kind of you to comment!

very well explained thanks!

He definitely means medial and lateral - it's an area that is definitely overlooked at Dental school as we are used to seeing the anatomy of the TMJ in the sagittal view. Google for 'coronal view of TMJ' and it will become a lot clearer!

@JamesYoung24 sorry I only partially replied to the first few sentences of your comment (the email cuts it). Yes agreed that the most common displacement is anterior but if you look at the discal ligaments - they are only medial and lateral. When they elongate (damage, strain) the disc displacements can happen. For the disc to move purely anteriorly without any medial or lateral component can happen but its too simplistic. As the lateral pterygoid has a medial vector to it (origin of LP) more strain is placed on the distal ligaments hence many displacements are actually anterior with a medial component. Hope that helps!

@@protrusive The superior head of the lateral pterygoid is directly attached to the articular disc, via the (anterior) ligament. It's supposed to pull the disc forward when you open, and provide stability for the disc to return back when you close. When I was first learning TMJ anatomy, I would say that this muscle alone can give you a disc displacement. However, when I discovered the collateral (discal) ligaments, it ruined that thought. Because how can a disc displace anywhere in any significant way if the collateral ligaments are intact? It almost feels like the collateral ligaments keep the disc on the condyle and in place more so than the anterior and posterior ligaments. Though it's all connected, and if any piece of the puzzle goes, it can all go. What makes me sad is that the imaging we have is so, well, primitive. I wish I could image for the anterior, posterior, medial and lateral intracapsular ligaments, as well as the capsular (joint capsule) and lateral (extra capsular) ligaments, and get some definitive answers about their condition. Because it's one thing for any of those ligaments to stretch, and it's a whole different thing if any of those ligaments is torn. For a torn ligament I probably want surgery ASAP to reconnect or replace it. And for a stretched ligament I either want to give it time and pray it doesn't stretch further or gets torn up, or perhaps I want to try PRP/Prolotherapy/Stem cells, to cause some inflammation there and hope the ligaments tighten up. Yeah, I'm completely ignoring the teeth it seems. I think teeth matter a lot. I don't believe that the bite is responsible only for a tiny amount of TMJ problems. A lot of TMJ experts seem to think so, and I think it's nonsense. But once you cross the line of muscular TMJ to intracapsular TMJ (internal derangement, clicking), I just don't see how fixing the bite will restore things to normal. Unless we want to put our faith in the unknown, and fix the bite, and then hope that in due time the body readjsts the ligaments and the disc into an optimal place again. I also fear the bite adjustment after a disc displacement. What if you adjust the bite to chase the displacement, and in chasing the displacement you make it even worse. TMJ needs a lot more research. You can visit some Facebook groups for TMJ, and people are suffering. They're suffering for 20 and 30 and 40 years, with no relief. It's very sad. Lives are ruined. Jaw pain, jaw clicking, muscle pain, vertigo, eustachian tube dysfunction, ear pain, hearing loss, eye floaters, vertigo, dizziness, swollen lymph nodes, swollen tonsils, inability to eat normally, inability to speak normally, clicking necks, tense necks droppy eyes, uneven shoulders, and the list goes on. TMJ is hell. I'd rather have both of my legs and arms broken than to have an intracapsular TMJ problems. The arms and legs will heal, the TMJ won't :(

​@JamesYoung24 some great reflections and I agree a lot especially that we need more research (easier said than done to get good quality research though). One minor point to add is part if the problem with the collateral ligaments is that they don't stretch and recoil, instead they elongate in response to stress. If the ligaments had more springback they would be more resilient and we would see less disc displacement. Thanks for the comment!

Excellent comment (that made me laugh, thank you!) I was frustrated for a long time about this. This is why I tried to learn as many philosophies as possible (and the literature on active TMD treatment is sparse and of poor quality ie. no concrete conclusions). As you mentioned, I created SplintCourse to share as GPs, exactly when (and how) I give stabilisation splints, B Splints and other AMPSAs, soft bite guards and Aqualisers. In practice I also use repositioning splints but I do think at that stage most GDPs should be referring if possible as thing (phase 2) can get very complicated. If ever you get such a panel and get to ask them the question....think of how a question about single tooth dentistry would vary among every Dentist - can you imagine how varied the management of TMD would actually be?