Understanding Jaw Popping, Clicking, Locking and Pain: Causes, Symptoms, and Treatment for TMJ

What is TMJ?

I have “TMJ”. My jaw “makes a clicking or popping sound”, or my “jaw is locking” are all common complaints we hear at REP Physio in Edmonton. While everone has “TMJ” (a temporomandibular joint), not everyone has a temporomandibular joint disorder (TMJD). TMJD is also used interchangeably with temporomandibular disorder (TMD). For the purposes of this article, we will refer to TMJ pain and dysfunction as TMD.

Pain in your jaw is not uncommon. The overall prevalance of TMD is approximately 31% of adults and 11%  children (Valesan 2020). The most common types of TMD is a disc displacement (more on this later), followed by degenerative joint disease (DJD).

There are two classifications of jaw pain or discomfort:

1. Articular (joint): This includes disc disorders, joint pain, joint disorders, and DJD.
2. Muscular: Dysfunction not rlated to the jaw joint itself. Typically this involves the jaw muscles responsible for mouth and jaw movement (opening, closing, grinding etc.). This includes the temporalis (side of forehead), masseter (side of cheeks) and pterygoid muscles (deep jaw/cheek muscles). Muscular jaw pain is often referred to as myofascial pain syndrome, or masticatory myalgia. Muscle tightness in the jaw that prevents opening is known as trismus.

What Causes Jaw Popping and Clicking?

Jaw popping and jaw clicking is a common complaint of individuals with TMD. There are multiple possible causes of this. In order to understand why your jaw is popping or clicking, we have to talk a little bit about the jaw joint itself. The jaw joint has 3 components. The mandible (jaw bone), the temporal bone and an intraarticular disc. The intraarticular disc is made of a type of fibrous cartilage, and acts as a cushion between the mandible and  temporal bone. When the jaw is closed, the mandible (specifically the mandibular condyle) and disc sit snugly in the temporal fossa of the temporal bone (see graphic below).

The jaw is a hinged joint. Jaw opening occurs via gravity and with the help of the pterygoid, mylohyoid and digastric muscles. During the initial stages of opening, the mandible rotates in place, and for the end stages of opening, it slides slightly forward within the joint.  In most cases when the jaw opens, the intraarticular disc also slides slightly forward with the mandible, ensuring their is always a cushion between both bones. For jaw closing, the masseter and temporalis muscles elevate the jaw bone, allowing the mandible to slide back slightly and “spin” into place. Again, as with mouth opening the disc and manidble move together.

People with jaw popping or clicking are often worried they are injuring their jaw. Good news! Jaw popping or clicking does not mean that you are doing damage to your jaw joint (provided the jaw popping or clicking is not painful). Typically, those individuals seen at REP Physio for jaw popping and clicking do not have a history of jaw injury. Rather, they have either a short or long history of grinding and or clenching their teeth.

When people grind and or clench their teeth, the intraarticular disc that sits between the jaw and temporal bone is compressed. If this happens for prolonged periods, the disc can begin to sit/move slightly forward within the jaw joint . If the pressure on the disc remains for prolonged periods (weeks/months)  the intraarticular disc may then have difficulty sliding back to its original resting position as the supportive structures of the disc (bilaminar area and capsule) become overstretched. With the intrarticular disc sitting slightly forward of the mandible, it can lead to jaw popping or clicking as the mandible has to hop or slide back onto the disc while the jaw continues to move through its normal range of motion. This popping or clicking can occur with both opening and closing the jaw. Most commonly, it happens in the early stages of jaw opening once the mandible starts to slide forward.

In the case of direct blow to the face, the jaw may pop or click when opening or closing secondary to damage to the joint itself, or as a result of muscle spasm or injury. Again, as per above the popping or clicking is as a result of the manidble and disc articulating with one another.

Interestingly, the jaw joint and disc is not innervated and therefore does not transmit pain signals to your brain. Rather, when the jaw joint is painful, it is typically due to the retordiscal tissue, which is richly innervated.  This typically presents with isolated, pin point pain directly at the jaw joint.  Conversely, if the jaw muscles are causing pain, it can be felt throughout the cheeks, face and temples. The muscles of the jaw may feel tight, and people may experience radiating pain.

Another cause of jaw popping or clicking, or jaw noise in general is degenerative joint disease (DJD), or osteoarthritis. With osteoarthritis, the surfaces of the jaw joint are no longer as smooth and congruent. This can result in noise as the jaw bone moves within the joint. Again, this is not a cause for medical emergency or concern. Physiotherapy can help in managing the pain associated with DJD with interventions directed at minimizing muscular tension and improving joint mobility. Your pharmacist or dentist may also recommend anti-inflammatories, muscle relaxers and/or various pain relievers to provide relief.

Fortunately, for the vast majority of people, jaw clicking or jaw popping without accompanying pain is not damaging and it should not be cause for medical concern (but yes, it can be annoying). Unfortunately, it is difficult to stop jaw clicking once it has been happening for greater than a few months. This is usually because the intraarticular disc is unable to return to its normal resting position as it has been compressed within the joint for too long. This can be due to trauma, or excessive clenching and grinding. To stop your mandible from compressing the intraarticular disc and to help minimize any excessive wear to your teeth, your dentist may recommend you wear a guard and/or splint to help find relief from jaw pain and dysfunction. While a splint may provide relief from pain, it will not necessarily stop your jaw from clenching or griding, especially at night. If you have questions about a splint, it’s a good idea to speak with your dentist or TMD specialist.

In some cases, people with a temporomandibular joint disorder may also experience a loud “clunking” sound. This usually occurs at the end range of mouth opening  This can sometimes be due to the mandible travelling too far forward in the joint and subluxing (a partial dislocation). If you’re able to close the mouth following a loud clunk, no worries. However, you may want to be mindful about opening your mouth too wide when taking large bites of food or yawning. At REP Physio, we recommend placing your hand underneath your jaw or placing your chin on your chest when yawning to prevent your jaw from opening too wide.

Whats Causes Jaw Locking?

If your jaw locks or gets stuck, preventing you from fully opening or closing your mouth, it is typically due to a change in the relationship between the intraarticular disc and the mandible. Medically, we refer to this as a disc displacement with/without reduction. As seen in the below graphic, when the jaw locks, the disc sits too far forward of the jaw bone, causing it to act as a structural block to the forward displacement of the jaw bone that allows for full opening. Fortunately, a locked jaw is rarely permanent. A disc that reduces “with reduction” suggests that the disc can return to its normal resting position. Without reduction means the disc is permanently stuck forward, alterning joint mechanics. In some cases the disc may be stuck forward for a period of time, and then return to its normal resting position (intermittent reduction).

In very rare instances, the jaw can open too far making it difficult/impossible to close the mouth. This is known as an open lock. This happens because the mandible has moved too far forward on one or both sides of the jaw. If this occurs, it can be quite concerning for the individual, as it can be nearly impossible for them to close their mouth on their own. They won’t be able to chew food and are stuck with a wide open gaping mouth, which also puts excessive strain on the jaw muscles as they get stretched beyond a comfortable range of motion. If your physiotherapist is unable to “unlock”/put your jaw back in place with manual therapy, then typically clients are sent to the emergency room, where they are placed under a general anesthetic and the jaw is manipulated back into place.

The bottom line about jaw popping and clicking is this: it isn’t a cause for concern unless the clicking sound is painful. Painful clicking typically is a result of severe joint damage, and imaging (Xray, MRI etc.) should be considered. Again, it is highly unlikely that non-painful popping or clicking is causing damage. Again, as noted above, it is difficult to stop jaw popping and clicking that has bee there for a long time. Lastly, if you experience episodes of jaw locking, jaw and facial pain, or a new onset of jaw popping or clicking, some see any of  the experienced physiotherapists at REP Physio in Edmonton.

Signs and symptoms of Temporomandibular Disorder (TMD)

Typically, our clients come to REP Physio in Edmonton for treatment of TMD when:

• They begin noticing pain in the jaw facial pain, or are looking for strategies to manage chronic jaw pain
• Their jaw makes a clicking sound (again, pain free noise is not a concern)
• They wake up with jaw pain and/or stiffness, and may have difficulty opening their mouths. They experience jaw pain throughout the day.
• They clench or grind their jaw and are looking for strategies to minimize these habits
• Jaw range of motion has decreased, or you can’t open your mouth
• They have had to go on a modified diet due to jaw pain. They can’t chew normal foods, and/or experience  limited range of motion
• They experience headaches associated with jaw pain
• They start to notice a clicking or popping sound in their jaw
• Their jaw deviates to one side when opening
• They are going through a stressful period that is causing them to clench their jaw. This can happen during the day or at night.
• They have a history of teeth grinding, or have been told by their dentist that there are signs of teeth grinding on their clinical exam
• They recently had a dental appointment and had their mouth/jaw open for extended periods of time, resulting in a jaw that is painful and difficult to open (this is known as a capsulitis and/or synovitis)
• They experience episodes of jaw pain pain and/or jaw locking
• Their teeth do not align (occlusion issues)
• They experience ringing in the ear associated with jaw pain and/or muscle tightness.
• They recently experienced trauma such as a car accident or blow to the face. Indeed, neck pain and dysfunction is typically seen with 70% of jaw disorders.

How to relieve jaw pain and discomfort

Dealing with jaw pain and dysfunction is not fun. However, there are many great options to help minimize your pain and improve function. These include:

• Using mindfulness and/or cognitive behavioural therapy to minimize episodes of jaw clenching due to stress and/or anxiety
• Soft tissue massage of the muscles of the neck and jaw to decrease tension and reduce pain
• Keep your teeth slightly apart when not talking or eating to minimize jaw discomfort and relax your jaw.
• Try keeping your tongue on the roof of your mouth with the jaw relaxed
• Address any sleep apnea issues
• Use heat to help relieve jaw pain and relax the jaw
• Acupuncture and/or dry needling to decrease musle tension and restore range of motion to the jaw and neck
• Manual therapy to help promote normal jaw function and/or treat open or closed locks.
• Specific therapeutic exercises for the jaw and neck to improve range of motion and relieve pain
• Education on and suggestions on lifestyle changes that can affect jaw pain and function (sleep quality, stress levels, overall health, body weight, medications, exercise routines etc.)
• Referral to your dentist and/or TMD specialist to discuss medication options, the benefits of a splint and/or night guard, as well as possibly a Botox injection for severe muscular pain and dysfunction
• Suggestions on a modified diet to minimize jaw irritability. i.e. soft foods such as cooked vegetables vs. raw
• Use a jaw splint or night guard to minimize the impact of grinding of the teeth at night or during the day
• Heat to the neck and face to promote relaxation
• Avoid opening your mouth wide

You don’t have to live with TMJ disorders

Jaw clicking and locking issues can negatively impact your quality of life. Discomfort and pain associated with jaw dysfunction is common. If you notice your jaw is starting to make noises and/or cause pain, come see us at REP Physio in Edmonton. We are expereinced in treating jaw problems and work closely with local dental and TMD specialists. We use an active, multi-disciplinary approach in the treatment of the common causes of jaw popping and locking issues. Our goal is to provide you, our valued client with complete care management that prevents jaw problems, improves function and reduces pain.