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Musicians and TMJ disorders
Temporomandibular Joint Musicians and TMJ disorders Background.—Patients who have temporomandibular joint disorders (TMDs) often complain of pain on function in the TMJ, preauricular area, and/or masticatory muscles; limited or distorted jaw movements, particularly with opening; and TMJ sounds such as clicking or crepitus. Other symptoms include headache, pain in the neck or face, earache, tinnitus, and hearing loss. TMD signs occur about twice as often as pain experiences, with signs seen in 1% to 75% of patients but pain symptoms only seen in 5% to 33% of patients. Professional musicians may develop disorders related to their occupation and lifestyle. The individual’s specific characteristics and those related to the type of instrument played often determine what disorder develops. Wind or string instruments held between the shoulder and the angle of the jaw could overload the masticatory muscles and orofacial skeletal system and may contribute to the development of a TMD or exacerbate the symptoms of a preexisting condition. Between 14% and 15% of professional musicians whose performance includes the orofacial region report having TMJ dysfunction, but whether playing a specific instrument could cause TMDs remains unclear. A review of the literature was undertaken to determine possible associations between playing a musical instrument and developing and/or having a TMD. Methods.—The PubMed search identified 14 articles that met the inclusion criteria. Six were case-control studies or pre-test/post-test designs, 7 were case reports, and 1 was a preliminary report/expert opinions. The Patient/populationIntervention-Control/comparison-Outcome/results (PICO) system was used to analyze the papers that were case control or pre-test/post-test designs, with the others simply summarized and tabulated. Results.—From 5 case-control studies and 1 pre-test/ post-test study it was clear that there was a potential association between TMD and playing a musical instrument. This was particularly evident among violin and viola players, who were studied in 4 of the studies. Discussion.—Playing the violin or viola was associated with TMD development. Professional musicians playing these instruments show clinical signs of TMD more often
than matched control individuals. The cause appears to relate to the mechanical overload on the orofacial region and/or the tendency to push the mandible toward the contralateral TMJ. How the instrument is held may explain why complaints arise on one side of the orofacial area more than on the other. Future research should target musicians who play wind instruments to determine if there is a relationship between these instruments and TMD.
Clinical Significance.—It was interesting that in addition to wind and string instrument players, four piano players had TMD complaints. Possibly the physical and psychosocial demands of the performance, the increased levels of concentration, the stress, and the anxiety may increase masseter and temporalis muscle activity while playing the piano. Tooth clenching may result and contribute to the development of TMD. Regardless of the instrument played, dental practitioners and professional musicians should be aware of any possible interactions between playing an instrument and developing TMD. This awareness will help clinicians properly assess, diagnose, and treat TMDs and alert musicians to the possibility so they will seek proper management. Further study is needed to determine the link between playing a musical instrument and developing TMD complaints.
Attallah MM, Visscher CM, Vn Selms MKA, et al: Is there an association between temporomandibular disorders and playing a musical instrument? A review of literature. J Oral Rehabil 41:532541, 2014 Reprints available from F Lobbezoo, Dept of Oral Kinesiology, Academic Ctr for Dentistry Amsterdam (ACTA), Univ of Amsterdam and VU Univ Amsterdam, MOVE Research Inst Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands; e-mail: [email protected]
Volume 60
Issue 5
2015
e157
than matched control individuals. The cause appears to relate to the mechanical overload on the orofacial region and/or the tendency to push the mandible toward the contralateral TMJ. How the instrument is held may explain why complaints arise on one side of the orofacial area more than on the other. Future research should target musicians who play wind instruments to determine if there is a relationship between these instruments and TMD.
Clinical Significance.—It was interesting that in addition to wind and string instrument players, four piano players had TMD complaints. Possibly the physical and psychosocial demands of the performance, the increased levels of concentration, the stress, and the anxiety may increase masseter and temporalis muscle activity while playing the piano. Tooth clenching may result and contribute to the development of TMD. Regardless of the instrument played, dental practitioners and professional musicians should be aware of any possible interactions between playing an instrument and developing TMD. This awareness will help clinicians properly assess, diagnose, and treat TMDs and alert musicians to the possibility so they will seek proper management. Further study is needed to determine the link between playing a musical instrument and developing TMD complaints.
Attallah MM, Visscher CM, Vn Selms MKA, et al: Is there an association between temporomandibular disorders and playing a musical instrument? A review of literature. J Oral Rehabil 41:532541, 2014 Reprints available from F Lobbezoo, Dept of Oral Kinesiology, Academic Ctr for Dentistry Amsterdam (ACTA), Univ of Amsterdam and VU Univ Amsterdam, MOVE Research Inst Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands; e-mail: [email protected]
Volume 60
Issue 5
2015
e157