Causes of Sudden Jaw Clicking
Sudden jaw clicking is most commonly caused by temporomandibular joint disorders (TMD), specifically internal derangement with anterior displacement of the articular disc, which affects 6-9% of adults globally. 1
Primary Causes of Jaw Clicking
1. Temporomandibular Joint Disorders (TMD)
- Disc Displacement: The most common cause is anterior displacement of the articular disc with reduction, creating an audible click when the jaw moves 2
- Internal Derangement: Abnormal relationship between the disc, condyle, and articular eminence 3
- Reciprocal Clicking: Clicking that occurs during both opening and closing of the jaw 4
2. Mechanical Factors
- Bruxism and Clenching: Grinding or clenching teeth, especially during sleep 5
- Occlusal Discrepancies: Slide from centric relation to centric occlusion of more than 1 mm 5
- Lateral Deviation: Mean mandibular lateral deviation of 2.2 mm anteriorly is observed at the time of click 5
3. Structural Changes
- Loss of Cortication: Decreased articular eminence cortication and mandibular condyle cortication 2
- Degenerative Joint Disease: Frictional impact between degenerated condyle surface and hypertrophied displaced meniscus 3
4. Other Contributing Factors
- Muscle Dysfunction: Palpable soreness in lateral pterygoid and temporal muscles is the most important clinical sign associated with TMJ clicking 5
- Missing Molar Support: Lack of posterior dental support increases risk of progressive TMJ issues 4
- Medication Side Effects: Some medications, including antipsychotics like paliperidone, can cause jaw pain and clicking as side effects 6
Clinical Course and Prognosis
Research shows that reciprocal clicking remains unchanged in approximately 71% of patients over a three-year period, with only 9% progressing to locking 4. Patients at higher risk for progression typically present with:
- More pronounced pain
- Joint tenderness
- Dental abrasion
- No molar support on the affected side 4
Diagnostic Considerations
When evaluating sudden jaw clicking, it's important to differentiate TMD from other conditions that may mimic it:
- Temporomandibular Joint Syndrome: Pain radiating to periauricular area, temple, or neck; history of gum chewing, bruxism, or recent dental procedure 1
- Furunculosis: Infected hair follicle in the outer ear canal 1
- Referred Otalgia: Pain referred from pathology outside the ear 1
Advanced imaging may be necessary in some cases:
- MRI: Gold standard for ligament and articular capsule structure analysis 1
- CBCT/CT: Gold standard for bone lesion assessment 1
Common Pitfalls and Caveats
Not All Clicking Indicates Disc Reduction: A common misconception is that all TMJ clicking represents anterior displacement with reduction. Studies show that 15% of clicking joints actually have non-reducing anterior displacement 3
Overtreatment: Most TMD symptoms improve without treatment, so invasive interventions should be avoided initially 7
Missing Systemic Causes: Failing to consider conditions like juvenile idiopathic arthritis that can affect the TMJ 1
Medication Effects: Overlooking medications that may contribute to jaw symptoms 6
By understanding these causes and considerations, clinicians can better evaluate and manage patients presenting with sudden jaw clicking.