Slipped Disc in the Jaw: Care Options and Causes

This Post Has 22 Comments

1. Elizabeth January 3, 2024 Reply

   Good Evening Dr. Zafer,

   Our 80 lb. rescue hound head-butted me on the right side of my face (jaw area) in April 2023. I experienced a vitreous detachment but didn’t think much about my jaw, even though it hurt. Fast forward to August, I experience an SS hearing loss (Sudden Sensory hearing loss) with tinnitus.

   First, it was thought to be eustachian tube dysfunction. The MRI concluded it was advanced TMJ. The first DMD did a panoramic dental x-ray, which showed the curvature of my right TMJ. He also reviewed the MRI and acknowledged the degenerative changes, grading them at 3/10 (10 being the worst). I then followed up with the DMD my dentist referred me to, who said I needed surgery. She said it was Avascular Necrosis and showed me where the disc was displaced. I’m confused at this point about how two doctors could be that far apart in their impressions. My jaw is sore, and I have click/pop with an infrequent lock; it is more like a joint hesitation. Your thoughts would be appreciated.

   1. Yama Zafer, D.C. April 23, 2024 Reply

      The two opinions are probably closer than they appear, and separating findings from interpretation is what will clear this up.

      Both clinicians saw the same things: degenerative change in the right jaw joint and a displaced disc. Where they differ is in what to call it and what to do about it. One graded the degeneration as mild to moderate. The other named avascular necrosis and recommended surgery. Avascular necrosis of the condyle is a specific diagnosis with specific appearances on MRI, and it can look similar to advanced degenerative change to a reader who is not a radiologist.

      So the tie-breaker is not a third clinical opinion first. It is the radiologist’s own report. Ask for a copy of the written MRI report, and read what the radiologist stated, in their words, about the condyle, the marrow signal, and the disc position. Two dentists interpreting the images themselves is where the divergence has come from. If the radiologist’s report does not mention avascular necrosis, that is important, and it is a fair question to put to the second clinician: what in the report supports that diagnosis.

      Then, if a surgical recommendation still stands, get a third opinion from an oral and maxillofacial surgeon at an academic center or from an orofacial pain specialist. A surgical recommendation for the jaw joint is exactly the situation where an independent opinion is worth the effort.

      The strongest argument for slowing down is your own function. You describe soreness, clicking and popping, and infrequent hesitation rather than true locking. Surgery on the jaw joint is generally reserved for significant persistent functional limitation or pain that has not responded to a proper conservative course, and joints with displaced discs commonly adapt over time with the disc remaining where it is. Measure your maximum opening in millimeters between the front teeth and record it. Normal is around 40 mm. If your opening is functional and stable, the case for operating is considerably weaker, and that number should be central to any surgical discussion.

      On the hearing loss, one point that matters and may have been conflated. Sudden sensorineural hearing loss is a separate condition and is not caused by jaw joint degeneration. Ear fullness and tinnitus can certainly be influenced by the jaw and the neck, but a documented sudden sensorineural loss is its own diagnosis with its own workup. Standard practice includes an MRI of the internal auditory canals specifically to exclude a tumor on the hearing nerve, and that is a different study from an MRI of the jaw joints. Confirm with your ENT specialist that this was specifically examined, since an MRI ordered for the jaw would not necessarily answer it.

      One more thing worth assessing: a blow of that force to the side of the face loads the neck as well as the jaw. The upper cervical segments refer pain into the jaw, the ear, and the side of the head, and after this kind of injury the neck is frequently the part nobody examines. If pressing the muscles at the top of your neck, or turning your head to the end of its range, changes your jaw or ear symptoms, that identifies a treatable component.

      Meanwhile: teeth apart and tongue on the roof of the mouth as the resting position, checked repeatedly through the day; smaller bites and softer food during flares; no gum; chewing on both sides; supporting your chin when you yawn; and gentle controlled opening within a comfortable range rather than forcing it.

2. Paul September 19, 2023 Reply

   Hi,
   Just a quick question. I was at the dentist getting an impression made for an implant I’m getting. I also had an X-ray. I felt no jaw pain during this visit. I believe my right TMJ started clicking when chewing a couple of days late. This is the side on which the procedure was carried out. I have full jaw movement and no other pain.
   What would be the best way to proceed here? My dentist was going to refer me to a specialist about this during my checkup, but I’m currently delaying this. This has been happening for around a month, and there has been no change in the condition (perhaps I don’t notice it so much now through adaptation). Should I see the specialist, or should I try some jaw exercises?

   1. Yama Zafer, D.C. May 1, 2024 Reply

      This is a recognized sequence and it is usually less concerning than it feels.

      Dental procedures hold the mouth open near the end of its range for extended periods, and the jaw joint is not built for sustained end-range loading. Long appointments stretch the ligaments and the tissue behind the disc, and the jaw-closing muscles are held lengthened and then work hard afterward. Clicking appearing a day or two later fits that pattern: mild laxity and irritation allow the disc to slip forward and snap back as you open, which is what you are hearing. The delay before it appeared is typical, since the strain shows up as the initial soreness settles rather than during the appointment.

      The outlook is generally good. Most of these settle over weeks as the tissue recovers, particularly where the joint was healthy beforehand. Clicking that is painless and does not limit opening frequently needs no treatment at all and often fades on its own.

      What helps in the meantime is load reduction rather than exercise of the joint. Check your resting jaw position through the day: teeth slightly apart, lips closed, tongue resting on the roof of the mouth, with teeth touching only when eating. Take smaller bites, soften food while it settles, avoid gum and tough or chewy foods, and chew on both sides rather than favoring the unaffected one, since one-sided chewing tends to create its own problem. Support your chin with a hand when you yawn. Gentle controlled opening within a comfortable range keeps the joint moving without provoking it, and heat over the muscles at the side of the face helps more than working them hard.

      Measure your maximum opening in millimeters between the front teeth and note it weekly. Normal is around 40 mm. As long as that number is holding, the clicking alone is not something to chase.

      One practical thing for the future: tell your dentist about this before your next appointment. Shorter working periods, deliberate breaks to close and rest the jaw, and support for the jaw during long procedures all reduce the strain, and most dentists will accommodate that readily once they know. With an implant still in progress, that is worth raising now.

      Seek assessment if the joint locks and does not release, if your measured opening starts falling, or if the pain becomes constant rather than related to chewing.

3. Alecia September 7, 2023 Reply

   I’ve been to two specialists and have been given opposing treatment options. My jaw pain is on my right side and is caused by a slipped disc in my jaw and severe arthritis that has caused bone-on-bone action, causing the grinding and sanding noise.
   I have a limited range of motion, making it difficult to eat, and when I open my mouth too far, it feels like it clicks out of place and is pretty painful. I also have had tinnitus for the past five years, fullness and popping constantly in my right ear, and dizziness.

   When my jaw flared up a couple of months ago, the volume of the ringing dramatically increased. I have been given two different options to treat my problem, and I’m confused about what I need to do. One doctor wants to try a custom guard with laser therapy and a stretching program. The cost is $6,000 upfront and insurance will not cover anything.
   The other doctor told me not that I have so much damage to the bone (jagged edges and such) that my only option is a total joint replacement and that I would be wasting money trying other treatments. The other kicker is that my insurance will not cover it, and the surgery is around $30,000.

   1. Yama Zafer, D.C. May 1, 2024 Reply

      When two specialists give opposing recommendations, the disagreement is usually not about the findings but about the goal, and identifying which goal each is aiming at is how you resolve it.

      Your findings are clear enough: a displaced disc plus advanced degenerative change with bone contacting bone, and restricted movement. What differs between the two opinions is almost certainly whether to manage this or to operate on it. So ask each of them the same four questions and compare the answers side by side.

      What is this option intended to achieve, pain relief or increased opening. Those are different goals and treatments differ in how well they deliver each.

      What is my current maximum opening in millimeters, and what opening would you expect afterward. Measure it yourself too, with a ruler between the front teeth. Normal is around 40 mm. That single number should be central to any surgical discussion and it often is not mentioned at all.

      What happens if I do nothing for another year.

      What is the plan if this does not work, and what does it commit me to.

      On the substance, two things are worth knowing, because they are not always volunteered.

      Advanced degenerative change in the jaw joint does not behave like a steadily worsening disease indefinitely. The pattern frequently seen is that the joint remodels, the process becomes less active over time, and pain reduces over the following years even though the imaging looks no better and sometimes looks worse. That is a real phenomenon and it is a reason not to rush into an irreversible option while the joint may still be in the active phase.

      And conservative management remains first-line even for advanced degenerative change. It is not the option of last resort. It consists of reducing the load on the jaw-closing muscles, managing any grinding, treating the muscles and the upper neck, which refer pain into the jaw and are frequently untreated, gentle graded movement to maintain what range you have rather than forcing it, and analgesia appropriate for arthritic pain. Many people function acceptably on that for years.

      Surgery for a joint in this state, at its furthest extent, means replacing it, and that is a considerable commitment with long-term consequences. It has a legitimate place where pain and functional loss are severe and conservative management has genuinely failed, and that decision should rest on your function rather than on the appearance of the joint.

      Given the disagreement, a third opinion from an oral and maxillofacial surgeon at an academic center with a dedicated jaw joint service would be reasonable, and take the radiologist’s written report with you rather than either clinician’s summary of it.

      Track your opening in millimeters weekly and note what you can and cannot eat. If that number is stable, you have time to decide properly.

4. Emily Reed February 23, 2023 Reply

   Hello!

   I’ve been reading your articles and your responses to others, and apparently, these jaw things may affect your airways. I started having internal derangement with a reduction in September 2022. They slowly progressed into short episodes of internal derangement without reduction; they would last an hour or a few at first, and then it was days; and now it has been three months since my jaw has been back into place. I have seen my TMJ specialist, and I finally got an appointment for an MRI, and I have my follow-up in a few days, but I’m wondering if this could be connected to my snoring. I NEVER snored until this all started happening. Should I be worried?

   1. Yama Zafer, D.C. March 8, 2023 Reply

      The progression you describe is the recognized course, and the stage you are at now is the one where acting promptly makes the most difference.

      The usual sequence runs from a disc that displaces and relocates with each opening, which is what clicking represents, to episodes where it fails to relocate and the jaw locks briefly, to locking that becomes prolonged and then persistent. You are in the middle stage, with episodes that started short and are lengthening. That is exactly the point at which assessment and treatment are most worthwhile, because a joint that has not yet been held short for long periods responds better than one that has. Waiting until episodes become permanent is what makes recovery harder.

      So the practical answer is to arrange assessment with an orofacial pain specialist or an oral and maxillofacial surgeon experienced with the jaw joint now rather than when it worsens, and to measure your maximum opening in millimeters between the front teeth and record it weekly. Normal is around 40 mm. That number, and the frequency and length of your locking episodes, are what any decision should rest on.

      On the airway question, an accurate answer rather than an alarming one. There is a real relationship, but it is more limited than the way it is often presented. Jaw position influences the space behind the tongue, and where the lower jaw sits well back, the airway behind it is smaller. There is also an association between jaw disorders, grinding, and disordered breathing during sleep, and the direction of that relationship is not settled: sleep-related grinding is linked to arousals during sleep, so breathing disturbance may drive the grinding as much as the reverse. What is not established is that a displaced jaw disc causes airway obstruction, and treatments sold on airway grounds for jaw joint disorders, particularly extensive orthodontics and expansion appliances, are not well supported for that purpose.

      Part of the confusion comes from appliances. A device that holds the lower jaw forward does open the airway, which is why that design is used to treat sleep apnea. The same forward-holding design has been used to try to recapture a displaced jaw disc. That overlap makes it easy to conflate the two, but they are different treatments for different problems, and prolonged wear of a jaw-forward appliance carries a real risk of permanent bite change.

      If you have snoring, waking unrefreshed, or daytime sleepiness, treat that as its own question and ask for a sleep assessment. That is worth doing on its merits rather than as part of the jaw treatment.

      Meanwhile: graded controlled opening within tolerance rather than forcing it, smaller bites and softer food during episodes, no gum, chewing on both sides, supporting your chin when you yawn, and checking your resting jaw position through the day with teeth apart and tongue on the roof of the mouth. Do not force the jaw open when it locks.

      Seek urgent care if the jaw locks in the open position and will not close, or if you develop swelling, fever, or difficulty swallowing.

5. Gwen Weiler September 8, 2022 Reply

   I have had issues with the disc in my left jaw (articular disc in the jaw) for some time, but in the spring had several surgeries that made it worse. My dentist advised going with Invisalign or something similar to fix my overbite, which she thought would help with my jaw disc problems, including grinding my teeth. What are your thoughts on that? It can get expensive, and the positive side is straight teeth, but I need something to fix my jaw. Would this help?

   1. Yama Zafer, D.C. September 10, 2022 Reply

      Straight teeth is a good reason to have orthodontic treatment. Fixing your jaw joint and stopping your grinding are not, and it is worth separating those before you spend the money.

      The idea that correcting the bite treats jaw joint disorders is a long-standing one in dentistry, but it has not held up. Reviews of the evidence consistently find that how the teeth meet plays a minor role in these disorders, that orthodontic treatment is not an effective treatment for them, and that it does not prevent them either. So an overbite is unlikely to be the reason your disc is displaced, and correcting it is unlikely to be the reason it improves.

      Grinding is the clearer case. Sleep-related grinding is generated centrally, in connection with arousals during sleep, and is influenced by sleep quality, stress, certain medications, alcohol and caffeine, and in some people by disordered breathing during sleep. It is not caused by tooth alignment, and straightening teeth does not stop it. If your grinding is significant and you have not been asked about snoring, waking unrefreshed, or daytime sleepiness, that is worth raising, because sleep-disordered breathing and grinding are associated and the first is treatable in its own right.

      There is a specific caution in your situation that matters more than the general evidence. You have had several jaw surgeries that made things worse, which means the joint is already irritated and its structure may still be changing. Two problems follow. Orthodontic treatment involves months of altering the way your teeth meet, along with appointments that hold the mouth open, and both can flare an irritated joint. And if the joint itself is still changing, the bite can shift after treatment finishes, which means finishing to a carefully planned position that then moves. That is an expensive and frustrating outcome, and it is a foreseeable one.

      So before committing, two things are worth doing. Get an opinion on whether your joint is currently stable, from an orofacial pain specialist or an oral and maxillofacial surgeon who focuses on the jaw joint rather than from the practitioner proposing the treatment. And ask the orthodontist directly what evidence supports orthodontics for jaw joint problems, and what the plan is if your bite changes afterward. Clear answers to both are reasonable to expect.

      If after that you want straighter teeth for their own sake, that is a perfectly good reason and the timing is the only question.

      For the jaw itself, what actually helps in your situation is unglamorous: reducing the load on the jaw-closing muscles, checking your resting jaw position repeatedly through the day with teeth apart and tongue on the roof of the mouth, a flat-plane night guard for the grinding, treatment of the jaw muscles and the upper neck, graded controlled opening rather than forcing range, and time, since these joints commonly adapt over months. Measure your maximum opening in millimeters between the front teeth and track it weekly, because after several surgeries that number is the most honest indicator of whether things are moving in the right direction.

6. Kristin August 11, 2022 Reply

   Good morning!
   I have some questions about my TMJ. I have had an MRI that shows the disc is displaced and not going back even upon opening. The dentist said that I needed surgery to get the disc back on. My biggest issues are all ear related versus my jaw. I have jaw pain, but I am most concerned about the ear pressure, ear pain, and tinnitus. Please let me know if you think there is a way to heal this without surgery. Thank you!

   1. Yama Zafer, D.C. August 28, 2022 Reply

      The ear symptoms being your main problem is the most important thing in your message, and it should shape the decision about surgery rather than being treated as a side issue.

      First, why they occur. The jaw joint sits directly in front of the ear canal, separated by a thin plate of bone, and the muscles that close the jaw refer pain into the ear. Ear pain, a sensation of fullness or pressure, and tinnitus alongside a jaw joint problem, with a normal ear examination and normal hearing tests, is a well recognized pattern. It does not mean anything is wrong with your ear. It means the ear is where you are feeling something generated next to it.

      Now the part that matters for your decision. Surgery to reposition a displaced disc is not the standard first-line treatment for a disc that no longer reduces. Most such joints adapt over time, function returns, and conservative management is the usual course. Surgical repositioning is generally reserved for people with significant persistent functional limitation who have not responded to a proper conservative program, and its results are mixed.

      More specifically: there is no good evidence that surgically repositioning the disc resolves ear pressure, ear pain, or tinnitus. Those symptoms are far more often driven by the jaw muscles and the upper neck than by the disc’s position. Agreeing to an operation whose main aim is disc position, in order to treat symptoms it has not been shown to address, is worth pausing over. A second opinion from an oral and maxillofacial surgeon who specializes in the jaw joint would be reasonable before proceeding.

      Two tests you can do yourself that are informative. Press firmly into the muscle at the angle of the jaw and into the temple on the affected side, and note whether that reproduces or intensifies the ear symptoms. Then turn and tilt your head to the end of its range, and press the muscles at the top of the neck just below the skull. If either changes the ear pressure or the tinnitus, that identifies a muscular and cervical source, which is treatable without surgery and is frequently the untreated part in cases like yours.

      What tends to help that component: reducing the load on the jaw-closing muscles, which means checking your resting jaw position repeatedly through the day with teeth apart and tongue on the roof of the mouth, addressing clenching particularly at night, smaller bites, no gum, and treatment directed at the jaw muscles and the upper cervical spine rather than at the joint mechanics.

      How far you can open, measured in millimeters between the front teeth, is the number that should drive any surgical discussion, and it is worth tracking. If your opening is functional and stable, the case for operating is weaker still.

7. Clowm4mely March 14, 2022 Reply

   Hi,

   I’ve been experiencing TMJ disorder from early 2020 until now (2022). I had clicking and popping sounds in my jaws. In the past, clicking lasted 1-2hrs, but it has become continuous as of late. I did visit a dentist who related the condition may have resulted from problems I have. The dentist did give me some treatments, and clicking is better. But now, I have more pain and cannot open my mouth fully, making meals difficult as I experience discomfort when I jew food. My jaw pain is getting worse, and I suspect it has to do with my articular disc. Is there anything your center can do to help me?

   1. Yama Zafer, D.C. March 24, 2022 Reply

      One detail in your message deserves attention, because it is often read as improvement when it may not be.

      Clicking that has reduced while pain has increased is a meaningful change, and it has two possible explanations that need to be told apart.

      The click is the sound of the disc snapping back into position as you open. If it becomes quieter or stops while your opening also becomes more limited, that suggests the disc is no longer relocating, meaning it has moved toward blocking the joint rather than gliding with it. That is a progression rather than a resolution, and it is worth acting on early because a joint held short for long periods becomes harder to restore.

      The other explanation is that the joint mechanics have settled and the pain is now coming from the muscles rather than the joint, which is common after two years of altered function and guarding. That version is more favorable and responds well to load reduction.

      One measurement separates them. Using a ruler against your front teeth, measure your maximum comfortable opening in millimeters and record it. Normal is around 40 mm or more, roughly three of your own fingers stacked vertically. If your opening is normal and the pain is reproduced by pressing the muscles at the side of the face and temple, this is muscular. If your opening has fallen toward 25 to 30 mm and stops against a hard barrier, the disc is the issue and you should be seen sooner rather than later. Track that number weekly.

      After two years, the drivers matter more than the treatments. Clenching, particularly at night and while concentrating, is the most common and the most correctable. Ask your dentist what the wear pattern on your teeth shows, since that gives an objective answer rather than a guess. Also ask specifically what was treated when the clicking improved, because knowing what worked tells you what to continue.

      Two things that are usually undertreated in long-standing cases. The neck: the upper cervical segments refer pain into the jaw, ear, and side of the head, and jaw problems that persist for years often have a cervical component nobody has examined. And daytime jaw posture: teeth apart, lips closed, tongue resting on the roof of the mouth, with teeth touching only when eating. Checking that repeatedly through the day changes the total load more than any single session does.

      Alongside that, smaller bites, no gum, no tough or chewy food during flares, chewing on both sides, and supporting your chin when you yawn.

      Be seen promptly if your measured opening keeps falling, if the jaw locks and does not release, or if pain becomes constant rather than related to use.

8. Tony February 17, 2022 Reply

   Hello, about a year or two ago, I purchased the “Jawxrsize.” It turns out this was a HUGE mistake. I would use the Jawxrsize daily, and it would get to the point where I would chew on it without even realizing it. Well, there were a couple of times when all of a sudden, my jaw just locked up, and I couldn’t open my mouth for a few seconds.
   
   After this happened several times, I threw it away and never used it again. Since then, my jaw pops whenever I open it and will occasionally feel stuck. My dentist says my bottom jaw is “sinking” back towards my throat if that makes sense. It gets significantly worse when I lay down. Some mornings I wake up and can only open my mouth halfway. It will take some massaging and warming up before it allows me to open my mouth. Do you have any idea of how much damage I have caused my jaw? I am desperate for feedback.

   1. Yama Zafer, D.C. February 20, 2022 Reply

      What happened is mechanically straightforward, and the useful part is that most of it is reversible once the load stops.

      A resistance chewing device loads the jaw-closing muscles the way a weight loads any other muscle, except that these muscles are among the strongest in the body relative to their size and the joint they act across is small, shallow, and stabilized by a soft disc rather than by bone. Using one daily, and worse, chewing on it absent-mindedly for long stretches, produces exactly the sustained overload that provokes jaw problems. The brief episodes where the jaw locked and then released are the disc in the joint catching and then relocating rather than gliding smoothly. That it released within seconds is the favorable version of that problem.

      First and most important: stop using it completely, not in reduced amounts. Muscle and joint overload of this kind settles with deloading, and partial deloading tends to keep it simmering.

      Then reduce the everyday load, because a habit like this usually has company. Check your jaw’s resting position repeatedly through the day: teeth slightly apart, lips closed, tongue resting on the roof of the mouth. Teeth should only touch when you are eating, and people who have been chewing on a device are usually surprised how often theirs are in contact. Take smaller bites, soften food when it flares, chew on both sides rather than favoring one, and cut out gum and tough or chewy foods for now. Support your chin with a hand when you yawn. Notice whether you clench while concentrating or at night, and if there is any suggestion of night clenching, a dentist can check the wear pattern on your teeth, which shows it objectively.

      For the joint itself, gentle controlled opening within a comfortable range, several short sessions a day rather than one long one, keeps it moving without provoking it. Heat over the jaw-closing muscles at the side of the face helps more than working them hard. Do not force the jaw or push into pain, and do not use any device or exercise that resists jaw closing.

      Measure your maximum opening in millimeters between the front teeth with a ruler and note it once a week. Normal is roughly 40 mm or more. That number is how you will know whether things are moving in the right direction, and it is more reliable than how a given day felt.

      Expect improvement over weeks to a few months rather than days, which is the usual timescale for overloaded muscle and an irritated joint to settle.

      See a dentist experienced in jaw problems, or an oral and maxillofacial specialist, if an episode of locking does not release within a minute or two, if your measured opening starts dropping, or if pain becomes constant rather than related to use.

      1. Andrea Clarke June 16, 2022 Reply

         I have a night guard for bruxism. I have disc slip without reduction in my right TMJ.

         Is the night guard I had custom made prior to the acute episode sufficient?

         Should I be getting a specific device whose goal is to recapture the disc? Are those effective? Safe?

         1. Yama Zafer, D.C. August 28, 2022 Reply

            Three clear answers, since these are three distinct questions.

            Is your existing guard sufficient. Probably, and it is worth understanding why. A custom night guard made for bruxism is normally a flat-plane stabilization splint. Its purpose is to protect the teeth and reduce the load the jaw-closing muscles place on the joint overnight. That purpose has not changed because your disc has displaced. If anything it matters more now, because the muscle overload from clenching is one of the few things you can actually influence. One caveat: have your dentist check the fit. An appliance made before an acute episode may no longer seat correctly if your jaw position has altered, and a guard that does not fit properly can do more harm than none.

            Should you get a device intended to recapture the disc. In your situation, no, and the reason is specific. Anterior repositioning appliances hold the lower jaw forward so that the disc sits back in its correct relationship with the condyle. That rationale applies to disc displacement with reduction, where the disc still relocates on opening, which is what the clicking represents. Once displacement is without reduction, as yours is, the disc is no longer being recaptured on movement, and an appliance designed around recapturing it does not have that mechanism available. The rationale simply does not apply to your diagnosis.

            Are they effective and safe. Their evidence in the situations where they are used is mixed, with results over the longer term not clearly better than a flat-plane splint. And there is a real safety consideration that should be stated plainly: prolonged wear of an appliance holding the jaw forward can produce permanent changes to how the teeth meet, most commonly an open bite at the back, which then requires orthodontic or restorative treatment to correct. That is why, where they are used at all, it is usually for limited periods under close supervision. Any clinician proposing one should be asked directly how long you would wear it, how the bite will be monitored, and what the exit plan is.

            What actually helps in disc displacement without reduction is less interventionist than it sounds. Most such joints adapt: the tissue behind the disc remodels, and opening gradually returns over months. Conservative management for this produces outcomes comparable to more invasive approaches in most people. The components are graded controlled opening within tolerance rather than forcing range, reducing load through smaller bites and soft food during flares, no gum, chewing on both sides, supporting the chin when yawning, treatment of the jaw-closing muscles and the upper neck, and continued management of the bruxism.

            Measure your maximum opening in millimeters between the front teeth and record it weekly. Normal is around 40 mm. That number, and whether it is rising, is the only reliable way to know if the joint is adapting, and it is the measure any decision about further intervention should rest on.

9. Alastair December 17, 2021 Reply

   Twenty-five years ago, In a motor vehicle accident, the seatbelt hit my right jaw. The right TMJ was damaged, and a maxillo-facial surgeon gave me cortisone injections to ease the pain. The pain in my right ear and jaw region flared up occasionally but has now become a chronic problem. My doctor referred me to my dentist, who made an excellent mouthguard which I use every night and then to an ENT specialist, who referred me first to an audiologist and then to a maxillo-facial surgeon.
   
   All medical tests and scans have shown no ear damage, but the articular disc does not move to cushion my jaw against my skull. The maxillo-facial surgeon told me that he refuses to operate on the TMJ and will not inject anything into it. He strongly advises me never to go that route with anyone else. He referred me to a physiotherapist specializing in TMJ problems, but his treatment aggravated the pain. I am left with pain management. I cannot use the Tramacet-family of drugs or NSAIDs, so my options are limited. Codeine helps for two or three hours but has addiction problems, and paracetamol is useless. What pain-management measures can I take?

   1. Yama Zafer, D.C. December 25, 2021 Reply

      Your surgeon’s advice is sound and worth reinforcing rather than second-guessing. Where a disc has been displaced and non-reducing for many years, the joint generally adapts and functions without it, surgical results for long-standing displacement are mixed with a real reoperation rate, and repeated injections into the joint carry their own risks. Declining to operate on a joint that is painful but stable and functioning is a conservative position, not an unhelpful one.

      That said, being left with pain management is not the end of the options, and there are three things in your account that suggest the pain may not be coming from where everyone has been looking.

      The first concerns the physiotherapy that aggravated things. In a joint whose disc has been permanently out of position for twenty-five years, the aim cannot be to restore normal disc mechanics, because that is not achievable. Treatment directed at regaining range or mobilizing the joint will predictably flare it. What is appropriate at this stage is low-load work aimed at the muscles and at tolerance rather than at the joint’s mechanics. That distinction is often not made, and it explains a treatment that made things worse without meaning the approach itself was wrong.

      The second is the ear pain with normal ENT and audiology findings. That combination is characteristic of referred pain rather than ear pathology, and there are two common sources. The jaw-closing muscles, particularly the deep part of the masseter, refer pain directly into the ear and are a well-documented cause of ear pain in people with entirely normal ears. And the upper cervical segments, C1 to C3, refer into the ear, the angle of the jaw, and the side of the head. After a seatbelt injury to the jaw, the neck almost certainly took load at the same moment, and twenty-five years later it is frequently the part nobody has examined. If the upper neck has not been assessed, that is the most substantial gap in an otherwise thorough workup.

      The third is worth raising with your doctor specifically. Pain that follows nerve injury from trauma behaves differently from joint or muscle pain: it tends to be constant rather than movement-related, often burning or electrical in quality, and it responds poorly to the ordinary analgesics while responding to a different class of medication entirely. Given a direct blow to the jaw region twenty-five years ago and pain that has become chronic and continuous, post-traumatic nerve pain is a recognized diagnosis in this exact scenario and it is regularly missed. If your pain fits that description, ask your doctor whether medications used for nerve pain rather than for inflammation would be appropriate for you, which matters particularly since anti-inflammatories and the tramadol family are closed to you.

      One further option worth asking about, and it does not conflict with your surgeon’s advice: injection of botulinum toxin into the jaw-closing muscles is used for persistent muscular jaw pain. That is muscle rather than intra-articular, so it sits outside the advice you were given about injecting the joint, and it is a reasonable question to put to a specialist in facial pain.

      Practically, the things that reduce load on those muscles every day are worth being systematic about, since your mouthguard already handles the night. Check the resting position repeatedly through the day: teeth apart, lips closed, tongue on the roof of the mouth, with teeth touching only when eating. Keep bites small, avoid chewy food and gum, chew on both sides, and apply heat to the jaw and upper neck muscles rather than working them hard.

      Finally, for pain that has run this long, the approaches with the strongest evidence are not injections or surgery but structured pain management: graded activity, sleep, and pain-focused psychological approaches. That is not a suggestion the pain is in your head. It is that after twenty-five years the nervous system’s own processing is part of the problem, and those methods work on that part. A multidisciplinary pain clinic is a reasonable referral to request.

10. Eve December 4, 2021 Reply

    Hi, my jaw has been out of place for the past week. I suspect a displacement of my jaw’s disc. I’ve been to many places like the doctors and the dentist who has given me a splint but won’t receive of for two weeks, and my osteopath who has just massaged my jaw, neck, and head. Do you have any advice for me? I’m not in any pain apart from trying to open my mouth fully, which I cannot do. I’ve been looking at what to do and came across this website and was hoping for some advice.

    Thanks

    1. Yama Zafer, D.C. December 12, 2021 Reply

       What you describe, a sudden limitation of opening without much pain, is the pattern of the disc in the jaw joint having moved forward and stayed there, so it blocks the joint instead of gliding with it. Clinicians call this a closed lock. Two questions confirm it, and both are things you can answer yourself.

       Did your jaw click or pop before this happened, and did that clicking stop at the moment the opening became limited. That sequence, clicking for months or years and then abruptly stopping as the jaw locked, is close to diagnostic. The click was the disc snapping back into place with each opening. When it stops clicking and stops opening, the disc is no longer relocating.

       How far can you open, measured rather than estimated. Normal opening is roughly three of your own fingers stacked vertically between the front teeth, around 40 mm or more. A closed lock typically limits opening to around 25 to 30 mm, near two fingers. Measure it in millimeters with a ruler against your front teeth and write it down daily, because that number is how you will know whether anything is working.

       A second self-test distinguishes a locked disc from muscle tightness, which produces similar limitation and is treated differently. Open as far as you comfortably can, then use gentle finger pressure to encourage a little more. If it gives a few extra millimeters with a soft, springy end, that suggests muscle. If it stops abruptly against a hard barrier, that suggests the disc is blocking it. Also note whether your jaw swings to one side as you open, which usually points toward the affected side.

       On the timing, this matters and is the reason to be a little insistent. Outcomes for a locked jaw are generally better when movement is restored earlier rather than after prolonged restriction, because a joint held short for a long period tends to develop adhesions and the limitation becomes harder to reverse. Waiting two weeks for the splint without doing anything in the meantime is not the best use of that time. Ask the dentist whether they can see you sooner, or whether they perform or can refer for a manual reduction attempt, which some clinicians experienced with the jaw joint carry out in acute cases. That should only be done by someone trained in it.

       In the meantime, and this is the part you can act on today. Keep the joint moving gently within the range you have rather than resting it completely, several short sessions a day rather than one long one. Take smaller bites and soften food temporarily, but do not move to liquids only. Support your chin with your hand when you yawn, since an unguarded yawn is a common way to make this worse. Avoid chewing gum and tough foods, and notice whether you are clenching, particularly at night or while concentrating.

       Your osteopath massaging the jaw, neck, and head is reasonable and the neck genuinely contributes, but massage alone will not restore the range if the disc is blocking the joint. What restores it is graded movement, and if that is not part of what you are doing, it is the missing piece.

       See a doctor urgently rather than waiting if you develop swelling, fever, or difficulty swallowing, or if the jaw locks in the open position and will not close.