Jaw-ClickClicks in the jaw joints are a really common finding in our patients. The question we most often hear is “how do I know it is ok to do the dentistry if my patient has a jaw click?”

There are many kinds of joint noises and many answers to this question. I think the real question is how comfortable are you in managing a patient with a true temporomandibular dysfunction (TMD)? I have made the decision not to treat complex joint issues. Yet, I have lots of patients who have some degree of TMD who are in need of restorative care.

It helps to understand what a click looks like, the short video clip below illustrates how the noise occurs as the condyle translates and clicks onto the disk on opening and then back off again on closing.

Watch this video - Jaw Click_NEW

Normal healthy joints are silent on opening and closing. A click indicates some degree of damage to the disk or retrodiscal tissues. A key question to ask is, when does the noise occur? The implication is less of a concern than if the click were occurring very early in opening and late in closing or a rotational click. Clicks occurring in rotation might mean a medial pole injury and the possibility of an unstable joint. Further examination and understanding of the patient’s history is important.

There are three key questions to ask in order to know if it is safe to do routine restorative dentistry.

  1. Has the noise changed in volume or character over the last two years? No change would indicate some degree of stability rather than a joint still in an active disease state. If the patient is still undergoing changes then doing any restorative dentistry that might change the bite could either contribute to further breakdown or at best have to be redone if the changes that occur are significant.
  2. Is there any pain associated with the movement? Pain indicates that there is inflammation present either in the joint or surrounding tissues. A joint that is painful is unstable and no dentistry should be done until the pain is fully understood and resolved.
  3. Is there any restriction of movement of the mandible? Restricted movement indicates either a significant muscle issue or disk damage that is preventing a full range of motion. If the limited movement is occurring because of a joint or disk that is continuing to deteriorate then understanding the cause is imperative before doing any dentistry.

If the answers to all three of these questions are no, then it is probably OK to do the case in the face of lateral pole or translational noises. If any of the answers are yes then further investigation is indicated or referral to someone who is well versed in treating TMD. This course in the Spear Course Library goes into much more detail.

Steve Ratcliff, D.D.S., M.S., Spear Faculty and Contributing Author  

 

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Comments

Commenter's Profile Image Jon Henley
May 7th, 2015
Hi Steve, can an early opening late closing click ever be a lateral pole problem, in the very early stages of the lateral pole of the disc becoming displaced and then reducing? In the early stages of opening, i.e. the pure rotational element of mandibular movement, why couldn't there be only a lateral pole of the disc that is displaced, or if there could be, why would there not be an audible click and why would there just be an audible click of the lateral pole in translation of the mandible only ? Many thanks, Dr Jon Henley, UK
Commenter's Profile Image Steve Ratcliff
May 8th, 2015
es, that could happen but it would be very unusual. The key factor here is the shape of both the fossa and condyle head. Typically, when the condyle is fully seated in the fossa only the medial pole is in contact with the fossa. As the condyle rotates in the first few mm of opening the load remains on the medial pole. As the condyle begins to translate and move down and forward against the fossa eminence the load or contact with the condyle head moves from medial to lateral. The later the click occurs in translation, the more lateral the detachment of the disk. In order for a lateral pole click to occur in rotation, the anatomy of the two structures would have to be unusual.