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You can have the following joint sounds:
* Clicking: distinct short lasting pops, clicks, etc.
* Crepitus: sandy rough sounds that may last throughout the opening and closing
movements
* Eminience clicks: duller "thud" like reciprocal sounds as the joint goes beyond the emininence and back
* "Crackling" sounds in patients with limited openings with disc displacement without reduction
Crepitation in joints usually indicate arthritic changes.
Most disc displacements are anterio-medial along the long axis of the lateral pterygoid
muscle. Anterio-lateral disc displacement is also common. Posterior disc displacements are
extremely rare (I have seen one in 35 years).
The two common disc displacements according to the TMJ/RDC are:
* Disc displacement with reduction DDWR. In these cases, the disc is displaced in front
of the condyle and clicks on as the joint comes underneath it when opening. There usually is a closing click, although this may be hard to hear.
* Disc displacement without reduction DDW/OR is when the disc has gotten so far out
in front of the condyle that it does not pop back on top and now the patient has limited opening or closed lock.
As we all know, painless clicking joints with no dysfunction do not need to be treated
according to evidenced-based standard of care.
So what do we look for?
[Editor's Note: See online message board for a list of what to look for.]
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Table of Contents for the Digital Edition of Dentaltown November 2013