Hi Everyone and welcome or welcome back to my YouTube channel! My name is Priya Mistry and
I'm a General Dentist with a practice dedicated to taking care of patients with TMJ disorders.
Todays video is about jaw joint noises! I am part of a wonderful Facebook Support Group for
patients who are suffering from TMJ Disorders and I've met some lovely people on there
and people that are just in a lot of
pain... and one of the questions that i see commonly in this group
is "my jaw made this sound what does that mean?", "I had a sudden snap in my jaw and
suddenly symptoms took off!" "I wasn't having any pain before but now it's
clicking and popping all the time
and I have pain with it", or just a variety of questions based off of jaw joint noises so I
wanted to make a video to help explain what some of these most common noises most likely mean.
Before we proceed into the noises themselves, it is important to review the anatomy of the joint
so i will be brief with this since i've done it in other videos and you may already know this
but the Temporomandibular Joint has two bony components - 1) the Condyle,
which is the bony knob that our mandible ends on and 2) the Temporal Bone, which is a skull bone.
The Temporal Bone has two parts to it that are pertinent to the Temporomandibular Joint
and that is a concavity called the (Glenoid) Fossa and convexity called the Articular
Eminence. Between the two bony components of the joint is an Articular Disc
that is made of cartilage, kind of similar to the meniscus in our knees.
That disc is biconcave in shape and serves as a shock absorber or a cushion between
the bony components of the joint. So in all movements - opening, closing, moving right
and left, forward and backwards - that disc should stay
between the body components of the joint.
In front of the articular disc is the "Troublemaker"
muscle. That's called the Lateral Pterygoid muscle.
Behind the disc is some highly innervated & highly vascularized tissue called the
Retrodiscal Tissue.
Along with all these structures, there's also joint space... There should be adequate
space between the condyle, the articular disc, and the temporal bone and that space
allows the disc to move the little amount that it should and for the synovial fluid to flow in
and out and keep everything nice and lubricated, and of course to prevent compression within the
joint that space is needed as well. And lastly, there's a fibrous capsule and some ligaments that
hold everything in place. The one ligament in particular that we'll be referring to today is
the Lateral Collateral Ligament and that is the one that most easily gets strained or stretched
in this joint. Moving forward - I've broken up the jaw joint noises into 4 main noises that we see at
our practice. The first is the pop or the click. That's probably the most common one I hear about -
"My jaw pops all the time!" or, "My jaw clicks all the time.. yeah that's normal for me."
Second is something called Crepitus and it's sort of like a crackly noise. Third
people have said that they hear a loud snap or crack or pop and they just hear it once
in one or the other joint and after that their TMJ/D symptoms typically start to
take off and they get a lot worse. That snap that isolated snap or crack or pop can be followed by
licking and popping that starts to happen all the time that wasn't there before,
or just pain in or around that joint. Then lastly, I don't know if this really counts as
a noise, but it's the cessation of noise. So it was popping and clicking all the time on one
side and then suddenly it stopped. We'll go over all four and what's happening in the joint The
first is that pop or that click; so if you take a look at the joint in this diagram here you'll see
that the disc is out of alignment. It is not between the two bony components of the joint,
so it's already being a bad boy.. and it's too far forward, it's not where it's supposed to be.
What happens is when this patient goes to open - or when the skull goes to open rather -
you're going to see
that the condyle regains that disc. The disc is able to get back onto the condyle and that's the
pop and then when the patient closes again, it gets back off the condyle.
click or pop again; pops and clicks are kind of the same thing. In medical terms, anytime a body
part can get back into alignment that is called "reduction" so every pop or click is a reduction
or getting back out of alignment non-reduction, I suppose. This right here is an articular disc
that is displaced so it's not where it's supposed to be, but it's able to get back into alignment
even for a little while during the open and then closed cycle. This is a disc that's displaced
with reduction - with the ability to get back into alignment. We'll take a moment and just sort
of look at this animation and you can see that when the patient goes to open [pop] gets back
on (the disc) and then close [pop] gets back off (the disc). Let's take a moment here to watch.
So that right there is an articular disc that is displaced with reduction. That is what that
popping and clicking is and it may stay that way forever OR it could progress to the disc being
displaced without reduction which is not a fun condition! That is the jaw locking closed. The
second noise is called crepitus. Crepitus is sort of a crackly, grainy sound in the joint and people
don't really like the way it sounds they don't like any of the noises, but this particular noise
just tends to rub people the wrong way - kind of like fingernails on a chalkboard.
With crepitus, what's happening is that there's too much compression within the joint. Typically,
the articular disc is too compressed; there's not enough joint space like we discussed before and
the articular disc can actually tear and there can be bone on bone contact. That bone can actually
start to roughen up as well. The condyle as well as the temporal bone in the skull. The two bony
components of the joint can start to break down if this has been going on for too long. That's going
to cause that kind of crackly sound. This crepitus is typically associated with chronic clenchers -
people that have been clenching for a long, long, long time. They've been putting way too
much pressure and if there's too much compression within the joint for a long period of time, that
can then thin out or tear the articular disc and cause these sounds. Crepitus is usually indicative
of advanced osteoarthritic degenerative changes in the joint. Can it be quieted down? Sometimes,
yes it can. What's great about the articular disc is it's highly capable of remodeling. It is a very
unique type of tissue that's only found in three places in our bodies - 1) in the (TMJ) joint
itself , 2)the pubic symphysis, and 3) where the clavicle attaches to the chest wall.
Because this tissue is so unique and highly adaptable and highly capable of remodeling,
it can repair itself to some extent
and that's sort of what we depend upon along with our orthotics and our jaw manipulation etc;
all the treatment protocols that we use here to to get patients good results and quieter joints.
The third sound is a loud "snap" or "crack" or "pop" that patients feel and hear
and they just say what was that. Sometimes it can happen
when they yawn really really wide or they're screaming on a roller coaster
or just kind of randomly -like they bite into something at just the wrong angle
and it they get that loud kind of snap sound. That's how I've heard it described most commonly
Typically what's happening there and that's followed by a progression of then TMJ symptoms so
the joints were quiet then there was a loud snap one day that was just an isolated incident
and then suddenly there was a incessant popping and clicking that was that was not there before
or their jaw started hurting a lot and that wasn't there before. Typically what happens with that
loud "snap" is that that lateral collateral ligament - which attaches to the disc - gets
stretched or strained. Then the disc is not held on to the condyle as tightly as it should be,
so it can more easily become displaced -pleading to pops and clicks , like we saw with the first
joint noise in this video. That's typically what that isolated snap, crack, or pop is. Fourth,
so i don't know if this really counts but it's the cessation of noise as i discussed before.
That fourth and last noise is the lack of noise so if a joint was clicking, popping,
clicking, popping clicking popping and suddenly boom it went silent;
typically what happens is the disc is completely out of alignment and
the jaw actually locks closed. That is a very difficult condition to treat.
It's very doable, but it's it's not super easy and i have a whole video on that
that's called "Jaw Locked Closed". You guys can check that out. Those
are basically the 4 joint noises! I hope you guys enjoyed this video!
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