Temporomandibular disorder or TMD is the problem in TMJ (temporomandibular joint) and the muscles controlling jaw moments. TMD can be the result of damage to the cartilage from arthritis, injury to TMJ, displacement of articular disc. The major symptom of TMD is clicking jaw, accompanied by jaw pain while extending mouth or while chewing.

Clicking jaw could be very loud and noticeable to others near you while you are eating or even talking. This noise can be very troubling and may or may not be associated with the experience of pain.

TMJ complications are affecting millions of people but it is found that women are more susceptible to these disorders. In most cases, the pain and discomfort of TMJ are temporary and can be relieved by self-managed care.

This problem can be annoying and painful, leading pain in the jaw region, headaches, neck aches, difficulty in opening and closing of the mouth.

Moving further in this article, we will understand in detail about TMJ,

How temporomandibular joints work?

Temporomandibular joints are two joints on either side of the skull connecting the jawbone to the skull. Major components of this joint are the joint capsule, articular disc, mandibular condyles, articular surface of the temporal bone, temporomandibular ligament, and lateral pterygoid muscle.

Condyle of the mandible and temporal bone are actually separated by an articular disc, which divides the joint into two distinct compartments. The disc cushions the load while enabling the jaw to open widely and rotate or glide.

The mandible (jaw bone) can move side to side, as well as backward and forward, making it one of the most complex joints in your body. The joint with muscles attached to it enables you to perform a range of motion like yawning, talking, chewing. (1)

Signs and symptoms of TMD

  1. Pain or tenderness in the jaw joint area while chewing. (2)
  2. Locking of the jaw, making opening and closing of mouth very difficult.
  3. Swelling on the side of the face near TMJ
  4. A clicking or popping sound is heard while opening or closing of the mouth. This may or may not be painful.
  5. Pain in face, TMJ, area around ears and neck and shoulders, muscles on the side of your face.
  6. You may also have toothaches, headaches, and ear pain.

The clicking sound can be annoying but doesn’t always confirm TMD, if there is no pain associated to this clicking or popping sound it may not require TMD treatment.

Immediately contact your dentist or your TMJ specialist if you have a continuous pain or tenderness in the jaw joint.

What makes the clicking sound in the jaw?

The disc separating jaw bone and temporal bone of skull (which forms a socket of the joint) is displaced forwards from its normal position, this can occur due to a number of reasons.

When the disc is relocated to its normal position due to jaw moments, the clicking sound is heard. Clicking that occurs on both opening and closing of the mouth is called a reciprocal click.

This sound indicates that there is something wrong with the position of the articular disc.

Causes for clicking jaw sound

  • Excessive forces on the joint from clenching, grinding, or extended mouth opening or trauma can disturb the disc position causing the disc to become displace forwards
  • The muscle that attaches to the disc can become overactive or go into spasm from overuse when the mouth is opened for a long time
  • Arthritis is a joint disease in which destruction of cartilage in TMJ occurs and can cause structural problems, which leads to disc displacement with popping sound and clicking sensation in the joint
  • A jaw injury to jaw due to some accident or sporting injury can lead to disarticulation of the joint
  • Malocclusion of teeth can cause problems with the aliment of upper and lower jaw bones, which is known as an overbite or underbite. It requires proper orthodontic treatment (3)
  • Sometimes popping can be caused by an infection in mouth glands

Should you be worried about clicking jaw?

Not always a clicking jaw indicates a problem with TMJ. Jaw popping without accompanying pain is not typically a cause for concern. This happens when the jaw is almost at its widest opening, like yawning.

That’s a normal occurrence caused by the hyperextended lower jaw. The Jaw popping can often be treated at home, especially if there is no pain or other symptoms.

The popping which involves displacement of the disc that is more concerning. This type of the jaw popping is very painful and requires immediate medical attention. These cracking noises with pain can be an indication of severe temporomandibular disorders.

Diagnosis of TMJ disorders

There is no standard procedure for the diagnosis of TMJ disorders such as TMD. The doctor notes down patient’s symptoms, take a detailed medical and dental history of the patient, examines affected area including head neck and face.

Blood tests are done to rule out possible medical problems to identify TMJ disorders. MRI and CT scan are recommended it provides a clear view of the bones of TMJ, disc and other soft tissues are also visible. (4)

Medical Treatment options

Oral splints or mouth guards

A mouth guard covers the teeth and gums and protects them from any injury.  Is most often used to prevent injury in contact sports, as a treatment for bruxism or TMD, or as part of certain dental procedures, such as tooth bleaching or sleep apnea. (5)

Physical therapy

stretch exercises with heat and moist to strengthen jaw muscles.

Arthrocentesis

involves the insertion of small needles into the joint so that fluid can be irrigated through the joint to remove debris and inflammatory byproducts.

TMJ arthroscopy

A small thin tube (cannula) is placed into the joint space, an arthroscope is then inserted, and small surgical instruments are used for surgery. (6)

Open-joint surgery

If your jaw pain does not resolve with more-conservative treatments and it appears to be caused by a structural problem in the joint then there is need to repair or replace the joint. This method is very risky.

Natural remedies

  • Try avoiding extensive chewing and shift to soft food and the liquid diet
  • Use non-steroidal anti-inflammatory medicines to reduce the swelling and pain
  • Practice stress management exercises
  • Relax your jaw by leaving the jaw open so a little space is present between the two jaws
  • Avoid activities which require over extension of mouth like yawning, singing and chewing gum
  • Apply ice and moist heat alternatively on your joint
  • Keep in mind not all jaw pain comes from over extension, a popper care of oral health is necessary

Final words on clicking jaw and TMD

Most temporomandibular joint (TMJ) disorders, such as TMD, improve over time and do not become worse. It is very rare to have any complications with this condition.

Most people do not need a surgery and they get better with simple treatments. Regular checkup with your dentist physiotherapist makes the course easier.

The major symptom of TMD is clicking jaw, accompanied by jaw pain while extending mouth or chewing. Jaw clicking could be loud & noticeable to others near you.