Hypermobility and the Jaw

Some individuals are more prone to these issues because of Generalized Joint Hypermobility (GJH). This condition means the joints can move beyond the normal limits. The Beighton Score (BS) is a simple nine-point test that clinicians use to assess GJH (Malek et al., 2021).

When the jaw joint is hypermobile, patients may notice:

• Clicking or popping sounds
• Jerky or irregular jaw movements
• Episodes where the jaw feels unstable or even gets “stuck” (Tuijt et al., 2018)

These symptoms can make wide opening, like yawning, biting into a large sandwich, or dental procedures, especially risky.

Practical Tips to Protect Your Jaw

1. Monitor your opening: Try to stay within the comfortable range (about 40 mm or two fingers).
2. Support during yawning: Place a hand gently under your chin to avoid excessive stretching.
3. Modify eating habits: Cut food into smaller pieces rather than taking large bites.
4. Communicate with your dentist: Let your provider know if you have hypermobility so they can adjust their techniques during dental care.
5. Practice jaw awareness: Notice when you tend to open wide (e.g., during laughter, stretching) and learn to limit the motion.

Why This Matters

Avoiding extreme movements helps reduce stress on the TMJ and lowers the risk of luxations, especially if you already experience joint hypermobility. A little daily mindfulness can go a long way in protecting your jaw health.

References:

Malek S, Reinhold EJ, Pearce GS. The Beighton Score as a measure of generalised joint hypermobility. Rheumatol Int. 2021 Oct;41(10):1707-1716. doi: 10.1007/s00296-021-04832-4. Epub 2021 Mar 18. PMID: 33738549; PMCID: PMC8390395.

Tuijt M, Parsa A, Koutris M, Berkhout E, Koolstra JH, Lobbezoo F. Human jaw joint hypermobility: Diagnosis and biomechanical modelling. J Oral Rehabil. 2018 Oct;45(10):783-789. doi: 10.1111/joor.12689. Epub 2018 Jul 19. PMID: 29972704.

What do you think is happening with your jaw?

→Clicking Jaw

Sometimes your jaw makes a clicking sound when you open or close your mouth. This happens to many people and usually doesn’t hurt or need any treatment. This is called disc displacement with reduction.

→Jaw Doesn’t Open All the Way

This is when your jaw can’t open fully because the disc inside the joint is fully sitting in front of the joint. It might hurt when you try to eat or talk. You also might not be able to move your jaw side to side very well. This is called disc displacement with no reduction.

→Jaw Gets Stuck Sometimes

Your jaw might get stuck closed for a bit. This is more likely to happen in people with a history of clicking noise in front of the ear, with the occasional jaw being stuck closed on waking. It often fixes itself. This is called episodic locking.

→Jaw Pops Out of Place

This happens when you open your jaw too wide, and get stuck open. It happens because the joint moved out of the socket. Seizure, trauma to your face, or hyper flexible jaw joints can cause this more frequently. This is called TMJ luxation.

→Jaw Gets Stuck Open

Sometimes your jaw can get stuck open, but you can close it yourself. This happens when the jaw joint moves out of the disc but not necessarily the socket. This is called open locking.

Why to deliver a medication through the oral mucosa?

1. To avoid the stomach and first-pass elimination
2. To avoid the influence of the presence of food
3. Direct access to a lesion or condition
4. Quick absorption

Intraoral Permeability

The oral mucosa is not a uniformly, highly permeable tissue like the gut, but shows regional variation. The keratinized areas (thicker), such as gingiva and hard palate, are least permeable and nonkeratinized lining areas (such as the tissue under the tongue) are most permeable. (Squier 1991)

Holding medication in place!

One of the major limitations associated with buccal delivery is low permeation of therapeutic agents across the mucosa. Various substances have been explored as permeation enhancers to increase the flux/absorption of drugs through the mucosa, but irritation, membrane damage, and toxicity are always associated with them and limit their use. (Sohi et al, 2010)

Technological advances in mucoadhesive, sustained drug release, permeability enhancers and drug delivery vectors are increasing the efficient delivery of drugs to treat oral and systemic diseases.  (Hearnden  et al, 2011)

It is possible to use a tissue coverage with an appliance similar to a bleaching tray. These oral appliances, whether used alone as a physical barrier or as a vehicle to deliver topical anesthetic, represent a safe and effective modality for the management of neuropathic orofacial pain disorders. (Bavarian  et al, 2022)

References

Sheikh S, Gupta D, Pallagatti S, Singla I, Gupta R, Goel V. Role of topical drugs in treatment of oral mucosal diseases. A literature review. N Y State Dent J. 2013 Nov;79(6):58-64. PMID: 24600767.

Squier CA. The permeability of oral mucosa. Crit Rev Oral Biol Med. 1991;2(1):13-32. doi: 10.1177/10454411910020010301. PMID: 1912142.

Kurosaki Y, Kimura T. Regional variation in oral mucosal drug permeability. Critical reviews in therapeutic drug carrier systems. 2000;17(5):467-508.

Sohi H, Ahuja A, Ahmad FJ, Khar RK. Critical evaluation of permeation enhancers for oral mucosal drug delivery. Drug Dev Ind Pharm. 2010 Mar;36(3):254-82. doi: 10.1080/03639040903117348. PMID: 19663558.

Hearnden V, Sankar V, Hull K, Juras DV, Greenberg M, Kerr AR, Lockhart PB, Patton LL, Porter S, Thornhill MH. New developments and opportunities in oral mucosal drug delivery for local and systemic disease. Adv Drug Deliv Rev. 2012 Jan;64(1):16-28. doi: 10.1016/j.addr.2011.02.008. Epub 2011 Mar 1. PMID: 21371513.

Bavarian R, Khawaja SN, Treister NS. Oral appliances in the management of neuropathic orofacial pain: A retrospective case series. Oral Dis. 2022 Apr;28(3):805-812. doi: 10.1111/odi.13824. Epub 2021 Mar 9. PMID: 33650141.

1. Wear your appliance as instructed.

2. Keep the appliance moist. If the appliance dries out it may wrap or crack.

3. Cleanse the appliance after each use with toothbrush and use a soft soap.  There are products available in the pharmacy for cleaning dentures.

4. If the appliance is uncomfortable or has been broken or cracked, call our clinic immediately for an appointment. Do not wear it until you have seen the doctor.

5. It is imperative that the appliance be adjusted by a dentist periodically. Please do not wear the appliance if it has not been checked.  NEVER ADJUST THE APPLIANCE YOURSELF.

6. Keep the appliance in a safe place, away from pets.

7. Some of the potential complications that can occur from using the appliance, include, but are not limited to:

1. increased symptoms
2. bite changes
3. jaw joint problems
4. jaw pain/muscle pain
5. muscle spasm
6. broken teeth
7. broken dental restoration