How the joint works and where the click comes from
The movement in this joint is two-stage and unique. At the beginning of the opening of the mouth, the head of the lower jaw rotates in place, and after about two centimeters it begins to slide forward along with the disk, which lies on it like a cap. The disc is held by ligaments and is mobile: it must remain between the head and the temporal bone all the time, playing the role of a shock absorber. When the ligaments are stretched, the disc slips forward and, at rest, is in front of the head.
Then the following happens. When the mouth opens, the head catches up with the displaced disk and with effort jumps under it - the first click is heard, after which the mouth opens freely. When closing, the head comes back off the disk and a second, usually quieter click is heard. This pair of sounds is called a reciprocal click, and this is the most common version of what happens. It means that the disc is displaced, but is still being set. If the ligaments are stretched more, there comes a moment when the head stops sliding under the disc: the click disappears, but the disc now interferes with the movement in front, and the mouth stops opening beyond two to two and a half centimeters. That is why the disappearance of the usual click along with the restriction of opening is not an improvement, but a transition to a more severe stage.
When is a click really normal?
Sounds in this joint occur in a very large proportion of adults, and not all of them mean a disease. Disc displacement in itself is not a death sentence and does not necessarily lead to joint destruction: for many it remains stable for years and does not interfere with life in any way. Therefore, the decision on treatment is made not based on the presence of sound, but on three criteria: whether there is pain, whether there is restriction of movement, and whether the situation changes over time.
- Observe: a single painless click when opening the mouth, the volume of opening is normal, the situation has been stable for years
- Observe: rare sounds when yawning or biting off large foods, not accompanied by discomfort
- See your doctor: the click is accompanied by pain in front of the ear or in the temple area
- See a doctor: mouth opening has decreased, the jaw moves to the side when opening
- See a doctor: the clicking noise has become louder, more frequent, or has turned into a rough crunching sound
- See a doctor urgently: the clicking has disappeared, and at the same time the mouth has stopped opening wide
The change in the nature of the sound deserves special attention. A soft click usually indicates a disc, while rough friction and squeaking more often indicate changes in the articular surfaces themselves. Dynamics are also important: a click that has existed for five years and has not changed, and a click that appeared a month ago and is already accompanied by morning pain, are different situations, even if they sound the same.
Muscle vs joint: where it really hurts
A significant part of what people call a joint problem is not a joint. Much more often, the source of pain is the masticatory muscles, which are in constant overstrain due to clenching of the jaws. It is important to distinguish between these two scenarios because they are treated differently, and attempting to correct muscle pain with joint intervention or bite adjustments ends in disappointment.
- Muscle pain: dull, diffuse, covers the temple, cheek and angle of the jaw, the point cannot be specified
- Muscle pain: the jaw gets tired when chewing and in the morning, as if working all night
- Muscle pain: pain when pressing on the temple and on the muscle in the corner of the lower jaw
- Joint pain: point pain, right in front of the tragus of the ear, intensifies when the jaw moves
- Joint pain: accompanied by a clicking, crunching or sensation of obstruction
- Common companions: headache in the temples in the morning, tooth marks on the edges of the tongue, increased sensitivity of the teeth, enlarged muscles in the corners of the jaw
Separately, it is worth mentioning ear pain. This is one of the most common reasons why people with joint dysfunction first go to an otolaryngologist: a feeling of fullness, noise and pain in the ear with a completely healthy ear upon examination is a typical picture. The joint is located close to the external auditory canal, and its discomfort is perceived as ear discomfort. If the doctor does not find any pathology in the ear, and the discomfort intensifies when chewing and in the evening, you should see a dentist.
Survey
- Подробный опрос: когда появились симптомы, была ли травма челюсти, есть ли бруксизм, стресс, привычка грызть ногти или предметы, подпирать подбородок рукой, спать на животе, долго жевать жвачку.
- Измерение максимального открывания рта в миллиметрах и оценка траектории движения челюсти — не уходит ли она в сторону.
- Ощупывание сустава через кожу и через наружный слуховой проход, выслушивание звуков при открывании и закрывании.
- Ощупывание жевательных, височных и шейных мышц с поиском болезненных точек — именно этот этап чаще всего и объясняет большинство жалоб.
- Оценка прикуса, стираемости зубов, отсутствующих жевательных зубов и качества имеющихся коронок и протезов.
- КЛКТ суставов — показывает костные изменения: уплощение головки, разрастания по краям, изменение положения головки в ямке. Диск на ней не виден.
- МРТ суставов — единственный метод, который показывает сам диск, его положение и подвижность, а также состояние окружающих тканей. Назначается при боли, ограничении открывания и перед серьёзными вмешательствами.
It is important to understand the difference between the two studies because it is often confused. Computed tomography answers the question about the condition of the bone, magnetic resonance - about the condition of the disc and soft tissues. The conclusion “everything is fine in the picture” after CBCT does not at all mean that everything is fine with the joint: the displaced disc is fundamentally not visible on it. Conversely, disc displacement found on MRI does not require treatment in itself, if there is no pain or limitation of movement - it also occurs in people without a single complaint.
Treatment: from simple to complex
The principle here is generally accepted and consistent: they start with the most gentle and reversible measures, and only if they are ineffective do they move on to the next steps. The reason is that most people feel noticeably better already in the first stages, and irreversible interventions - grinding of teeth, total prosthetics, surgeries - do not help with the muscular nature of the pain and leave the person with new problems in addition to the previous ones.
- Разъяснение и самоконтроль: на 2–3 недели мягкая пища, отказ от жвачки, орехов, вязких и жёстких продуктов, привычка не открывать рот широко, зевать с придерживанием подбородка, не спать на животе и не подпирать челюсть рукой.
- Контроль положения покоя: зубы в течение дня разомкнуты, язык у нёба, губы сомкнуты. Простые напоминания в течение дня работают лучше, чем кажется.
- Упражнения и мягкий самомассаж жевательных и височных мышц, тепло на область мышц, при острой суставной боли — наоборот, холод.
- Окклюзионная капа, изготовленная индивидуально по слепку. Она защищает зубы от стирания и снимает нагрузку с мышц и сустава. Готовые аптечные капы для этой задачи не подходят.
- Работа с причинами перенапряжения: режим сна, снижение уровня стресса, при подозрении на нарушения дыхания во сне — обследование у соответствующего специалиста.
- Восстановление отсутствующих жевательных зубов: без задних опор вся нагрузка при жевании ложится на сустав, и никакая капа этого не компенсирует.
- Ортодонтическое лечение или коррекция протезирования — только по показаниям и после того, как боль снята, а не в качестве первого шага.
- Артроцентез, внутрисуставные инъекции, артроскопия и открытая операция — редкие варианты для тех случаев, когда консервативное лечение исчерпано.
Prognosis and what really helps
The prognosis for joint dysfunction is generally good, and it is worth knowing this in advance, because anxiety and anticipation of disaster themselves increase muscle tension. For most people, symptoms improve markedly or go away with conservative treatment, and only a small proportion require joint intervention. Even persistent displacement of the disc is often compensated over time: the tissues behind the head are rebuilt, the opening volume is restored, and the person lives without restrictions, although the disc never returned to its place.
- Consciously keeping your teeth open throughout the day is the most underrated and most effective measure.
- Do not chew gum or chew hard foods, especially during periods of exacerbation.
- Chew evenly on both sides, do not put the load on one
- Improve sleep and deal with nighttime jaw clenching
- Do not delay the restoration of extracted chewing teeth
- Monitor the position of your head and neck when working at the computer and phone
Timelines should be presented realistically. Muscle pain usually subsides within a few weeks of regular adherence to the regimen, joint symptoms go away more slowly - it takes months. The improvement is not linear: periods of calm are replaced by short exacerbations, often due to stress or lack of sleep, and this does not mean failure of treatment. The main criterion for success is not the complete disappearance of all sounds, but the absence of pain and a normal volume of mouth opening.