Today is the first session of the “Occlusal Diagnosis: Identifying Risk” online seminar and the topic will be joint diagnosis. It can be a challenging situation when a patient suddenly develops a joint “pop” or “click”. Especially if it follows a routine dental visit like hygiene or a buccal pit composite. There are a group of patients we see in that are predisposed to develop a lateral pole disc displacement. We have the ability to determine who some of these patients are and help them understand the underlying condition.
Checking for “ligament Laxity” is a routine part of my dental exam. The lateral ligament in the Temporomandibular Joint can be permanently damaged or stretched. Simply place your gloved pinky fingers into the patients external auditory meatus, with the pad of your finger facing anteriorly. Ask the patient to open fully and increase to a firm pressure in an anterior direction once they reach maximum opening. Then ask them to close and feel for a “pop” or “click”. The laxity of the lateral ligament will allow the pressure from your finger to displace the disc anteriorly as the patient closes.
This “pop” or “click” will disappear again once you remove your finger pressure. A majority of the time the patient has never experienced joint noise before. Discovering ligament laxity helps us find an underlying anatomic change to the joint that. When I find ligament laxity I make sure to help the patient understand that they may never develop any other signs or symptoms. They also need to understand that something as simple as a wide yawn, opening to eat a large sub or a dental appointment could be followed by them hearing the “pop” or “click” on a more routine basis. I also help them understand what the sounds mean and that we will monitor their joint health and will work together to manage any changes.
Go ahead, I know you want to try this in your own ears! I have participants do this in my lectures and there are always a good number of dentists who learn they have ligament laxity!