TMD Symptoms: Clicking or Popping Jaw
Jaw clicking, popping, or snapping is the most common of all TMJ Symptoms.
There may or may not be pain in the jaw when the clicking or popping sound is heard. The clicking sound may even be so loud that others can hear it when you chew or speak. However, it is not always cause to see TMJ specialists.
Usually the cause of the popping jaw is a displaced disc in the jaw. The jaw joints are ball and socket joints, just like the shoulder joint. When ball and socket joints are functioning properly, the ball and socket do not touch because of a thin disc of cartilage located between the ball and socket. This disc of cartilage is held in place and guided by a muscle and when it slips during jaw movement it can make all sorts of sounds most commonly they are a jaw popping or clicking sound. Read on to learn why the jaw may make a series of different sounds and how these may be related to TMJ.
JAW POPPING AND CLICKING
These common symptoms refer to noises from the joint during jaw movement that may be intermittent. Joint noises tend to be described as clicking, popping or snapping or in scientific terms crepitus.
Jaw Clicking /Snapping
Clicking is the most common TMD-related sound. It’s a single sharp sound that occurs suddenly while you are opening your jaw. The sound occurs when the disc that rests between the rounded part of your jawbone and the socket into which it fits have been displaced. When you open your jaw, this disc slips back into place, causing the sharp clicking sound. Occasionally, there will be a similar sound when the jaw is closing and the disc slips out of place again (this is less common). The jaw snapping sound is normally caused by a more pronounced relationship between the jaw muscles, boney structures and the soft tissue of the cartilage.
Jaw Popping is another sound that people report when describing TMD-related sounds. This popping sound is caused by different factors. First, if the disc slides back in to place a little later, the mouth is open wider. This creates a greater resonance cavity that can dull the sharpness of the sound, making it more like popping rather than clicking sound.
Second, it may also be due to the anatomical shape of the joint parts that can cause a rounder sound.
Crepitus is the scientific word for multiple, grating, rough sounds. These sounds occur when your bones are actually grinding together. More specifically, the cushioning disc has been damaged by wear, constant displacement, injury, or disease. Grinding may also occur when the disc is displaced and the joint is now resting on the soft tissue designed to hold the disc in place, not to cushion the bones.
Typically, crepitus is a sign of an advanced TMJ disorder. Please talk to a trained neuromuscular dentist to diagnose TMJ before your joint reaches the crepitus state.
Anatomy of TMJ
To understand why the joint noises occur, we first need to understand the basic structure of the temporomandibular jaw joint (TMJ).
The TMJ is the dual articulation of the mandible with the skull. It involves the condylar process of the mandible below, and the articular fossa (or glenoid fossa) of the temporal bone above. Sandwiched between these two surfaces is the articular disc (or meniscus).
Each TMJ is covered by a fibrous capsule. There are tight fibers connecting the disc to the mandible. Loose fibers also connect the disc to the temporal bone. Therefore, we can say that there are two joint capsules, creating an upper joint space and a lower joint space, with the articular disc in between.
This disc is nourished by the slick synovial fluid which aids in the smooth movement similar to a lubricant for door hinges.
The back of the disc is attached to the back of the joint with a soft band of tissue that has blood and a nerve supply. The front part of the disc is connected to a small muscle (lateral pterygoid muscle) that pulls it forward during the opening of the jaw. The discal ligaments hold the disc tied down to the head of the condyle.
Mechanisms of jaw noises
Now that we have a better understanding of the parts involved in TMJ, we can start to examine why the joint noises occur during TMD. Most joint sounds are due to internal derangement (instability or abnormal position of the articular disc) of the TMJ.
Why is my jaw clicking?
Clicking is caused by an anteriorly misaligned disc in relationship to the mandibular condyle. This means the cartilage isn’t moving or setting correctly with the movement of the jaw bones in the TMJ. In healthy a TMJ joint, the disc is always positioned directly on top of the condyle throughout the entire opening and closing cycles, acting as a cushion to promote smooth and comfortable rotation and translation of the condyle.
When the disc is anteriorly misaligned relative to the mandibular condyle, the condyle slips under the disc as it translates anteriorly during opening which causes an opening click. When the jaw closes, the condyle resumes its former position posterior to the disc often resulting in a closing click as it slips back over the posterior edge of the disc.
Clicking often accompanies either jaw opening or closing, and usually occurs towards the end of the movement. This may be associated with TMJ lockjaw if the disc displaces and does not move back in to position which may occur if a condition goes untreated. In most cases this is a treatable condition and does not require any sort of jaw surgery.
Are Jaw Sounds the Same as Crepitus?
Crepitus usually indicates advanced TMJ damage. Crepitus is usually due to a tear in the disc or the posterior attachment which produces bone to bone contact of the mandibular condyle with the joint socket. Eventually, this causes wearing or flattening of the condyle head. Crepitus is usually associated with pain and limitation of opening.
Crepitus often indicates arthritic changes in the joint, and may occur at any time during mandibular movement, especially lateral movements. When arthritis has occurred in the jaw joint a neuromuscular dentist may need to conduct a scan to diagnose the advancement of the TMJ dysfunction condition and recommend a proper treatment.
Causes of Jaw Sounds
There are many factors which can lead to joint noises including excessive bruxism (tooth grinding and night grinding), acute trauma, partial subluxation or damage to the disc, lateral pterygoid dysfunction (Jaw muscles are not working properly) or occlusal imbalance (a bad bite).
Sometimes, the loss of posterior teeth or poor fitting dentures can cause an over- closed bite. This leads to an anteriorly misaligned disc relative to the condyle resulting in clicking. With an over-closed bite, the condyle swings toward the posterior of the joint space, behind the disc, as the jaw over-closes leading to joint noises.
If you have postural problems, that may also lead to an anteriorly misaligned disc due to posterior positioning of the condyle in the joint space. However, this is due to muscle pull rather than an over-closed bite.
When is TMJ clicking or popping a problem?
A normal, healthy TMJ is quiet during function. It is easier to tolerate and minimize the use of other joints in the body afflicted by arthritis. The TMJ, however, is in use every time you eat, speak and swallow which happen 10,000 times a day! Thus, TMJ clicking, popping and crepitus can really impact the quality of one’s life if it advances.
Although the clicking may not be accompanied by pain, the actual sound can be so loud that others can hear it when you chew or speak. Some patients find the noise to be socially embarrassing, especially when eating in public. Due to the proximity of the TMJ to the ear canal, joint noises are perceived to be much louder to the individual than to others.
A clicking and popping TMJ may lead to irreversible damage to the joints if it becomes consistent. It is best to take corrective action at an early stage. In the case of crepitus, it is a sign that the condition has reached a degenerative state. By the time that a patient experiences crepitus, TMJ treatment options may be limited and, as a last resort, surgery might be the only course of action available.
Is Jaw Popping The Same As TMJ?
To be clear, TMJ refers to the joint, the correct question would be “Is jaw popping the same as TMD?” which refers to the disorder.
Clicking alone is not diagnostic of TMD since it is present in a high proportion of the general population, mostly in people who have no pain. However, clicking along with pain or other TMD symptoms can indicate impairment of TMJ function and can require a checkup by a trained neuromuscular dentist who will listen to the TMJ with a stethoscope to detect joint noises to begin their diagnosis.
Clicks of the joint may also be palpated over the joint itself via a finger inserted in the external acoustic meatus, which lies directly behind the TMJ.
The differential diagnosis is with degenerative joint disease (e.g. osteoarthritis), rheumatoid arthritis, temporal arteritis, otitis media, parotitis and mandibular osteomyelitis.
By running these TMD tests, the specialist or neuromuscular dentist can begin to analyze the health of the joint, position of the bite and the relationship between the different parts of the TMJ throughout the path of the jaws movement.
How to Treat a Popping Jaw
Many patients tolerate clicking for many years without pain or functional difficulties. Jaw noises alone without pain or limited jaw movement do not tend to indicate a TMJ disorder. In these instances, treatment is not required and observation and relevant information is the best course of action.
If you experience pain and/or locking, then treatment tends to be required. Therefore, it is best to manage clicking and popping by ensuring that the jaw has a healthy bite using the neuromuscular TMJ treatment techniques before it leads to issues associated with crepitus or “closed lock’ (difficulty opening the mouth) which are more likely to need intra-articular steroid injections, arthroscopy and surgery.
There are also exercises and home remedies that you can use to help get relief from symptoms:
Why Neuromuscular Dentistry?
“TMJ is mistakenly thought of and treated as just a ball and socket joint comprising of head of mandible and glenoid fossa with cartilage in between. The attaching muscles are completely missed and ignored in the diagnosis and treatment of TMD symptoms.” says Dr. Mark Duncan, DDS, the clinical director of LVI Global.
Specially trained neuromuscular dentists start the diagnosis and subsequent treatment with soft tissues. The focus is first on attaching muscles, their origin and insertion and their physiologic rest position. TMD symptoms such as jaw clicking, popping and crepitus can be eliminated by restoring a balanced relationship within your TMJ and facial muscles with the help of TMJ orthotics, TENS therapy, restorative dentistry and other home care measures.
This is why there is a high rate of success in treatable advancements of the condition. This often helps patients avoid use of narcotic pain killers, surgeries and other treatments that may have side effects while ignoring the root cause of the condition itself.
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