“My left jaw pops by the ear so abruptly and so loud. Right side hardly anything. Besides TMJD what exactly does this mean?”

This was a question asked on an internet TMJ group. Perhaps you had the same or similar question. The following is my answer to that question.

Sandy…you asked ‘besides TMJD what exactly does this mean?”

Just to be sure, I am guessing that by TMJD you mean ‘ Temporo Mandibular Joint Disorder ’, right? That term simply means that the ‘jaw joint is not working well’. I would agree with that if the jaw is popping.

There are many signs of TMJD

A sign is something a knowledgeable doctor recognizes as clinical evidence of a problem. Clicking or popping of TM Joint means that the cushioning disc that is located between the glenoid fossa of the temporal bone (the socket) and mandibular condylar head (ball) is out of place. In order for it to be out of place, the collateral ligaments that hold the disc in place over the condylar head have to be damaged or partially torn. As the lower jaw (mandible) opens to a point, the disc snaps IN TO place which makes the clicking or popping noise. As the mandible closes back, the disc slips out of place, often quietly before the teeth come together. If the disc is either worn through (perforated) or completely missing, it results in the bones of the fossa and condyle rubbing against each other causing a grinding or sand paper noise called crepitus. This is a sign of advanced degeneration of the joint. It may still not cause any pain in the beginning. However, any joint in which bone is rubbing against bone during function eventually gets inflamed and painful. It is then called Osteoarthritis or wear and tear arthritis of that joint. Arthritic TM Joints often cause pain with any movement, even movement during smiling, speaking or singing and not just when chewing food that requires forceful closure.

What EXACTLY does this popping mean?

Lots of people have joint sounds and typically ignore it if it is not hurting. Most dentists would tell them that clicking TM joints are ‘normal’ and they should just ignore it or ‘watch it’ if it is ‘painless’ or ‘asymptomatic’. Would the same dentists ‘watch’ a painless cancer, painless cavity or painless gum disease? Of course, NOT. They would most likely recommend a solution for those. Why then would they ‘watch’ the clicking TM joint? Could it be because most of them were never taught a solution for a dislocated disc during their dental school training? That is the case in almost all dental schools in USA and Canada. Besides a night guard that protects the teeth if they are being worn down by night time grinding, most dentists have no solutions to offer. When it becomes ‘symptomatic’ which means that it is now painful, eating only soft or blended foods, taking muscle relaxers, pain medications and moist heat are management strategies but are not really solutions. The patient would be referred to an Oral maxillofacial surgeon for jaw joint surgery. Such surgeries have many risks including complications with anesthesia, bleeding, infection and months of healing. Their success rate is not stellar even though it is an irreversible procedure.

What the ‘TMJ popping’ really means is that there is a mis-alignment of the lower jaw to the upper jaw which is fixed to the cranium. Cranio Mandibular Dysfunction or better yet…Cranio Cervical Mandibular Dysfunction CCMD are more accurate descriptors of this condition.

Symptoms are what the patient ‘feels’ that impact their quality of life. A large number of ‘symptoms’ could present as a result of CCMD. No two CCMD patient presents with the exact same set of symptoms or to the same intensity. This is what is confusing for patients as well as for most doctors. They are used to having pretty much the same symptom for everyone with a certain condition. For example, just about everyone with an ear infection would have ear pain. Not so much with TMD / CCMD. That is what is challenging, interesting and rewarding to treat CCMD since often we can solve seemingly ‘incurable’ conditions labeled with diagnoses such as fibromyalgia, trigeminal neuralgia, migraine, etc. etc.

You may not have ANY of the symptoms such as headaches, neck pain, vertigo, pain behind the eyes etc. etc. that usually compels people to seek treatment. You may never end up with any of these symptoms depending on your individual adaptive capacity. BUT every one of the patients that seek my care started off at some earlier point in time – sometimes just months and other times years – of ‘painless’ signs before it deteriorated to the point of seriously affecting their quality of life. That is typically when they seek care. So the academics that say TMJD would just ‘settle down over time’ are not actually treating patients that I see or by others who treat TMD / CCMD full time.