Recognize the Symptoms

and on leaving out diagnostics

Clicking of the Jaw is not an Illness

What is colloquially referred to as “jaw cracking” is actually a noise produced by the temporomandibular joint. Like many other joints in the human body, the temporomandibular joints can develop noises. The most common is a cracking sound when the jaw opens.

Cracking of the temporomandibular joints is almost always due to an anterior position of the joint disc – in technical language: the discus. The discus of the temporomandibular joint is ideally located between the head of the temporomandibular joint and the articular surface of the skull. The joint capsule and the ligaments connect and stabilize the discus with the joint head and the base of the skull.

In many people, the joint capsule and posterior ligaments of the temporomandibular joint stretch somewhat over the course of life. As a result, the discus shifts forward and then lies fully or partially in front of the articular head. When the jaw opens, the discus slides back onto the head of the temporomandibular joint, which may cause a cracking sound.

When the jaw closes, the discus usually slides back down from the condyle without making a noise. This also makes it clear that it is actually not the jaw itself that cracks here, but its joint.

Earlier View: Cracking is an Alarm Signal

In the past, it was assumed in dentistry that “jaw cracking” was a disease or would necessarily trigger such a disease. It was assumed that in the long term, cracking would always lead to arthritis and eventually to osteoarthritis of the temporomandibular joints.

Due to this assumption of a steady downward development with a fatal end, often very expensive and invasive therapies were offered for prevention. To this day, the occurrence of a clicking in the temporomandibular joint represents an unresistible temptation for many physicians to bring elaborate diagnostic and therapeutic procedures to their patients.

For this reason, most of the information that can be found on the websites of doctors and other health professionals about “jaw cracking” should only be taken with great caution. The tendency is always that the in itself harmless jaw clicking is dramatized and declared a disease, i.e. pathologized.

Das „Kieferknacken“ entsteht im Kiefergelenk vor allem bei der Kieferöffnung: in der Ruheposition befindet sich der Diskus (grün) vor dem Gelenkkopf (1). Beim Öffnen schiebt der Gelenkkopf den Diskus vor sich her (2), bis der Diskus unter Spannung auf den Gelenkkopf aufspringt (3) – das Knackgeräusch ist als roter Stern markiert. Beim Schließen (4-6) gleitet der Diskus meistens geräuschlos vom Gelenkkopf herunter, ein Knackgeräusch kann aber auch dabei entstehen.
The “jaw cracking” sound occurs in the temporomandibular joint primarily during jaw opening: In the rest position, the discus (green) is located in front of the condyle (1). During opening, the condyle pushes the discus in front of it (2) until the discus springs up onto the condyle under tension (3) – the cracking sound is marked as a red star. When closing (4-6), the disc usually slides noiselessly off the condyle, but a cracking sound may also occur.

About 300 Human Joints

In fact, many other of the 300 or so human joints can also experience sounds such as cracking without anyone being interested. The temporomandibular joint simply has the misfortune of being close to the inner ear, so sufferers hear cracking sounds from this joint very loudly via bone conduction.

This also explains why in search engines like Google almost 100 % of the entries on joint cracking are related to the temporomandibular joint. This overrepresentation alone makes it clear that “jaw cracking” receives more attention than would be appropriate.

Manuelle Untersuchung des Kiefergelenks: in der Regel ausreichend, um ein „Knacken des Kiefers“ zu diagnostizieren
Manual examination of the temporomandibular joint: usually sufficient to diagnose a “cracking of the jaw”.

Patients Worry About It

Affected patients are often very worried because of the clearly perceptible noise. We can tell them with certain knowledge that the cracking of the “jaw” can simply be ignored and does not usually result in any secondary diseases.

The cracking usually changes in the course of time, it can become louder or quieter, often disappears completely. In no case should such changes in the cracking sound be a cause for concern.

Today’s View: Clicking is Harmless

The current scientific opinion, however, is that “jaw popping” is not a disease, but merely a harmless diagnostic sign of an anterior disc position. An anterior disc position is found in magnetic resonance imaging (MRI) examinations in around one third of the adult population.  This does not even necessarily involve cracking noises.

The majority of those affected do not experience any further symptoms due to the cracking. The anterior discus position and the “jaw cracking” often associated with it are therefore very common and ordinary findings that are more likely to be peaceful house guests than threatening intruders.

In fact, many other of the 300 or so human joints can also produce noises such as clicking without anyone being interested. The temporomandibular joint simply has the misfortune of being close to the inner ear, so that those affected hear cracking noises from this joint very loudly via bone conduction.

This also explains why almost 100% of the entries for joint clicking in search engines such as Google relate to the temporomandibular joint. This overrepresentation alone makes it clear that more attention is paid to “jaw popping” than is appropriate.

Manual examination of the temporomandibular joint: usually sufficient to diagnose “clicking of the jaw”

Affected patients are often very worried about the clearly audible noise. We can tell you with certainty that “jaw popping” can simply be ignored and does not usually lead to any secondary diseases.

Therapy for Cracking is Superfluous

Unfortunately, many doctors exploit the existence of a harmless “jaw cracking” to frighten patients with gloomy prognoses and at the same time offer expensive and pointless “therapies” for the supposed illness. This approach is simply the invention of diseases as a business model, known as “disease mongering”.

Unnecessary diagnostic procedures such as computerised jaw measurements and imaging procedures such as MRI and DVT are unnecessary for jaw cracking.

The superfluous therapies range from complex splint therapies, which are charged at several €1,000, to the prosthetic treatment of complete dental arches with crowns or “tabletops”, where €30,000 is charged per jaw. In terms of cost, there are adventurous orthodontic “repositioning therapies” in between, which are intended to restore the ideal relationship between the temporomandibular joint head and the discus.

Unfortunately, surgical reduction of the discus (known as discopexy) is also still offered today, although it is associated with high risks and uncertain benefits. All these therapies are highly invasive, stressful and expensive, but have no proven benefit.

On the contrary, a targeted therapeutic influence on “jaw popping” is not even possible. In the rare cases in which the clicking is so loud that it is disruptive in social life, a minimally invasive surgical procedure on the temporomandibular joint (arthroscopy or arthrocentesis) can bring improvement under favourable circumstances, although success cannot be guaranteed.

While most “cracking therapies” are as superfluous as they are pointless, therapeutic help for pain and restricted movement that may exist at the same time is of course useful. The principles of non-invasive, reversible and cost-effective apply here – or in short: keep your head down.

Radiological Reports

Radiological reports of findings following MRIs of cracking temporomandibular joints often contain dramatic-sounding findings such as “internal derangement” followed by a graduation from I to V. This simply describes how far the disc has moved forward from its ideal position. This simply describes how far the disc is displaced forward from its ideal position – but it does not mean disease, nor does it mean a poor prognosis.

Therefore, “internal derangement grade IV” is by no means a threatening finding. As a rule, the temporomandibular joint continues to function without complaint even with total dislocation of the disc.

Those affected by a “cracking jaw” should therefore not be impressed by such reports. Unfortunately, certain radiological practices with a large catchment area (in this respect a very bad one: a large radiological practice in Frankfurt am Main), which willingly provide gloomy-sounding reports and thus give referring physicians an excuse for unnecessary therapies – it seems to be a lucrative barter business for both sides.

The greatest skepticism must also be shown towards the many medical statements on jaw cracking on the internet, whereby the recurring basic pattern is the construction of a threatening backdrop in connection with questionable therapy offers.

Beware of Misinformation

Unfortunately, the internet is full of misleading information about “jaw cracking”. This starts with speculative statements about the causes of the clicking or the anterior disc position: in fact, these are usually unknown and, incidentally, completely irrelevant for further treatment.

All statements about the danger and need for treatment of cracking should not be taken seriously. All therapy offers for cracking are fundamentally questionable, as there are no possibilities at all to specifically influence cracking.

Statements such as “Get rid of jaw cracking – once and for all!” and the like, which give the impression that special masters can reverse the anterior disc position, are therefore dubious.

Tip for People with Temporomandibular Joint Clicking

Above all, resist the whispers of enterprising doctors and under no circumstances have expensive and invasive therapies performed because of a trivial “jaw clicking”! Computer measurements should be avoided, as well as MRI examinations, both of which are basically not useful in the case of a jaw clicking as the only finding.

Justifiable indications for an MRI are severe pain in the temporomandibular joint that does not respond to usual therapy or the planning of an operation. However, both of these occur extremely rarely.

In the case of a simple “jaw crack” without pain and movement restrictions, neither in-depth diagnostics nor any therapy is required – do nothing and let it crack is the best strategy!

MRT des Kiefergelenks (Ausschnitt): bei „Kieferknacken“ als einzigem Symptom überflüssig!
MRI of the temporomandibular joint (detail): unnecessary if “jaw clicking” is the only symptom.


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