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Case 6: The case of a 16 year old complaining of a loud sound while chewing

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A 16 year old girl came in with her mother and sister extremely worried about a loud sound arising from her right jaw joint every time she chewed. They said it was so embarrassing at times because they could hear it from the next room. The child also said that her right jaw joint hurt when she tried to open her mouth wide like when yawning and while chewing also.

It sounded like the disc which lies in the middle of the jaw joint had lost its laxity and had become loose. Everytime she opened and closed her mouth the disc popped out and then popped back in again, causing the clicking sound.

Let’s address the “Why”. An examination, diagnosis and treatment planning was carried out. This is typically done with 21 photographs, a deprogrammed bite of the jaw and a record that orients the upper jaw with the face. These records are “mounted” on a jaw simulator for me to work on when the patient is not in the clinic. It leads me to the “Why” of the problem in order to come up with a tailored solution.

Prior to this a small appliance to fit the upper front teeth was made in order to find out whether the patient would be able to tolerate an occlusal splint or would the occlusal splint worsen her pain? In this case it was determined that the pain did not worsen once the jaw placed back in centric relation (CR).

In this case a 3 D scan(CBCT) of the jaw joint was also made. This revealed that there were arthritic changes in the right jaw joint. This occurred due to severe grinding of the teeth at night. The grating noise from the teeth grinding was so loud at times that the mother would wake the child up in the middle of the night to intercept the habit. The constant nocturnal grinding had also caused the muscles around the joint to become sore and the ligaments that held the disc in place subsequently became loose. Hence the disc started popping out causing the clicking sound and pain.

The treatment addressed the cause:

An “Occlusal splint in Centric Relation” was fabricated for this patient. She had to wear this as often as possible, definitely at night. The click in the jaw joint was gone at her next recall and the pain started reducing within 2 weeks of using the splint. Low level laser therapy was given twice a week to the right jaw joint area. She was advised a soft diet and hot fomentation of the right jaw joint area. She now felt the pain only when she yawned. This also was completely resolved within 3 months of using the occlusal splint.

She requires “Orthognathic surgery” in order to permanently correct her bite but the patient is happy with the results of our conservative management. She continues to wear the splint at night and is no longer embarrassed to enjoy a meal with her friends and family!

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Case 1: Case of the floating teeth

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