Reductible anterior disk displacement of the temporomandibular articulation: Development of an educational support for patients and health care professionals

Abstract: Joint clicking has a prevalence of 18 to 35% in the general population. Temporomandibular joint sound are the essential diagnosis criteria for three out of the twelve TMD-diagnosis on the axis 1 of the DC/TMD. Meanwhile, clicking jaw appears to not caus pain but some of its predisposing factors are similar to those responsible for pain onset. Yet, clicking can be the primary reported complain from patients and could be a precursor sign to avoid pain onset. This narrative review aims to create an educational tool enabling an easier and clear way to take over a first session of a pain free clicking jaw by suggesting an infographic that could be given to the patient and usable for both patient and health care professional. Method: A review of the literature was conducted across Pubmed, PEDro, Embase, Cochrane and Scopus databases. Information was extracted by 1 investigator and conflicting studies were discussed with two independent TMD experts. The infographic development method was based on recommendations from 3 studies involving the use of educative physical support for the patient. Results: 34 studies met the inclusion criteria. Clicking did not appear to be responsible for pain onset. Clicking seemed to be stable or naturally decrease over time. In case of painful clicking jaw, clicking can persist after pain disappeared. Prevalence of clicking was high in the general population (18 to35%) as high as in the painful TMD population. Predisposing factors were essentially psychosocial and poor habits. Finally, a pain-free clicking jaw did not need any treatment, recommended treatment in case of painful clicking jaw is multimodal treatment and irreversible treatments were always contraindicated. Discussion: This narrative review produces an evidence and expert-based educative infographic that can help first lined health care professionals that encounter clicking jaw the most. Those therapists are dentists, physiotherapists, and psychologists but it aims to be usable for all health care professionals. This tool has been developed but not tested and not validated in this study thus its clinical efficiency has not been stated. Nevertheless, it provides the first practical development for further research about its validity and/or the development of other tools for the other parts of TMDs. Conclusion: This tool can be used in a routine by health care professionals encountering pain free clicking jaw, and so in order to reassure and downplay the situation using the patient infographic as an education support and an information for home and with the professional infographic as an easy access or a reminder of the knowledge about the clicking jaw. Further studies should validate the tool by investigating its effects on the evolution of TMD symptoms or pain onset, its ease of use in practice as well as for the patient.