1067: Are We Asking the Right Questions About Clicking Joints? - Dr. Jim McKee

A clicking jaw joint may not hurt, but pain alone does not reveal whether the joint is healthy, stable, or affecting growth and occlusion. In this episode, Kirk Behrendt speaks with Dr. Jim McKee, a restorative dentist and educator, about evaluating clicking joints from a structural and orthopedic perspective.

You will learn how the articular disc supports condylar position, mandibular and maxillary growth, vertical dimension, bone protection, and load distribution, as well as why patient age, malocclusion, and joint anatomy should guide diagnosis. To understand why dentists need to ask better questions about clicking joints, listen to Episode 1067 of The Best Practices Show!

Main Takeaways:

• The articular disc acts like a gasket that positions the condyle three-dimensionally and supports a repeatable bite.
• A displaced disc can affect mandibular and maxillary growth even when the patient does not report pain.
• Malocclusion can be an early clinical indicator of structurally altered temporomandibular joints.
• Changes in vertical dimension at the joint level can contribute to excessive loading and breakdown of terminal posterior teeth.
• MRI and CBCT provide information about soft-tissue and hard-tissue joint anatomy that cannot be determined from symptoms alone.
• Appliances can redistribute load and support adaptation, but they cannot guarantee that every structurally altered joint will adapt.
• An asymptomatic clicking joint in a stable adult should be evaluated differently from an asymptomatic clicking joint in a growing patient with malocclusion.

Snippets:

00:00 Intro

02:28 Why pain may be a late-stage indicator of a joint problem.

04:31 What a clicking disc may be unable to do compared with a normal disc.

08:12 Why teeth are only one part of the occlusal system.

10:27 How the disc supports mandibular growth.

15:12 How disc displacement may affect maxillary growth.

19:35 Why joint diagnosis matters before orthodontic treatment.

22:54 Understanding vertical dimension at the joint level.

26:44 How the disc protects bone and distributes load.

29:42 Using malocclusion to identify patients who may need joint evaluation.

36:05 How patient age and occlusal stability change the clinical significance of clicking.

38:19 Educational resources for learning joint diagnosis and restorative treatment planning.

44:27 Final Takeaways

Guest Bio/Guest Resources:

Dr. Jim McKee is a restorative dentist and educator focused on occlusion, TMD, and restorative diagnosis. He is a member of the Spear Resident Faculty. He has maintained a private practice since 1984 in Downers Grove, Illinois, where he treats a wide variety of cases with a focus on predictable restorative dentistry. He is a member of the American Academy of Restorative Dentistry and former president of the American Equilibration Society. He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.

Resources mentioned in this episode:

Stephen Phelan’s online program featuring Dr. Jim McKee’s:

https://courses.phelandentalseminars.com/tmd-webinar-wj

Advanced Occlusion Workshop at Spear Education : https://app.speareducation.com/events/workshops/advanced-occlusion

EP779: The Restorative Diagnostic Practice:

https://www.actdental.com/blog/779-mckee

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