Click, click — a snap every time you open your mouth. Some people ignore it, others tolerate it with annoyance or resignation. But many live for years with ear pain, dizziness, headaches, or even neck pain without realizing that the real culprit is that very “click.”
Yes, because that small sound may signal a more serious issue: temporomandibular joint dysfunction, a condition that affects about 6% of the population yet remains poorly understood and often underestimated, even among physicians. We discuss it with Piero Cascone, Maxillofacial Surgeon at Paideia International Hospital.
Opening the mouth is such a simple gesture that we assume it’s “trivial.” But it is actually quite complex.
Absolutely. The temporomandibular joint (TMJ) is one of the most complex joints in the human body. It connects the jaw to the skull bones, near the ears. It allows us to open and close the mouth, but also to move it forward, backward, and side to side — essential for eating, speaking, and, above all, kissing. It is made up of several components that interact with each other, and when one of them is altered, the entire system goes off balance.
What happens when something goes wrong?
The most common signs are clicking or popping when opening or closing the mouth, difficulty fully opening it, jaw pain, headaches, or pain in the neck and shoulders — the so-called cervicobrachialgia. Sometimes people also experience tinnitus (ringing in the ears) or dizziness.
These symptoms are very different from one another and often make people think of anything except the temporomandibular joint. As a result, people seek help from specialists who are not experts in maxillofacial disorders.
Ear pain? Off to the ENT.
Neck pain? To the physiotherapist.
Headaches? To the neurologist.
Few immediately think of the TMJ. This leads many patients to spend years without a precise diagnosis, receiving treatments that don’t target the actual issue. Fortunately, things are changing, and more and more ENTs and neurologists are now referring patients to us.
What are the main causes of this disorder? One might think of the teeth.
Absolutely not. This is a multifactorial condition — there is no single cause. It may stem from direct trauma or repeated microtraumas, but also from habits such as clenching or grinding the teeth (bruxism), often related to stress and anxiety.
Some people may have an anatomical issue or a predisposition linked to posture or dental occlusion. But be careful: simply putting on braces does not solve the problem. The most recent scientific literature discourages invasive dental procedures as a treatment for this condition.
So is it all caused by stress, as usual?
No. In recent years, we have understood temporomandibular disorders better from a biomechanical perspective, and this has improved our ability to treat them.
Unfortunately, some still underestimate them or attribute them to “psychological” issues when they don’t know how to treat them — especially in women.
It is essential to understand that this is not a minor annoyance to endure, but a condition that can and should be addressed seriously, because a correct diagnosis is the first step toward feeling better.
Of course, if anxiety leads us to clench or grind our teeth during sleep, that can cause TMJ problems — but that does not mean that the solution for the jaw is to see a psychotherapist.
How is the diagnosis made?
Through a thorough medical history (listening carefully to the patient’s symptoms and background), a detailed clinical exam, and, when necessary, imaging tests such as MRI of the temporomandibular joints. This test allows us to see whether the small disc inside the joint is in the correct position.
And how is it treated?
It depends on the cause.
In most cases, treatment is conservative: targeted physiotherapy, rehabilitation exercises, and night guards to prevent overloading the joint during sleep.
Only the most severe cases require surgery. The goal is always the patient’s well-being — not simply eliminating a sound or isolated symptom if it does not cause discomfort.
So intervention isn’t always necessary?
Exactly. The priority is the person’s well-being.
If the “click” does not cause pain or limit movement, often nothing drastic is needed — physiotherapy may be enough.
But if there is pain, joint locking, or an impact on daily life — such as in people who speak in public or singers — then intervention becomes important.
And it should not be ignored.
Similarly, if the jaw locks — a very painful event — one should not assume it was just a one-off once it “unlocks.”
Jaw locking is not a simple warning sign. It is the third and most advanced stage of a problem. Ignoring it is a serious mistake.
I always give this example: it’s just like a knee joint issue — you don’t ignore it. You see an orthopedist who, depending on severity, may prescribe physiotherapy or surgery. But they certainly won’t advise ignoring the problem, because they know it will worsen.
A maxillofacial surgeon is essentially the “orthopedist” of the temporomandibular joint.
Can it happen in children too?
Yes, although more rarely.
For this very reason, it is wrong to assume that a simple orthodontic appliance will always solve the issue. Each case must be evaluated individually.
