What causes clicking sounds and pain in the temporomandibular joint of an otherwise healthy adult?

What Causes Clicking Sounds and Pain in the Jaw

Clicking sounds and pain in the jaw are most commonly caused by temporomandibular disorders (TMD), which affect the temporomandibular joint and surrounding muscles of mastication, with clicking itself being a benign finding that does not predict or cause pain. 1

Primary Etiology: Temporomandibular Disorders

The vast majority (85-90%) of TMD cases are muscular in origin (extra-articular), not from problems within the joint itself. 1 This is a critical distinction because it fundamentally changes the treatment approach—most patients do not have structural joint damage requiring invasive intervention. 1

Key Causative Factors

• Muscle dysfunction: Dysfunction of the masticatory muscles (muscles of chewing) is the predominant cause, accounting for approximately 45% of all TMJ-region symptoms 1
• Bruxism and clenching habits: Teeth grinding and jaw clenching create excessive muscle tension and joint stress 1
• Stress and psychological factors: Emotional stress, depression, and catastrophizing behaviors contribute significantly to TMD development and chronicity 2
• Trauma: Local trauma to the jaw or face can trigger TMD 3
• Genetic predisposition: TMD has a hereditary component, making family history relevant 1

The Clicking Sound Specifically

Importantly, clicking sounds in the TMJ do not cause pain and are not a risk factor for developing pain. 4 The clicking typically represents disc displacement or movement within the joint, but this mechanical phenomenon exists independently of pain symptoms. 4 Many people have clicking without pain, and many have pain without clicking. 4

Clinical Presentation Pattern

The typical presentation includes: 1, 2

• Pain characteristics: Sharp or aching pain in the TMJ area that worsens with jaw movement (chewing, speaking, yawning) 2
• Radiation pattern: Pain commonly radiates to the ear, temple, or down the neck 2
• Associated sounds: Clicking, popping, or grating sounds (crepitus) during jaw movement 1
• Functional limitations: Restricted jaw opening, difficulty chewing, or jaw locking 1
• Referred symptoms: Headaches, earaches, and neck pain are common 5

Epidemiology and Risk Profile

• Prevalence: Chronic TMD pain affects 6-9% of the general adult population, making it the second most common musculoskeletal pain disorder after low back pain 6
• Age distribution: Peak incidence occurs between ages 20-40 years, with highest prevalence between ages 40-60 years 6
• Gender disparity: Women are affected nearly twice as often as men (ratio 1.89:1) 6
• Chronicity risk: Up to 30% of acute TMD cases progress to chronic pain lasting ≥3 months 6

Critical Red Flags Requiring Immediate Evaluation

Before attributing symptoms solely to benign TMD, certain serious conditions must be excluded: 1, 7, 2

• Malignancy: Progressive pain, history of tobacco/alcohol use, or neuropathic pain characteristics warrant complete head and neck examination to rule out cancer 7, 2
• Giant cell arteritis: In patients over 50 years old with jaw pain, this vascular emergency must be excluded with ESR/CRP testing 7
• Bleeding disorders: Any systemic signs (unusual bruising, bleeding tendencies) require hematologic evaluation before dental procedures 7
• Infection: Fever, swelling, or acute onset may indicate septic arthritis or abscess 1

Intra-Articular Causes (Rare)

Only 5% of TMD cases involve true intra-articular pathology requiring invasive treatment: 1

• Disc displacement: Torn, dislocated, or misshapen articular disc 1
• Degenerative joint disease: Osteoarthritis of the TMJ 1
• Traumatic arthritis: Following direct injury 1
• Ankylosis: End-stage joint fusion 1
• Developmental anomalies: Congenital structural abnormalities 1
• Neoplastic conditions: Tumors affecting the joint 1

Common Diagnostic Pitfall

The single most important pitfall is assuming that clicking sounds indicate structural joint damage requiring invasive treatment. 4 The evidence clearly demonstrates that clicking is not associated with pain development and does not require treatment to prevent future pain. 4 Most patients with clicking and pain have muscular TMD that responds to conservative management, not joint pathology. 1, 2

Examination Findings That Confirm TMD

Physical examination reveals: 1

• Palpation tenderness: Pain when pressing on the TMJ, masticatory muscles, or trigger points in head/neck muscles 1
• Movement-related pain: Pain worsening with jaw opening, lateral movement, or protrusion 2
• Muscle hypertrophy: Enlarged masseter or temporalis muscles from chronic clenching 1
• Dental findings: Excessive tooth wear facets indicating bruxism 1
• Normal ear examination: Ruling out primary otologic pathology when ear pain is present 2