#198 Why is My Jaw Clicking and Popping?

The most common sign of Temporomandibular Joint Disorder (TMD) is joint noise.  Notice I said SIGN of TMD, not symptoms.  The main difference between the two is a sign is objective evidence of a disease that can be seen or measured by others, while a symptom is a subjective experience felt only by the patient.  Often, the noise coming from the temporomandibular joint (TMJ) during jaw motion can be heard by others.  Sometimes, it can be so loud it can be heard by people eating at the next table in the restaurant. (How embarrassing.)  

Another difference between a sign of TMD and symptoms is that symptoms can be controlled and eventually diminished, while the objective sign of joint noise, once established, will always remain in some form or another. 

Let’s first describe and define why there is joint noise in the first place.  The temporomandibular joint (TMJ) in laymen’s terms, is composed of a ball and socket. In between the ball and socket is a small piece of cartilage about the size of a nickel with a bi-concave surface. 

The disc is held in place with ligaments around its circumference.  These ligaments become loose and stretched when the joint is damaged.  The damage causes chronic inflammation, and it’s the chronic inflammation within the joint that damages the ligaments.   The loosened disc then jumps back and forth over the prominent point of bone in front of the disc as the jaw is opened and closed causing the clicking or popping sound. 

In the early stages of TMD there are no symptoms of the disease.  There is only the clicking. But this is a sign that there is something going wrong with the joint.   There is no pain involved, no headaches, earaches, jaw pain, or neck pain.  Most people ignore the clicking when there are no painful symptoms.  The clicking may go on for a while until there is enough manifestation of the chronic inflammation within the joint to create some of the subjective painful symptoms. 

By the time the patient begins to have painful symptoms TMD is often advanced to the point that parts of the joint have begun to degenerate. 

Once the degeneration of the joints begins it’s a slippery slope.  There is no way to predict how fast the joint will degenerate.  In some patients the process goes slowly and may take decades for the degenerative changes to show up on an x-ray.  And in other patients, the degeneration develops rather rapidly, and evidence can be seen in a couple of years.  One thing is for sure. Once the process starts, it always progresses.  TMD is a progressive disease. 

Because estrogen exacerbates inflammatory processes, TMD is almost pandemic in adolescent females.  The first sign of clicking is almost always seen between the ages of 12 or 13 and early 20’s.  Sometimes the clicking goes on for decades before any symptoms appear.  So, I always tell the patient, or the mother of the patient to return when they have symptoms and not treat a clicking joint unless the patient or mother insists on treating the noise prophylactically.  

In summary, the TMJ becomes damaged because of 1. Bruxism, 2. Acute trauma, and 3. Functional Malocclusion.  The damage creates inflammation which then creates chronic inflammation, which then causes the TMJ ligaments to loosen, which then causes the disc to click when the jaw moves.