Joint noises, or noises that arise in the temporomandibular joints, can take several different forms. Some patients describe popping or clicking. Other describe hearing grinding as they open and close their mouths. No matter how they are described, joint sounds are common and can occur before, during, orthodontic treatment. Do braces or aligners cause joint sounds and can they cure them? Do joint disorders begin as noises and eventually progress to pain?
Jaw joint issues can involve muscles, ligaments, tendons, and/or the cartilages associated with the joints. Many times these problems are due to the anatomy of the patient’s joints. Some folks’ joints just make noises or move roughly because of their shape and size. It is not uncommon for patients’ ankles to pop when they stand up, but rarely do they seek treatment for that noise. A pop in the jaw joint however is much more noticeable because it occurs close to the ear where the patient can hear it.
So what do we know about TMJ noises and what causes them? First of all, the jaw joints are like many other joints in the body. There are two bones that come together with a piece of padding (a disc made of cartilage) between them. The disc is held between the bones by a ligament from behind and a muscle from the front. As the joint functions, the muscle pulls on the disc to keep it centered between the two bones. When it works perfectly, it functions almost silently.
If the ligament is loose so that it doesn’t hold the disc in the right place however, the disc travels a little too far upon opening and then suddenly pop back into place when the ligament finally becomes taught. If the muscle pulls too hard on the front of the disc, it can also hold it too far forward until the ligament ultimately pulls it back into place. Ligaments can be naturally loose, get loose during childbirth (when all the ligaments in the body relax), or become damaged by trauma. The muscles can contract too much if they have been busy chewing (gum, bagels, etc.), clenching, or grinding. Clenching or grinding can actually cause spasms in the chewing muscles which can be painful as well as pull the disc forward.
Nearly half of American women report they have had a pop or a click in their jaws while about one-fourth of the men report the same. While some popping may not be related to an identifiable event, many patients know exactly what sets it off. Studies have indicated that more than 50% of TMJ symptoms are attributable to stress alone. That helps explain the rise in calls we get during the last two weeks of the school year. Almost without fail our patients identify that their symptoms arrived about the same time as their finals and associated end-of-year projects. While there definitely are TMJ conditions that warrant treatment, most popping and clicking is not serious. Sometimes just recognizing the relationship between these noises and their stress level is all that is needed to get a patient on the road to recovery.
Finally, the scientific literature has determined that joints that start making popping or clicking sounds do not progress into more serious, painful temporomandibular disorders. While some patients may have both issues, doctors have found that those who have joint noises do not predictably develop TMD and neither do those with joint pain always have a history of pops and clicks.
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.