TMJ Clicking: Evidence, Causes, Imaging Considerations, and Natural Course

Clinical Exam: TMJ Clicking

TMJ clicking may be identified during a clinical examination by placing a finger lightly over the lateral pole of the joint or by using a stethoscope to listen for a clear, reproducible click as the jaw opens. The jaw may deviate slightly toward the affected side before straightening once disc reduction occurs. Although the clinical exam can reliably detect joint noise, its diagnostic accuracy for confirming disc displacement with reduction is limited. MRI-validated studies report a sensitivity of approximately 44 percent and a specificity of approximately 51 percent, indicating that clinical findings alone cannot confirm disc position.

MRI: TMJ Clicking

Advanced imaging is not routinely indicated for joint sounds alone and is typically considered only when symptoms such as pain, locking, or functional limitation are present.

MRI is considered the reference standard for evaluating disc displacement with reduction because it visualizes soft-tissue anatomy directly. In the closed-mouth image, the disc may be positioned anterior to the condyle. In the open-mouth image, the disc may return to its position on top of the condyle, a finding consistent with disc reduction. MRI can also identify features such as joint effusion, adhesions, perforation, and degenerative changes, providing the most complete assessment of TMJ soft-tissue structure and function.

CBCT: TMJ Clicking

CBCT evaluates only the bony structure of the TMJ and cannot visualize the disc. When the disc is displaced anteriorly, the condyle may appear posterior and superior in the glenoid fossa, a finding that may support—but cannot diagnose—disc displacement. CBCT is valuable for identifying fractures, erosions, osteophytes, ankylosis, and other bony abnormalities that may mimic symptoms or contribute to joint dysfunction. Confirmation of disc position still requires MRI.

Natural History of TMJ Clicking

TMJ clicking often follows a benign course in many individuals and may remain stable over time. Long-term MRI studies show that approximately seventy-six percent of joints with disc displacement with reduction demonstrate no structural change. Roughly ten percent show improvement, and clicking may diminish or resolve. Approximately fourteen percent demonstrate structural progression, although symptoms may not develop. Clinical studies similarly report that about seventy-one percent of clicking remains unchanged and about twenty-nine percent resolves spontaneously. A smaller proportion of individuals develop locking, typically in the presence of baseline pain or increased joint-loading risk factors. TMJ clicking does not necessarily indicate progressive degeneration.

Causes of TMJ Clicking

TMJ clicking is commonly associated with anterior disc displacement in which the disc snaps back onto the condyle during jaw opening. Laxity or elongation of the discal ligaments may allow the disc to shift forward. When supporting tissues weaken, overload may contribute to disc displacement. Microtrauma may include clenching, bruxism, gum chewing, forward-head posture, sleep parafunction, unilateral chewing, and reduced molar support. Macrotrauma may include chin impact, whiplash injury, sports-related blows, and facial trauma. General joint hypermobility and connective-tissue laxity may increase susceptibility.

Management Considerations

Painless TMJ clicking does not necessarily require intervention. Joint noise alone is common and may remain stable over time. Education, reassurance, and reduction of joint load are commonly emphasized. Individuals may be advised to limit wide opening, gum chewing, hard foods, and daytime clenching. Conservative measures such as self-care instruction, short-term stabilization splints, or physical therapy may be considered when clicking is accompanied by pain, limited opening, or locking. Irreversible procedures such as occlusal adjustment, orthodontic treatment, or TMJ surgery are not indicated for isolated clicking.

Evaluation and management of temporomandibular disorders are individualized and may involve coordination with clinicians trained in orofacial pain or related medical disciplines when indicated.

Summary

TMJ clicking may occur when an anteriorly displaced disc reduces during jaw opening. The clinical exam can identify joint sounds, but imaging may be required to confirm disc position in selected cases. CBCT evaluates bony anatomy only and cannot diagnose disc displacement. Many cases remain stable or improve over time, while a smaller proportion may progress to locking. Factors such as ligament laxity, microtrauma, macrotrauma, and joint hypermobility may contribute. If joint sounds are accompanied by pain, limitation, or functional changes, a clinical evaluation may be appropriate.