TMJ]]
[[Category:Orthopaedic_Surgical_Procedures]]
[[Category:Orthopaedic_Surgical_Procedures]]

Latest revision as of 17:56, 4 November 2021

Original Editor - Andrea Reineke

Top Contributors - Abbey Wright, Lynda Chukwu, Admin, Kim Jackson, WikiSysop, 127.0.0.1, Andrea Reineke and George Prudden  

Introduction[edit | edit source]

Temperomandibular joint displacement, also known as internal disc derangement, is an abnormal relationship between the articular disc, the mandibular condyle and the mandibular fossa[1]. The most frequent displacement of the disc is anterior to the mandibular condyle however, in rare cases it can be posteriorly. The prognosis for these conditions is good and normally recover with minimal intervention or conservative management.[1]

Limited TMJ opening[2]

Imaging studies have demonstrated that a more anterior disc position is relatively common in the asymptomatic population.[3] It is also thought that in the majority of people the TMJ adapts to the disc position and rarely produces pain from being in a different position. [4]

Clinically Relevant Anatomy[edit | edit source]

See TMJ anatomy

Also see muscles of mastication

Clinical Presentation[edit | edit source]

Symptoms[edit | edit source]

  • Pain or discomfort associated with anyone or combination of: chewing, yawning, talking, bruxism[5]
  • Headaches
  • Ear pain
  • TMJ range of movement may be restricted
  • Crepitus/clicking during movement of the jaw
  • Pain or discomfort can be acute or chronic that can fluctuate in intensity.
  • Emotional issues such as depression is commonly associated with TMJ pain

Duration of symptoms may vary from hours to days.

Red flags[edit | edit source]

  1. Neurological signs
  2. Swelling
  3. Nose bleeding
  4. Dysphagia or dysarthria
  5. Unexplained weight loss
  6. Auditory complaints
  7. Constant pain unrelated to jaw movement

Types of TMJ disc displacement[edit | edit source]

[6]

  1. Disc displacement with reduction (DDWR)[1][7]: The articular disc displaces anteriorly to the condylar head, when the mouth is opened the disc relocates on the the condylar head.
    • Hearing and palpating joint noises during opening and closing
    • Protrusive opening and closings stops the reciprocal click
    • There is unlikely to be any restriction in ROM due to the disc relocating when the mouth opens
  2. Disc displacement with reduction with intermittent locking[1][7]: identical to DDWR with the additional symptom of intermittent limited jaw opening. This occurs when the disc does not reduce.
  3. Disc displacement without reduction (DDwoR) with limited opening:[1][8] the articular disc displaces but does not reduce.
    • TMJ pain
    • Limited jaw range of movement <40mm
    • Clicking and popping 4. Disc displacement without reduction without limited opening: identical to DDwoR without limited ROM, although limited ROM must have occurred at some point.

These stages are under review and a new classification system is being trialled however at present it has only been trialled in adolescents.[9] This classification reports five stages of disc displacement based on MRI results.

Yang’s Classification of Juvenile TMJ Anterior Disc Displacement[edit | edit source]

stage Disc Condyle Marrow
Stage 0 Basic shape Normal condylar shape and height Normal volume and quality
Stage 1 Basic shape Mild and local condylar resorption, but normal condylar height Partially reduced on the top
Stage 2 Basic shape Moderate condylar resorption, reduced condylar height. Mildly reduced
Stage 3 Basic shape or distorted Severe condylar resorption Moderately reduced
3A Basic shape remains, or mildly distorted and shortened Small, but basic shape is present Moderately reduced
3B Severely distorted and shortened Small, but basic shape is present Moderately reduced
Stage 4 Basic shape or distorted Severe condylar resorption Moderately reduced with inflammatory changes, or severe reduced, or absent
4A Basic shape remains or distorted. Perforation is common Severe resorption, loss of integrity of cortical bone. Moderately reduced with severe inflammatory changes
4B Basic shape remains or distorted. Perforation is common Severe resorption, or complete resorption Severe reduced, or absent

[9]

Diagnostic Procedures[edit | edit source]

Assessment of disc displacement can be done via subjective assessment, objective assessment and radiography.[10]

Subjective assessment[edit | edit source]

The patient may have the history of:

  • Insidious or traumatic onset
  • Difficulty chewing food
  • Reduced mouth opening
  • Subjective clicking and popping

Objective Assessment[edit | edit source]

  • Pain on TMJ palpation[11]
  • Potential clicking on jaw opening
  • Reduced TMJ range of movement
  • Associated muscular tightness of cervical and facial muscles such as sternocleidomastoid, upper trapezius and masseter.

Radiography[edit | edit source]

  • XR[12]
  • Ultrasound can be useful in assessing the extent of disc derangement
  • MRI is considered gold standard

Management/Intervention[edit | edit source]

Disc displacement without reduction[edit | edit source]

The best treatment plan for disc displacement without reduction is still under discussion and requires more evidence as treatment is usually based on experience rather than evidence.[13][8]

Interventions can range from conservative management to surgical intervention. Although primary management for disc displacement should always be conservative.[14]

Conservative management (primarily physiotherapy)[edit | edit source]

  1. Education and self-management[8]
  2. Splinting
  3. Therapeutic exercise
  4. Joint mobilisation of the TMJ and cervical spine
  5. Active jaw exercises and strengthening
  6. Cognitive behavioural therapy
  7. NSAIDs and analgesia

Surgical intervention[edit | edit source]

  1. Arthrocentesis[15]
  2. Arthroscopy
  3. Open joint intervenetion

On analysis of the surgical interventions there was no change in outcomes (pain and TMJ range of movement) when compared with each other. [8]

Clinical bottom line[edit | edit source]

Regardless of intervention disc displacement without reduction has shown to improve over time, therefore the optimum treatment would be the least invasive and most cost effective i.e. education, self-management and early TMJ manipulation.[8] In some extreme cases surgical intervention may be required but should be treated as a last choice.

Differential Diagnosis[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Young AL. Internal derangements of the temporomandibular joint: A review of the anatomy, diagnosis, and management. The Journal of the Indian Prosthodontic Society. 2015 Jan;15(1):2.
  2. ↑ Wright EF, North SL. Management and treatment of temporomandibular disorders: a clinical perspective. Journal of Manual & Manipulative Therapy. 2009 Dec 1;17(4):247-54.
  3. ↑ Kircos LT, Ortendahl DA, Mark AS, Arakawa M. Magnetic resonance imaging of the TMJ disc in asymptomatic volunteers. Journal of oral and maxillofacial surgery. 1987 Oct 1;45(10):852-4.
  4. ↑ Poluha RL, Canales GD, Costa YM, Grossmann E, Bonjardim LR, Conti PC. Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation. Journal of Applied Oral Science. 2019;27.
  5. ↑ Canales GD, Guarda-Nardini L, Rizzatti-Barbosa CM, Conti PC, Manfredini D. Distribution of depression, somatization and pain-related impairment in patients with chronic temporomandibular disorders. Journal of Applied Oral Science. 2019;27.
  6. ↑ The Dentist! TMJ disc displacement. Available from: https://www.youtube.com/watch?v=IHl6WNeSXIk [last accessed: 11/8/2017]
  7. ↑ 7.0 7.1 Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. Journal of oral & facial pain and headache. 2014;28(1):6.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Al-Baghdadi M, Durham J, Araujo-Soares V, Robalino S, Errington L, Steele J. TMJ disc displacement without reduction management: a systematic review. Journal of dental research. 2014 Jul;93(7_suppl):37S-51S.
  9. ↑ 9.0 9.1 Shen P, Xie Q, Ma Z, Abdelrehem A, Zhang S, Yang C. Yang’s Classification of Juvenile TMJ Anterior Disc Displacement Contributing to Treatment protocols. Scientific reports. 2019 Apr 4;9(1):1-8.
  10. ↑ 10.0 10.1 Wright EF, North SL. Management and treatment of temporomandibular disorders: a clinical perspective. Journal of Manual & Manipulative Therapy. 2009 Dec 1;17(4):247-54.
  11. ↑ Ali HM. Diagnostic Criteria for Temporomandibular joint Disorders: A physiotherapist's perspective. Physiotherapy. 2002 Jul 1;88(7):421-6.
  12. ↑ Razek AA, Al Belasy FA, Ahmed WM, Haggag MA. Assessment of articular disc displacement of temporomandibular joint with ultrasound. Journal of ultrasound. 2015 Jun 1;18(2):159-63.
  13. ↑ Haketa T, Kino K, Sugisaki M, Takaoka M, Ohta T. Randomized clinical trial of treatment for TMJ disc displacement. Journal of dental research. 2010 Nov;89(11):1259-63.
  14. ↑ Schiffman EL, Look JO, Hodges JS, Swift JQ, Decker KL, Hathaway KM, Templeton RB, Fricton JR. Randomized effectiveness study of four therapeutic strategies for TMJ closed lock. Journal of dental research. 2007 Jan;86(1):58-63.
  15. ↑ Monje-Gil F, Nitzan D, González-Garcia R. Temporomandibular joint arthrocentesis. Review of the literature. Medicina oral, patologia oral y cirugia bucal. 2012 Jul;17(4):e575.
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