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Normal TMJ anatomy

Jaw Clicking (Popping) Explained

TMJ Jaw clicking or popping on one or both sides is a common problem affecting millions in the United States. Jaw clicking may occurs while chewing, yawning, talking or mouth opening. Although, jaw clicking is not painful in most cases, it might be annoying and cause social embarrassment. Understanding how the jaw noises occur is a key to stop jaw clicking.

Understanding Jaw Popping

To understand why you have jaw clicking on one side or both sides, you should understand the anatomy of the temporomandibular joint (TMJ) and how it works.

The TMJ is the hinge joint of your jaws. It is located directly in front of your ear that allows your mouth to open and close properly. The TMJ is an anatomical structure that found on both sides of the head. The temporal part of the TMJ is a shallow socket called the articulating fossa while the mandibular part of the TMJ is a rounded bony projection called the condyle.

Between the fossa and the condyle located the cartilage disc. The TMJ disc maintains its relation to the TMJ condyle by 2 ligaments called the medial and lateral collateral ligaments. This disc helps the jaw to move smoothly without friction. The boney structures of the TMJ and the disc are surrounded by a fibrous sheet called the capsule. However, the movement of the jaw is carried by the muscles of mastication and limited by ligaments. The spaces between the different parts of the TMJ are filled with a viscous fluid called the synovial fluid. The synovial fluid act as a lubricating media between the TMJ parts allowing smooth none-friction movement of the jaw.

What happen when you open your jaw?

A bird opening very wide

During the first 25mm of mouth opening, the TMJ condyle rotate inside the fossa, it does not move or translate. When you open more than 25mm, both the condyle and the TMJ disc move forward to allow wider opening without closing your airways. This is called jaw translation. When you close your mouth, the TMJ translates backwards first then rotates in opposite direction to mouth opening.

 

Normal TMJ Front View

Why Your Jaw Click?

There are six common mechanisms for jaw clicking or noise in your TMJ.

1. TMJ disc dislocation with reduction

Let me explain that. We said that the disc is held in place with collateral ligaments that helps the disk to move only when the TMJ condyle moves. Sometimes, the collateral ligaments get stretched and the disc dislocated in front or anterior-medial to the TMJ condyle. In this case, when your mouth is closed, the disc is not between the condyle and the fossa anymore, it is outside. This is called disc dislocation.

If your disc is dislocated and you open your jaw, the first 25mm, you need only rotation movement that can happen without having the disc in the correct position. If you need to open your mouth more than 25mm, the condyle needs to translate forward. When the disc is dislocated, one of two scenarios will occur:

The first scenario: the disc is locked forward and does not move back over the condyle when the condyle translate. In this case, you will have a closed locked jaw or what is called, disc dislocation without reduction. Patients with locked jaw may not be able to open the mouth more than 30mm (average normal mouth opening is 45-55mm).

The second scenario: the disk will slide back over the condyle during translation to allow the jaw to allow norma maximum jaw opening. When the disc slides back, a popping or clicking south will occur. The strength of the clicking sound depends on the friction the disc has while moving back. This condition is called, disc dislocation with reduction.

Unfortunately, when you close your mouth, the disc will slide out again because the stretched collateral ligaments cannot keep the disc in normal position between the condyle and the fossa. This is why you may feel jaw clicking during jaw closing.

2. TMJ disc shape distortion

The TMJ disc is a donut shaped structure. Continuous micro trauma during teeth grinding and clinching might cause the disc to loose its shape. A distorted disc might not stay in place during jaw opening causing a clicking jaw sound. 

Dr. Khalifeh recommends managing teeth bruxism as early as possible to avoid long term TMJ and teeth complications.

3. TMJ Arthritis

Like other joints in the body, your TMJ might get arthritis. Arthritis is inflammation of the joints that might cause pain, swelling, movement limitation and bone resorption. Osteo arthritis, rheumatoid arthritis and other forms of arthritis associated with lime disease, joint infection and autoimmune conditions such as lupus may affect your TMJ. 

TMJ arthritis can make cracking or crepitus noise while moving your jaw. We recommend that you get help ASAP if you are suffering from TMJ arthritis. 

4. Muscles spasm or muscle cramp.

A sudden involuntary contraction of your jaw closing muscles may restrict the TMJ movement and cause jaw clicking. Generally speaking, this might be a temporary problem that self resolve whenever your muscles recover and restore their normal function. 

5. TMJ disc sticking to the fossa.

This condition is caused by loosing the TMJ lubricating media (synovial fluid). Not having enough synovial fluids caused by trauma, arthritis and aging may cause your TMJ disc stick to the fossa and produce TMJ noise on jaw movement. 

However, Dr. Khalifeh might inject Sodium Hyaluronate (Hyalgan) or Plasma Rich Fibrin (PRF) into your TMJ. This will help lubricate you TMJ and reduce your pain and jaw clicking noise.

6. TMJ disc perforation.

Continuous trauma to the TMJ might perforate the disc and cause bone to bone friction during jaw movement. This is usually associated with severe pain and crepitus sound on jaw movement. 

 

The following youtube video by Dr. Westesson and Dr. Eriksson is a great visual tool to understand jaw clicking. 

What Conditions Causes Jaw Clicking?

Anything that stretches the collateral ligaments or alter the TMJ structures may cause your jaw click on on one side or both sides. The causes could be one ore more or the following:

  • Bruxism or teeth grinding.
  • Myofascial pain syndrome.
  • Muscle spasm.
  • Jaw trauma during fights, physical assaults, trips and falls.
  • Some habits like pencils biting, ice chewing, nail biting, and excessive gum chewing.
  • Orthodontic treatment.
  • Bad bite.
  • Genetics.
  • Joint disease such as rheumatoid arthritis, osteoporosis arthritis, Lupus, psoriasis, lime disease etc.. 
  • Diseases associated with increased joints flexibility (Ehler Danlos Syndrome).
  • Too wide mouth opening while eating or yawning.
  • Sport injuries.
  • Automobile accidents (whiplash injury).
  • Sleep disorders such as sleep apnea.
  • Tumors.

Should I Be Concerned About My Clicking jaw?

Jaw clicking is painless in most cases. Therefore, no treatment may be needed for chronic, pain free clicking joint. Dr. Khalifeh recommend treatment if the clicking is new or associated with pain and jaw movement restriction during normal functions such as chewing and talking. However, a clicking TMJ that is associated with pain or dysfunction while eating, swallowing or talking warrants seeking immediate help. 

In addition, a clicking sound in your TMJ that just happened should be discussed with a TMJ specialist ASAP. 

How is Jaw Clicking Treated?

How to stop jaw clicking on one side or both sides? As mentioned earlier, whenever the TMJ disc get dislocated, it will be very hard to put it back permanently. Therefore, many surgical and none surgical procedures were recommended to put the disc to its original location after being dislocated. However, none of the techniques used were successful. After that, a painless clicking jaw need no treatment. When jaw clicking is associated with pain while chewing or talking , many medical and home remedies are suggested to relief your TMJ symptoms. 

What are Medical Treatments Available for Painful Clicking Jaw?

Depending on the cause of the jaw clicking or the existence of other medical conditions, professional interventions may be needed.

Medical treatment options to stop jaw clicking on one side or both sides during normal functions such as chewing and talking include:

Home Remedies for Painful Clicking Jaw

Final Thoughts on Jaw Clicking

Generally speaking, jaw clicking when chewing or talking is a painless condition that can be managed with home therapy and lifestyle changes.

However, people who have a persistent painful jaw popping, that recurs, or restricts your jaw movement, should consult their doctor. Therefore, it is important to treat the underlying cause of jaw clicking to prevent other complications from happening.

Who I should see for my jaw clicking in Los Angeles?

Dr. Mohammad Khalifeh, DDS, MS. Is board-certified Orofacial Pain and TMJ specialist. He is a Diplomate American Board of Orofacial Pain. Above all, Dr. Khalifeh is TMD and Orofacial Pain Board Certified doctor. Additionally, for over 25 years, Dr. Khalifeh is helping patients with TMJ and jaw pain in Los Angeles, Miracle Mile, Park La Brea, Beverly Hills, Larchmont Village, Hollywood, Santa Monica, California, and the rest of the word.

Our address: SAG-AFTRA Plaza, 5757 Wilshire Blvd., Suite #5, Los Angeles, CA 90036

Phone: (323) 933-3855

 


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