Not Every Clicking Jaw Needs Treatment

First we sort out what to watch and what to treat

Key points in 30 seconds

1. Jaw joint problems affect one in three adults. They're not rare.
2. If your jaw only clicks, doesn't hurt and opens fully, watching and waiting is usually the right call.
3. The signs that you should come in are different: pain, not opening as far, or the jaw getting stuck.
4. When 48 studies were pooled, the group that also worked on habits and stress improved the most. That means you can't look at the jaw alone.
5. We start by measuring how wide your mouth opens in millimeters. We check whether it's improving by numbers, not by feel.

What we often hear

• "My jaw catches when I yawn, and it scares me."
• "It clicks when I eat, and I worry other people can hear it."
• "My jaw feels stiff in the morning. I wonder if I grind my teeth."
• "I take headache pills, but they only help for a while."
• "I end up chewing on one side only, because the other side hurts."

We see many women around their 40s who can open only in the 30 mm range and also get morning headaches. They came in for headaches, not their jaw, and when we measured, the jaw turned out to be the cause.

Here's what happens when you visit us

You'll go home on the first day knowing three things: how many millimeters your mouth opens right now, why, and whether to treat it or watch it.

We work out whether the pain is in the chewing muscles or the joint, and measure how wide your mouth opens in millimeters. Not by feel, like how many fingers fit, but in numbers. A maximum opening of 40 mm or more is usually considered within the normal range. We also check which way your neck and shoulders tilt, whether you grind or clench your teeth, and how you sleep.

If you only have clicking, we don't recommend treatment. Instead, we tell you "come back if this happens" and send you home. Not starting treatment you don't need is part of good care too.

If it does need treatment, we start with what can be undone. We use acupuncture and pharmacopuncture (herbal acupuncture) for stiff muscles and pain, and Chuna (Korean manual therapy) to balance the neck and jaw joint together. For those who need it, we fit a jaw splint. We don't just hand it over. We check and adjust it at set times. On top of that, we help you work on teeth grinding, posture and stress habits. Dr. Jihun Kim, our lead director, has completed the specialist course of the Korean society for jaw joint balance medicine and has long treated the jaw together with the balance of the whole body.

We've actually seen a patient who could open only 25 mm get back to 40 mm. At 25 mm, even taking a spoonful of rice is something you have to be careful about.

That's the point we aim for: your mouth opening 40 mm or more again, waking up without a stiff jaw, chewing evenly on both sides. But how much it changes, and how quickly, differs from person to person.

After a few weeks, we measure again the same way and show you. We put the new number side by side with the first one. If the number doesn't move, we don't repeat the same treatment. We change direction. If a stuck jaw doesn't free up or a structural problem is suspected, we recommend a detailed exam first.

Clicking alone is very common

One in three adults has jaw joint problems. When 21 studies using the same diagnostic criteria were pooled, about 31% of adults had them, and the most common type was the "clicking" type.

Inside the jaw joint is a disc of cartilage that cushions the bones. When it slips slightly out of place and then pops back in as you open your mouth, you hear a "click." A great many people have this, and many of them go their whole lives without any problem.

Come in when

• It starts to hurt: when chewing, when opening your mouth, or in front of your ear
• Your mouth doesn't open as far as it used to: a big yawn feels like a strain, or biting into an apple is hard
• Your jaw gets stuck: at some point, your mouth catches and won't open. This needs to be seen quickly
• Your jaw feels stiff and tired in the morning: you may be grinding your teeth at night

From this point, putting it off tends to make things worse. It hurts, so you don't chew on that side; chewing on one side throws the muscles further off balance, and that makes it hurt more. It's a loop. Once you're in it, it gets harder and harder to tell what the original problem was.

Why we don't look at the jaw alone

The internationally agreed order is to start with treatments that can be undone: education and habit correction, acupuncture and manual therapy, and a splint if needed. Grinding down teeth to change your bite or starting with surgery can't be undone, so going that way from the start isn't recommended.

And there's one finding we pay particular attention to. When 48 studies on splint treatment were pooled and compared, the group that improved most was the one that also had counseling, where clenching and grinding habits, stress and posture were addressed together. It did better than a splint alone. That's why we always combine habit correction with splints.

The jaw is tied to the neck, shoulders, posture, sleep and stress. If you leave that whole bundle as it is and only treat the jaw, it only feels better while you're being treated.

Several reports say acupuncture reduced pain and helped the mouth open wider. But when you look only at trials comparing real and sham acupuncture, the difference isn't consistently large, so how much of the improvement is due to the acupuncture itself hasn't been settled yet. That's why we measure and check. The less certain the evidence, the more you need to look at the numbers.

What changes

Yawning without worry. Not having to chew on one side only. Waking up without a stiff jaw.

What we aim for isn't getting rid of the click. It's being able to use your jaw without discomfort. The patient who went from 25 mm back to 40 mm, in the end, was able to eat comfortably again.

How jaw joint problems progress varies from person to person depending on the type (muscle or joint), teeth grinding habits, stress and any neck or shoulder problems that come with it.

Come in and get measured if you

• Can't open your mouth as wide as you used to
• Wake up every morning with a stiff jaw or a headache
• Chew on one side only
• Have had your jaw get stuck

Measuring doesn't take long. On the day, you'll know how many millimeters it is and hear whether it needs treatment or watching. We don't recommend treatment if your jaw only clicks, so feel free to come in.

Sources for this article

Source	What was studied	Findings
Valesan et al., 2021	Pooled analysis of 21 studies using the same diagnostic criteria	About 31% of adults and 11% of children and teens. Most common type: clicking
List et al., 2017	Review of the concepts and management of TMJ disorders	The principle is to start with conservative treatments that can be undone
Al-Moraissi et al., 2020	Comparison pooling 48 clinical trials of splint treatment	The group that also had counseling improved most. Quality of evidence ranged from moderate to very low
La Touche et al., 2010	8 acupuncture trials (4 well designed)	Reduced pain, improved chewing function and mouth opening
Jung et al., 2011	Pooled analysis of only the 7 trials comparing with sham acupuncture	Evidence versus sham acupuncture is still limited

References

1. Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, Januzzi E, de Souza BDM. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clinical Oral Investigations. 2021;25(2):441-453. doi:10.1007/s00784-020-03710-w

2. List T, Jensen RH. Temporomandibular disorders: old ideas and new concepts. Cephalalgia. 2017;37(7):692-704. doi:10.1177/0333102416686302

3. Al-Moraissi EA, Farea R, Qasem KA, Al-Wadeai MS, Al-Sabahi ME, Al-Iryani GM. Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials. International Journal of Oral and Maxillofacial Surgery. 2020;49(8):1042-1056. doi:10.1016/j.ijom.2020.01.004. PMID: 31982236

4. La Touche R, Goddard G, De-la-Hoz JL, Wang K, Paris-Alemany A, Angulo-Díaz-Parreño S, Mesa J, Hernández M. Acupuncture in the treatment of pain in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. Clinical Journal of Pain. 2010;26(6):541-550. doi:10.1097/AJP.0b013e3181e2697e

5. Jung A, Shin BC, Lee MS, Sim H, Ernst E. Acupuncture for treating temporomandibular joint disorders: a systematic review and meta-analysis of randomized, sham-controlled trials. Journal of Dentistry. 2011;39(5):341-350. doi:10.1016/j.jdent.2011.02.006

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If your jaw clicks, come in and get it measured. We'll start by telling you whether it's a click that needs treatment.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.