Temporomandibular disorders

In some individuals, a popping sound can be heard when they move their jaw joints, such as when they talk, yawn, or eat. You might be concerned about such noises, but they are usually more of a social inconvenience than a genuine health issue. Occasionally, the jaw joint can become painful, get stuck, or you might experience difficulty while chewing.

This pages provides further information on the causes of a popping or locking jaw joint and the potential treatments.

It is estimated that between 30 to 50 percent of the population frequently experiences noises in the temporomandibular joint. Two primary forms of these noises are recognized:

Clicking or Popping Sound: Most commonly, people hear a snapping or clicking sound when opening or closing the mouth. This brief, sharp noise can sometimes sound startlingly loud and can be clearly audible to those nearby. This clicking is particularly prevalent among individuals aged 15 to 40 years. It occurs four to six times more frequently in women than in men.

Gritty, Grinding Sound (Crepitation): Occasionally, there is a sandy or grinding noise accompanying a broader range of jaw movements. This sound is especially common among older individuals. It's often a result of arthritis in the jaw joint, but it can also arise from other causes, such as local changes to the cartilage. Sometimes this sound is audible to others, but it's mainly bothersome to the person experiencing it, given the proximity of the jaw joint to the ear. Jaw joint arthritis typically doesn't cause pain unless the joint is overstrained. In such cases, a mild inflammatory response can develop, leading to discomfort.

The brief popping sound in the jaw joint is typically caused by a discus that has shifted forward and suddenly snaps back to its normal position during mouth opening or lateral movements.

Usually, just before the popping sound, there's a slight difficulty in opening the mouth and some discomfort can be felt. After the popping, with the discus now back in its standard position, the mouth can open further. In the past, it was believed that the manner in which the teeth interlock played a significant role in the occurrence of popping joints.

However, contemporary understanding shows this is not the case. In fact, the upper and lower teeth only come into contact for an average of about five minutes per day, primarily during swallowing and eating.

Factors such as loose joint ligaments, injuries to the joint structures (like overextending the jaw, sports injuries, or difficult tooth extractions), overuse (for example, from teeth grinding or clenching the jaws), and so on, play a much more significant role in this phenomenon's development.

Popping sounds in the jaw joints can be easily detected, for instance, using a stethoscope. One can also feel the discus shifting with fingertips. Therefore, there's no need to resort to high-tech methods to identify a popping joint.

If the popping sound does not cause pain, you can attempt to prevent or reduce it by considering the following measures:

Avoid Extreme Mouth Opening: Be cautious, for example, when yawning.

Avoid Straining the Jaw Muscles: Clenching your teeth, especially under stress, can add extra strain to the jaw. Other activities indicating tension that can burden the jaw include habits like nail-biting.

Popping Jaw Joints:

• Seek Alternative Stress Relievers: Explore relaxation techniques, possibly with a focus on relaxing the jaw muscles. Placing the tip of your tongue between your teeth during concentration, exertion, or stressful moments can also be helpful.
• Practice Adapted Chewing Techniques: Through targeted exercises, learn to eat without causing the joint to pop. Take small bites. Move the jaw mainly in an up-and-down motion during eating, and avoid making circular grinding movements. This can largely prevent the discus from shifting.
• Chewing on the Side with Popping Sound: If the popping occurs on one side, it's best to chew on the side where the sound is noticeable.

Adjusting Jaw Position When Both Sides are Affected: If both jaw joints produce sounds, you can reduce this by eating with the lower jaw slightly forward.

Physical Therapy Guidance: Sometimes, exercises supervised by a physiotherapist may be recommended to help you adopt these new chewing techniques.

In cases of arthritis, there can be an overburdening of the more vulnerable joints when there are too few teeth at the back of the mouth, on either or both sides. In such scenarios, a removable or fixed prosthesis (a crown or bridge on the remaining teeth or sometimes on implanted artificial roots) can provide valuable support.

Sometimes, a popping discus does not return to its position and remains stuck in front of the jaw head, leading to a blocked joint. Typically, the mouth can then only open slightly (e.g., only up to three cm, whereas the usual opening is about five cm). The pain and limitation of movement can usually be addressed without surgical intervention. Some individuals wake up in the morning with a jaw joint that seems "uncooperative," appearing stuck, or can only be released with a painful pop. These symptoms suggest a tendency for the jaw to become blocked due to overnight overuse or incorrect use.

It remains uncertain whether a popping joint has a higher risk of suddenly becoming blocked. Studies indicate that popping does not necessarily lead to blockage, and many joints may suddenly lock without any prior popping sounds.

Popping Jaw Joints

Often, individuals can initially unblock the joint themselves, for instance, by moving the chin slightly back and forth. However, this blockage tends to recur and may eventually seem permanent.

A blocked jaw joint usually causes pain because the attachment ligaments and tissues surrounding the discus are incorrectly strained, leading to mild inflammation.

Causes

• There can be multiple reasons for a blocked discus. If the clinical diagnosis is unclear, an MRI can provide a clearer image, as traditional X-rays do not show it.
• Grinding sounds in the jaw joint can also have multiple origins, such as arthritis or local cartilage changes. CT scans are typically the most appropriate imaging method to visualize these issues.

Treatment
Conservative Approach: Normally, you should eat gently and adhere to several preventative measures, just like with a popping joint, to prevent the joint from causing pain again. Usually, it takes a few months for the pain and symptoms to completely disappear.

Exercises: Exercises with a physiotherapist and using an occlusal splint can support the healing process.

Occlusal Splint: Individuals who regularly wake up with a sticky jaw or experience pain and difficulty starting their day might consider wearing an occlusal splint at night. This transparent plastic prosthesis is placed on the teeth in the evening to support the jaw system. It also mitigates the effects of nighttime teeth grinding. The splint can help prevent the discus from becoming adhered overnight or recurring pain.

Surgical Intervention: Most of the time, by avoiding overstraining and facilitating the adjustment process (including physiotherapy), the blocked jaw can be rendered pain-free, and mouth opening can be improved. Surgical procedures are rarely needed to address the issue, even with a painful joint.