#117 Fact Checking TMD/TMJ (Part 2)

This is the second in a series of articles written to dispel the confusions, inaccuracies, fixed ideas, and poorly constructed theories presented as facts concerning Temporomandibular Joint Disorder, (TMD).  Today, we’ll focus on joint noises. 

Noise emanating from the jaw joints is the most common sign, and or symptom of Temporomandibular Joint Disorder. Notice I used the words “sign” and “symptom”.  In medical diagnosis, a sign is an objective finding that can be seen or experienced by another person, and a symptom is a subjective complaint that is experienced only by the person with the disease.  In the case of noise emanating from the TMJ, it can be both a sign and a symptom. Sometimes only the patient can hear the noise while more frequently, both the patient and the observers can hear the noise.  

Noise emanating from the TMJ is usually the first indicator that something about the joint is amiss.   Because noise is not painful, the patient will, more often than not, ignore it until becoming painful or some other signs and symptoms of the disease present themselves.  The description of the noises can vary widely with sounds of clicking, popping, crunching, squeaking, and  “Rice Crispies” among the most common.  

It is not a good idea to ignore a noisy joint since it is an indicator that something is wrong.  But just because a joint is noisy, does not mean the joint requires treatment.  That depends on the number and degree of the other signs and symptoms present. In our practice, when a patient presents with only noise and no other signs and symptoms of TMD/TMJ, they are told to return when other symptoms occur.  Many patients have noisy TMJs for years who never experience any of the other well-known symptoms.  Although noise is an indicator of a damaged joint, it is up to the patient to decide when the signs and symptoms of TMD are severe enough to warrant treatment.  Alternatively, it is not unusual for a patient to seek prophylactic treatment to prevent mild symptoms from developing further. 

The noise, of all varieties, is created by the ball of the joint slipping over the disc or cushion between the ball and socket of the joint.  Much too much emphasis is placed on the noises from the joints by some health care providers.  Some will even pull out a stethoscope, listening intently to the sounds, as if the type, amplitude, or frequency of the sounds makes a difference in the ultimate diagnosis or treatment.  Although it may make the doctor look very clinically interested and professionally important by using the stethoscope from around his neck, (Think “Gray’s Anatomy” or for the older generations, “Dr. Kildare”), joint noises play no part in the differential diagnosis or treatment of TMD/TMJ.  Joint noises simply indicate the joint is deteriorating.  If the onset of the noise is recent, it indicates the joint has started to deteriorate recently.  If the joint noise has gone on for years, it indicates the deterioration of the joint began to occur years ago.  The occurrence of joint noises simply means there has been damage within the joint. A perfectly healthy joint does not make noise, while on occasion, a very damaged and diseased joint makes no noise at all. 

There has been much confusion among patients and doctors about the importance of noise emanating from the TMJ. Ultimately, the noisy joint just indicates a need to take a more thorough history and physical examination.  The different varieties or amplitude of the sounds are basically unimportant. Once a joint becomes noisy, it is always going to have noise of some type, and these often change in character from time to time. 

Sometimes the noisy joint occurs simultaneously with intermittent or permanent locking of the jaw joint.    Locking of the jaw joint is the ultimate sign and symptom of the noisy joint gone untreated.  This set of circumstances demands immediate treatment since it can only get worse and not better. 

Final Conclusion:  Pulling out the stethoscope and listening to joint noises is good for its dramatic effect but adds nothing to the decisions necessary to treat the disease.