TMJ Sounds — What Clicking and Grating Mean
Table of Contents
Types of TMJ sounds
Sounds heard when opening and closing the jaw are broadly classified into clicking and crepitus. The type of sound provides important diagnostic clues about the internal state of the joint. Rather than panicking over the sound itself, the key is to evaluate whether pain or functional impairment accompanies it.
Clicking — a sign of disc displacement with reduction
A single 'click' heard when opening the mouth occurs at the moment when the articular disc, which had been displaced anteriorly, slides back over the condyle into its normal position. This is called disc displacement with reduction. If clicking also occurs on closing, the disc is being pushed forward again. Loudness does not correlate with severity.
Crepitus — a sign of degenerative change
If a continuous coarse grinding sound such as 'gritty' or 'crackling' is heard throughout opening and closing, this is crepitus, suggesting that the cartilage of the joint surface has degenerated and bone is rubbing on bone, or that the joint surface has become irregular. It is a finding of degenerative joint disease (DJD) and represents a more advanced stage than clicking.
When treatment is needed and when to observe
- Treatment strongly recommended: When the sound is accompanied by pain, when there is limited mouth opening, or when the sound becomes louder or changes character (clicking → silent locking → crepitus). This indicates the disorder is progressing.
- Observation may be sufficient: When there is only sound without any pain or functional impairment. About 30–40% of the population has asymptomatic clicking, which does not necessarily require treatment.
Korean medicine treatment approach
For clicking with pain, acupuncture at Xiaguan (ST7), Tinggong (SI19), and Jiache (ST6) combined with TMJ chuna (joint mobilization) is used to encourage the disc to return. In the degenerative stage with crepitus, pharmacopuncture (Jahage/placental extract) and tonifying liver-kidney herbal medicine (modified Yukmijihwang-tang/Liuwei Dihuang Tang) are administered to improve the joint environment and slow cartilage degeneration.
Self-check method
Place both index fingers in front of the ears (over the TMJ) and slowly open the mouth, checking for sound and pain at the same time. If three fingers fit vertically into the mouth at maximum opening, the range is normal. If a new sound appears or the pattern changes, it is best to seek professional evaluation.