#155 Click! Click! Click! Click! Click! Click! Click! Click! and TMD

Why am I having all this noise coming from my jaw joint?  

 If you are a patient with Temporomandibular Joint Disorder (TMD), it’s important that you understand what it really means to have clicking in your Temporomandibular Joint (TMJ) and what it doesn’t mean. 

Noise coming from the jaw joints is a sign that there is something going wrong.  It’s a warning that there is trouble ahead.  When it first occurs, most people ignore the warning since it does not create pain.  Patients think that because there is no pain associated with the clicking it’s not important, and there is nothing to worry about.  Nothing could be further from the truth. 

First let’s define TMD.  TMD is a disparate set of symptoms which includes frequent and/or recurring headache, earache, neck pain, jaw pain, ringing in the ears, subjective hearing loss or a feeling of fullness in the ears, dizziness/vertigo, upper back and shoulder pain and tightness, arm/hand/finger tingling and numbness, and various kinds of jaw locking.  Each of these symptoms is directly created by chronic inflammation with the jaw joint. It occurs when the joint is damaged due to clenching and grinding the teeth (Bruxism), acute traumatic events to the face, head, or jaws, and something called functional malocclusion when your bite is so bad it overloads the joint. 

When the joint is damaged the body answers the insult by bringing inflammation to the area of damage.  (INFLAMMATION IS THE BODY’S RESOPONSE TO DAMAGE IN AN ATTEMPT TO HEAL).  If the damage does not heal in a reasonable amount of time the inflammation changes characteristics and converts to something called chronic inflammation.   

The TMJ has three main parts.  1. The socket (Fossa) into which fits a 2. ball (Condyle), and 3. a cushion of cartilage about the size of a dime, called the (Meniscus) that fits between the ball and socket.  It is this cushion (Meniscus) which makes all the noise.   

Chronic inflammation within the TMJ causes the ligaments that hold the cushion (Meniscus) in place to get loose.  Once it becomes loose it starts to click back and forth within the joint. (Click!, Click!, Click!, Click!, Click!) As the ligaments become loose over time the clicking becomes more prominent until the meniscus is so loose it is pushed out of the socket in front of the ball as the joint moves. This results in a louder POP which is now usually associated with pain.  When this is also ignored for a length of time, the jaw joints begin to lock and the patient will have trouble opening their mouth, and jaw locking will occur.   

Joint noises and clicking are usually the first signs that there is jaw damage and jaw locking is the final end stage of TMD.  Patients almost always have many of the other symptoms of TMD after it starts clicking and before it starts to lock.  TMD is a progressing disease which begins with clicking and ends with locking.  Headaches and neck pain are the two most frequent symptoms associated with TMD.  All the symptoms, including locking, begin to go away and dissipate when the joint is treated with an oral device and protocol which unloads the jaw joint like a set of crutches unloads a damaged knee.  However, clicking is classified as a sign rather than a symptom.  A SIGN is an objective observation, and a SYMPTOM is a subjective perception of the patient.  Symptoms will eventually go away, but once the joint becomes noisy, it’s always going to make some kind of noise and can vary between, click, pop, crunch, or a grating sound.  Sounds are signs of the disease and objectively heard by both patient and doctor.  Symptoms can be fixed; the sign of joint noises will most often remain. 

Because TMD is most prevalent in females because estrogen exacerbates inflammation, females will usually start to hear clicking in the TMJs in early adolescence, ages 11 to 15.  This warning should not be ignored.