Update on Temporomandibular joint disorders (TMD) in musicians

Update on Temporomandibular joint disorders (TMD) in musicians

Musculoskeletal disorders in musicians are common and in one review were reported to affect up to 93% of musicians over a lifetime.1Ackermann BJ, Driscoll T, Kenny DT. Musculoskeletal pain and injury in professional orchestral musicians in Australia. Med Probl Perform Art 2012;27(4):181-7.^,2Kok LM, Huisstede BM, Voorn VM, et al. The occurrence of musculoskeletal complaints among professional musicians: a systematic review. Int Arch Occup Envi 2016;8:373-97. https://doi.org/10.1007/s00420-015-1090-6. Among studies conducted, some over the last four decades have investigated the effect of playing musical instruments on the craniomandibular region. In this article, part 2 of a series, we’ll review findings related to temporomandibular joint disorders (TMD) in musicians.

Definition and manifestations of TMD

TMD involves the temporomandibular joint (TMJ), masticatory muscles, and associated structures, and articular disorders include disc displacement conditions, degenerative disease, and subluxation.3Klasser GD. Overview of Temporomandibular Disorders (TMDs). Merck Manual, Sept 2023.^,4Schiffman E, Ohrbach R, Truelove E et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28(1):6-27. In addition, pain associated with TMD includes myalgia, arthralgia, and TMD-associated headache, and may involve fascia and muscles controlling the TMJ, neck, and shoulder. Other manifestations include pre-auricular pain, limitations in mouth opening, mandibular deviations, and TMJ sounds (clicking, crackling or popping noises).5The Johns Hopkins University, the Johns Hopkins Hospital, Johns Hopkins Health System. Temporomandibular Disorder (TMD). Diagnostics 2021;11:459. https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disordertmd. ^,6Cavalcanti A. Is playing string or wind musical instruments a risk factor for temporomandibular dysfunction? A Systematic Review. J Oral Res 2017;6(11 SE):299-306. doi:10.17126/joralres.2017.083.^,7Attallah MM, Visscher CM, van Selms MK, Lobbezoo F. Is there an association between temporomandibular disorders and playing a musical instrument? A review of literature. J Oral Rehabil 2014;41(7):532-41.

Reviews on the prevalence of TMD in musicians

Following early research on TMD in musicians,8Taddey JJ. Musicians and temporomandibular disorders: prevalence and occupational etiologic considerations. Cranio 1992;10(3):241-4. several reviews and numerous studies have been conducted on its prevalence and manifestations. In one systematic review and meta-analysis (2021) with 13 studies, approximately 54% of musicians were found to experience TMD, with a pooled prevalence of 53.9% and 52.8%, respectively, for string and wind instrumentalists.9Campos LGN, Pedrosa BH, Cavalcanti RVA et al. Prevalence of temporomandibular disorders in musicians: a systematic review and meta-analysis J Oral Rehabil 2021;48(5):632-42. In 2017, TMD prevalence based on a systematic review across 10 studies (9 cross-sectional and one a clinical intervention study) ranged from 47% to 89%, and was highest for violinists.6Cavalcanti A. Is playing string or wind musical instruments a risk factor for temporomandibular dysfunction? A Systematic Review. J Oral Res 2017;6(11 SE):299-306. doi:10.17126/joralres.2017.083. Conversely, in a second review that year, the available evidence did not indicate a higher prevalence of TMD for instrumentalists nor instrument-specific relationships.10van Selms MKA, Ahlberg J, Lobbezoo F, Visscher CM. Evidence-based review on temporomandibular disorders among musicians. Occ Med 2017;67(5):336-43. Nonetheless, in an earlier review of 32 articles, the researchers concluded that TMD was one of the more common issues among instrumentalists.11Rodríguez-Lozano FJ, Sáez-Yuguero MR, Bermejo-Fenoll A. Orofacial problems in musicians: a review of the literature. Med Probl Perform Art 2011;26(3):150-6. The section below addresses several studies on instrumentalists, followed by studies focused on upper string and wind instrumentalists.

TMD prevalences and manifestations found in individual studies

In a recent multicenter cross-sectional study (2024) with several hundred participants, the validated Performance-related Pain among Musicians Questionnaire was used to evaluate TMD.12Zao A, Altenmuller E, Azevedo L. Factors Associated With Performance-Related Pain Among Musicians: A Multicenter Study Using Validated Tools. J Occ Rehabil 2024;25(2):393-406. The lifetime prevalence of performance-related pain was found to be 57.5% and 42.5%, respectively, among professional musicians and music students. In a second study conducted in 2024, both a general questionnaire and a validated TMD Pain Screener test questionnaire were completed by almost 500 individuals.13Z'Graggen S, Ettlin DA, Alessandri1 E et al. Prevalence of Painful Temporomandibular Disorder Symptoms Among Professional and Student Musicians: An Online Survey. I Oral Rehabil 2025;52(1):9-16. Overall, 19.5% of musicians reported painful TMD, with a more than two-fold risk found for upper string players (violin and viola) and an almost three-fold risk of painful TMD found for keyboard players (piano, harpsichord and accordion). In the same year, in an observational cross-sectional study on music students, 72% of participants reported varying degrees of TMD, while for 58% of participants mild TMD was experienced.14Garcez LR, Souza RA, Sales AA, Fernandes ML. Incidence of signs and symptoms of temporomandibular dysfunction in music students: a cross-sectional observational study. J Health Biol Sci 2024;12(1):1-5. In a large survey conducted in 2019 with 1470 respondents, overall, 18.3% of the group evaluated specifically reported TMJ pain while 42.5% and 52.5%, respectively, reported headache, and neck and shoulder pain, highlighting the various structures involved.15van Selms MKA, Wiegers JW, van der Meer HA et al. Temporomandibular disorders, pain in the neck and shoulder area, and headache among musicians. J Oral Rehabil 2019;00:1-11. https ://doi.org/10.1111/joor.12886. (Figure 1)

Furthermore, among more than 400 hundred professional orchestral players in an earlier review, the self-reported prevalence of TMJ pain and pain in the teeth/jaw ranged from 15% to 34% and 19% to 47%, respectively, and varied by instrument.16Steinmetz A, Zeh A, Delank KS, Peroz I. Symptoms of craniomandibular dysfunction in professional orchestra musicians. Occup Med (Lond) 2014;64:17‐22. Lastly, in an earlier study in which almost 250 elite symphony instrumentalists were surveyed on their experience in the prior month and year, 86% reported pain that occurred largely in the neck, shoulder and lower back.17Leaver R, Harris EC, Palmer KT. Musculoskeletal Pain in Elite Professional Musicians From British Symphony Orchestras. Occ Med (Lond) 2011;61:549-55.

TMD prevalence and impact in studies on violinists

While the prevalence of TMD found among musicians playing different instruments is similar in some studies,18Stechman Neto J, de Almeida C, Rodrigues Bradasch E et al. Occurrence of signs and symptoms of temporomandibular dysfunction in musicians. Rev Soc Bras Fonoaudiol 2009;14(3):362-6. [Article in Portuguese]^,19Jang JY, Choi YC, Bae JH, Kim ST. Signs and symptoms of temporomandibular disorders in instrumental performers. J Dent Rehabil Appl Sci 2015;31(2):86-95.^,20Ahlberg JJ, Wiegers JW, van Selms M et al. Orofacial pain experience among symphony orchestra musicians in Finland is associated with reported stress, sleep bruxism, and disrupted sleep ‐ independent of the instrument group. J Oral Rehabil 2019;46:807‐12. in others significant differences have been found.

In two studies among violinists, the reported prevalence of TMD was 58% and 28.6%, respectively.21Amorim MI, Jorge AI. Association between temporomandibular disorders and music performance anxiety in violinists. Occup Med (Lond) 2016;66(7):558-63. doi:10.1093/occmed/kqw080. ^,22Rios B, Alvarelhão J, Pinheiro A. Temporomandibular Dysfunction and its relationship with Anxiety regarding musical performance in violinists - a cross-sectional study. Portug J Occ Health 2022;14:esub0362. doi:10.31252/RPSO.15.10.2022. In one of these, the temporomandibular dysfunction disability index and disabling temporomandibular pain screening instrument were utilized in addition to an online survey. The most frequent symptoms were found to be bilateral masseter pain, headache and neck pain, and individuals reported alterations in chewing, mouth opening and jaw movement.22Rios B, Alvarelhão J, Pinheiro A. Temporomandibular Dysfunction and its relationship with Anxiety regarding musical performance in violinists - a cross-sectional study. Portug J Occ Health 2022;14:esub0362. doi:10.31252/RPSO.15.10.2022. In a third study, 51.2%, 40%, 29.3%, 24.4% and 17.1% of violinists, respectively, reported TMJ sounds, neck pain, difficulty in fully opening the mouth, pain at maximum mouth opening and jaw locking.23Rodríguez-Lozano FJ, Sáez-Yuguero MR, Bermejo-Fenoll A. Prevalence of temporomandibular disorder-related findings in violinists compared with control subjects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(1):e15-9. doi:10.1016/j.tripleo.2009.08.032. (Figure 2) Compared to the control group, which consisted of non-musicians matched for age and gender, the violinists experienced more TMJ pain, greater pain with maximum mouth opening, pain in the masseter and temporalis muscles associated with clenching, and more common TMJ sounds. Furthermore, in one review from 2017, the overall self-reported prevalence of headache, and neck and shoulder pain, was 42.5% and 52.5%, respectively, while among violinists and violists the respective prevalences were 69% and 45%.15van Selms MKA, Wiegers JW, van der Meer HA et al. Temporomandibular disorders, pain in the neck and shoulder area, and headache among musicians. J Oral Rehabil 2019;00:1-11. https ://doi.org/10.1111/joor.12886. Lastly, in a small survey conducted in 2009, pain in the shoulder and/or upper limbs, neck, and TMJ/teeth were reported, respectively, by 83%, 80% and 63% of upper string and wind instrumentalists.24Steinmetz A, Ridder PH, Methfessel G, Muche B. Professional musicians with craniomandibular dysfunctions treated with oral splints. Cranio 2009;27(4):221-30. doi: 10.1179/crn.2009.033.

TMD prevalence and impact in studies focusing on wind instrumentalists

In comparing examination findings for wind instrumentalists, healthy non-musicians and patients with TMD in one study to determine the impact of playing, almost all wind instrumentalists were found to exhibit parafunctional habits and pre-auricular pain as well as differences in mandibular protrusion compared to other subjects, and popping noises were more common.25Pampel M, Jakstat HA, Ahlers OM. Impact of sound production by wind instruments on the temporomandibular system of male instrumentalists. Work 2014;48(1):27-35. It was concluded that wind instrumentalists are at risk for occupation-related TMD. In another study, conducted in 2015 among wind instrument students (mean age 17), both questionnaires and clinical examinations were conducted, and 68.3% were diagnosed with TMD (including disc dysfunctions and degenerative conditions).26Lacerda F, Barbosa C, Pereira S et al. Prevalence study of temporomandibular joint disorders in wind instrument students. Rev Portug Estomatol Med Dent Cir Maxi 2015;56(1):25–33. doi: https://doi.org/10.1016/j.rpemd.2014.11.208. [Article in Portuguese] In other studies, a prevalence of almost 46% was found for TMJ sounds27Jang JY, Kwon JS, Lee DH et al. Clinical signs and subjective symptoms of temporomandibular disorders in instrumentalists. Yonsei Med J 2016;57:1500-7., and 89% for TMD28Yasuda E, Honda K, Hasegawa Y et al. Prevalence of temporomandibular disorders among junior high school students who play wind instruments. Int J Occup Med Environ Health 2016;29:69‐76.; in both of these studies the highest prevalence was found in wind instrumentalists. In contrast, in another survey, TMD was reported by approximately 22% of wind instrumentalists.29Sayegh Ghoussoub M, Ghoussoub K, Chaaya A et al. Orofacial and hearing specific problems among 340 wind instrumentalists in Lebanon. MJ Med Liban 2008;56(3):159-67. [Article in French]

Risk Factors for TMD in musicians

Risk factors reported for TMD include poor technique, parafunctional habits, frequent and long-duration practice and performances, while increasing practice hours is considered a risk factor for its exacerbation.9Campos LGN, Pedrosa BH, Cavalcanti RVA et al. Prevalence of temporomandibular disorders in musicians: a systematic review and meta-analysis J Oral Rehabil 2021;48(5):632-42.^,21Amorim MI, Jorge AI. Association between temporomandibular disorders and music performance anxiety in violinists. Occup Med (Lond) 2016;66(7):558-63. doi:10.1093/occmed/kqw080. ^,26Lacerda F, Barbosa C, Pereira S et al. Prevalence study of temporomandibular joint disorders in wind instrument students. Rev Portug Estomatol Med Dent Cir Maxi 2015;56(1):25–33. doi: https://doi.org/10.1016/j.rpemd.2014.11.208. [Article in Portuguese]^,29Sayegh Ghoussoub M, Ghoussoub K, Chaaya A et al. Orofacial and hearing specific problems among 340 wind instrumentalists in Lebanon. MJ Med Liban 2008;56(3):159-67. [Article in French]^,30de Souza Moraes GF, Antunes AP. Musculoskeletal disorders in professional violinists and violists. Systematic review. Acta Ortop Bras 2012;20:43‐7.^,31Rensing N, Schemmann H, Christoff C et al. Musculoskeletal Demands in Violin and Viola Playing: A Literature Review. Med Probl Perform Art 2018;33(4):265-74. Other potential risk factors include perfectionism, fatigue, stress and anxiety which are common among musicians, and psychosocial factors.13Z'Graggen S, Ettlin DA, Alessandri1 E et al. Prevalence of Painful Temporomandibular Disorder Symptoms Among Professional and Student Musicians: An Online Survey. I Oral Rehabil 2025;52(1):9-16. ^,22Rios B, Alvarelhão J, Pinheiro A. Temporomandibular Dysfunction and its relationship with Anxiety regarding musical performance in violinists - a cross-sectional study. Portug J Occ Health 2022;14:esub0362. doi:10.31252/RPSO.15.10.2022.^,32Jacukowicz A. Psychosocial work aspects, stress and musculoskeletal pain among musicians. A systematic review in search of correlates and predictors of playing‐related pain. Work 2016;54:657‐68.^,33Wollenburg M, Wolowski A. Impact of professional, recreational and nonsinging on temporomandibular disorders - a comparative study based on a self-assessment questionnaire. Head Face Med 2024;20:19. https://doi.org/10.1186/s13005-024-00419-z.^,34Moller D, Ballenberger N, Ackermann B, Zalpour C. Potential Relevance of Altered Muscle Activity and Fatigue in the Development of Performance-Related Musculoskeletal Injuries in High String Musicians. Med Probl Perf Art 2018;33:147-5. (Table 1)

In one study, 73% of orchestral violinists reported being anxious, and those with the worst music performance anxiety were six times more likely to report TMD compared to those with the least anxiety.21Amorim MI, Jorge AI. Association between temporomandibular disorders and music performance anxiety in violinists. Occup Med (Lond) 2016;66(7):558-63. doi:10.1093/occmed/kqw080. TMD symptoms are proposed to worsen among less experienced musicians (i.e., students).31Rensing N, Schemmann H, Christoff C et al. Musculoskeletal Demands in Violin and Viola Playing: A Literature Review. Med Probl Perform Art 2018;33(4):265-74. However, in another study, while pain intensity was greater among professional musicians, it affected their playing less than for students, proposed to be due to better coping mechanisms.12Zao A, Altenmuller E, Azevedo L. Factors Associated With Performance-Related Pain Among Musicians: A Multicenter Study Using Validated Tools. J Occ Rehabil 2024;25(2):393-406. Differences in the manner in which instruments are played can influence the likelihood of TMD and manifestations.

Instrument-specific risk factors

Among violinists and violists, proposed risk factors include the asymmetrical and unnatural posture required while playing, muscle activity, and the static and dynamic loads during playing.31Rensing N, Schemmann H, Christoff C et al. Musculoskeletal Demands in Violin and Viola Playing: A Literature Review. Med Probl Perform Art 2018;33(4):265-74.^,35Clemente M, Coimbra D, Silva A et al. Application of Infrared Thermal Imaging in a Violinist with Temporomandibular Disorder. Med Probl Perform Art 2015;12;30(4):251-4. The violin/viola is sandwiched by the mandible sitting on the chin rest and the inferior surface of the shoulder rest sitting on the shoulder/outer clavicle area when playing, and the musician applies pressure to keep the instrument stable (fixation forces). (Figure 3)

Applying fixation force and playing requires activity and coordination of the orofacial and neck muscles (e.g., masseter, elevator, sternocleidomastoid), as well as shoulder muscles (upper trapezius and anterior of the left deltoid muscle36Kok LM, Schrijvers J, Fiocco M et al. Use of a Shoulder Rest for Playing the Violin Revisited: An Analysis of the Effect of Shoulder Rest Height on Muscle Activity, Violin Fixation Force, and Player Comfort. Med Probl Perform Art 2019;34(1):39-46.). The fixation forces and vibrations are transmitted to the TMJ, and clenching of teeth is common – sometimes also occurring when playing challenging passages of music.37Lourenço S, Clemente M, Coimbra D et al. Do pianists play with their teeth. Int Symp Perf Sci 2009;1-6. www.performancescience.org. The importance of ergonomics is highlighted by the finding that fixation force increases as the shoulder rest’s height increases, negatively impacting comfort.36Kok LM, Schrijvers J, Fiocco M et al. Use of a Shoulder Rest for Playing the Violin Revisited: An Analysis of the Effect of Shoulder Rest Height on Muscle Activity, Violin Fixation Force, and Player Comfort. Med Probl Perform Art 2019;34(1):39-46.

For wind instruments, abnormal postures and orofacial muscular activity are necessary, and the maxillary-mandibular complex is integrally involved in playing. Contact with the mouthpiece and fine, and intricate movements of the orofacial musculature are required to produce music with wind instruments,9Campos LGN, Pedrosa BH, Cavalcanti RVA et al. Prevalence of temporomandibular disorders in musicians: a systematic review and meta-analysis J Oral Rehabil 2021;48(5):632-42. and the tone, quality, articulation and volume of the sound produced from the instrument is determined by the way in which air is funneled into the mouthpiece.38Papsin BC, Maaske LA, McGrail JS. Orbicularis oris muscle injury in brass players. Laryngoscope 1996;106(6):757-60. This relies on the instrument-dependent ‘embouchure’ – the position and use of the lips, tongue and teeth while playing.39“Embouchure.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/embouchure. Specific mandibular positions and movements are also required. For example, among brass players, mandibular protraction is necessary for the upper and lower incisors to meet in a vertical direction, to ease playing very low tones, and to help avoid lip abrasion.40Woldendorp K H, Boschma H, Boonstra AM et al. Fundamentals of Embouchure in Brass Players: Towards a Definition and Clinical Assessment. Medical Problems of Performing Artists. 2016;31(4):232-43. https://www.jstor.org/stable/48714435. (Figure 4) In addition, the forces generated can affect the TMJ and in a recent study using piezoresistive sensors, maximum forces while playing the trombone, French horn, trumpet, oboe, saxophone, clarinet and bassoon were found to reach 325g, 305g, 172g, 125g, 120g, 106g, and 31g, respectively.41Clemente MP, Moreira A, Mendes J et al. Wind Instrumentalist Embouchure and the Applied Forces on the Perioral Structures. Open Dent J 2019;13(1):107-14. doi:10.2174/1874210601913010107.

Recent developments in screening tools and evaluation of TMD

Screening and evaluation tools have been developed that can be helpful, including lateral teleradiography, piezoresistive sensors (force) sensors, infrared imaging and cephalometry. In one evaluation using these techniques, cephalometric analysis of three lateral cephalograms was performed (one in normal occlusion, and one each in the oboe (with force sensors) and English horn embouchure positions).42Clemente MP, Mendes JG, Vardasca R et al. Combined Acquisition Method of Image and Signal Technique (CAMIST) for Assessment of Temporomandibular Disorders in Performing Arts Medicine. Med Probl Perform Art 2018;33(3):205-12. Discomfort in the left masseter muscle and TMJ pain were confirmed using thermography. In another study infrared thermal imaging was used to evaluate in TMJ-related superficial tissues, while in a third study, infrared thermal imaging and piezoresistive sensors were used in addition to clinical examination to diagnose and inform treatment.35Clemente M, Coimbra D, Silva A et al. Application of Infrared Thermal Imaging in a Violinist with Temporomandibular Disorder. Med Probl Perform Art 2015;12;30(4):251-4.^,42Clemente MP, Mendes JG, Vardasca R et al. Combined Acquisition Method of Image and Signal Technique (CAMIST) for Assessment of Temporomandibular Disorders in Performing Arts Medicine. Med Probl Perform Art 2018;33(3):205-12.

Implications for oral health professionals

TMD among musicians can cause intense pain, fatigue, anxiety, and impact quality of level.12Zao A, Altenmuller E, Azevedo L. Factors Associated With Performance-Related Pain Among Musicians: A Multicenter Study Using Validated Tools. J Occ Rehabil 2024;25(2):393-406.^,9Campos LGN, Pedrosa BH, Cavalcanti RVA et al. Prevalence of temporomandibular disorders in musicians: a systematic review and meta-analysis J Oral Rehabil 2021;48(5):632-42.^,13Z'Graggen S, Ettlin DA, Alessandri1 E et al. Prevalence of Painful Temporomandibular Disorder Symptoms Among Professional and Student Musicians: An Online Survey. I Oral Rehabil 2025;52(1):9-16. Furthermore, it can impact music performance, causing further distress. Despite these negative effects, in one study it was estimated that two-thirds of professional instrumentalists who were suffering pain, and slightly under half of music students experiencing pain, did not seek healthcare.12Zao A, Altenmuller E, Azevedo L. Factors Associated With Performance-Related Pain Among Musicians: A Multicenter Study Using Validated Tools. J Occ Rehabil 2024;25(2):393-406. Considering these facts, screening for TMD during healthcare visits is particularly important for early diagnosis, advice and management.

Dental professionals are well-positioned to implement routine screening for TMD during regular dental visits, using questions in medical history forms, and should understand the potential for TMD and risk factors among musicians.42Clemente MP, Mendes JG, Vardasca R et al. Combined Acquisition Method of Image and Signal Technique (CAMIST) for Assessment of Temporomandibular Disorders in Performing Arts Medicine. Med Probl Perform Art 2018;33(3):205-12. If the screening result is indicative of TMD, information and advice can be provided to the patient - who should also understand the importance of treatment to alleviate pain, manage TMD and help prevent further deterioration. Patients can be advised to chew sugar-free non-acidic chewing gum, and to seek help from musical and healthcare experts on practice, posture and other ergonomic improvements (such as changes to shoulder rest height in the case of upper string musicians). As with all patients, oral hygiene instruction, appropriate in-office and home preventive care should also be provided.

As indicated, patients can be referred to specialists for TMD management, including TMJ and orofacial pain specialists, clinicians specializing in treating musicians (if possible), occupational health specialists and physical therapists.

Treatment of TMD is complex and may consist if physical treatment or a mix of physical treatment and other disciplines, depending on the individual. In one study investigating the use of oral splints to reduce pain and other associated symptoms in violinists, violists and wind instrumentalists, 4 in 5 individuals (n=30) experienced improvement in their main symptoms, and pain in the neck, TMJ/teeth, and shoulder and upper extremity was reduced by 91%, 83% and 76% of study participants, respectively.24Steinmetz A, Ridder PH, Methfessel G, Muche B. Professional musicians with craniomandibular dysfunctions treated with oral splints. Cranio 2009;27(4):221-30. doi: 10.1179/crn.2009.033. Where resolution is not obtained with physical treatment alone, it has been recommended that psychological and other factors may also need to be managed.21Amorim MI, Jorge AI. Association between temporomandibular disorders and music performance anxiety in violinists. Occup Med (Lond) 2016;66(7):558-63. doi:10.1093/occmed/kqw080. Additionally, biofeedback can be used to help musicians reduce unnecessary stress in relation to prevention and treatment.30de Souza Moraes GF, Antunes AP. Musculoskeletal disorders in professional violinists and violists. Systematic review. Acta Ortop Bras 2012;20:43‐7.

Conclusions

The reported prevalence of TMD among musicians has varied considerably in systematic reviews, as have the conclusions. The studies included differing screening test methods, other design criteria and findings, and quality, and further studies were recommended. Since then, recent studies have been conducted that are more robust and provide support for TMD as a frequent disorder among musicians in comparison to the general population, with general and unique potential risk factors. Furthermore, TMD can cause intense pain, debilitating, and negatively impact music performances. Dental professionals should understand the potential for TMD and risk factors among musicians. In conclusion, dental professionals are well-positioned to implement routine screening for TMD during their regular dental visits and to collaborate with interprofessional specialists.

References

• 1.Ackermann BJ, Driscoll T, Kenny DT. Musculoskeletal pain and injury in professional orchestral musicians in Australia. Med Probl Perform Art 2012;27(4):181-7.
• 2.Kok LM, Huisstede BM, Voorn VM, et al. The occurrence of musculoskeletal complaints among professional musicians: a systematic review. Int Arch Occup Envi 2016;8:373-97. https://doi.org/10.1007/s00420-015-1090-6.
• 3.Klasser GD. Overview of Temporomandibular Disorders (TMDs). Merck Manual, Sept 2023.
• 4.Schiffman E, Ohrbach R, Truelove E et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28(1):6-27.
• 5.The Johns Hopkins University, the Johns Hopkins Hospital, Johns Hopkins Health System. Temporomandibular Disorder (TMD). Diagnostics 2021;11:459. https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disordertmd.
• 6.Cavalcanti A. Is playing string or wind musical instruments a risk factor for temporomandibular dysfunction? A Systematic Review. J Oral Res 2017;6(11 SE):299-306. doi:10.17126/joralres.2017.083.
• 7.Attallah MM, Visscher CM, van Selms MK, Lobbezoo F. Is there an association between temporomandibular disorders and playing a musical instrument? A review of literature. J Oral Rehabil 2014;41(7):532-41.
• 8.Taddey JJ. Musicians and temporomandibular disorders: prevalence and occupational etiologic considerations. Cranio 1992;10(3):241-4.
• 9.Campos LGN, Pedrosa BH, Cavalcanti RVA et al. Prevalence of temporomandibular disorders in musicians: a systematic review and meta-analysis J Oral Rehabil 2021;48(5):632-42.
• 10.van Selms MKA, Ahlberg J, Lobbezoo F, Visscher CM. Evidence-based review on temporomandibular disorders among musicians. Occ Med 2017;67(5):336-43.
• 11.Rodríguez-Lozano FJ, Sáez-Yuguero MR, Bermejo-Fenoll A. Orofacial problems in musicians: a review of the literature. Med Probl Perform Art 2011;26(3):150-6.
• 12.Zao A, Altenmuller E, Azevedo L. Factors Associated With Performance-Related Pain Among Musicians: A Multicenter Study Using Validated Tools. J Occ Rehabil 2024;25(2):393-406.
• 13.Z'Graggen S, Ettlin DA, Alessandri1 E et al. Prevalence of Painful Temporomandibular Disorder Symptoms Among Professional and Student Musicians: An Online Survey. I Oral Rehabil 2025;52(1):9-16.
• 14.Garcez LR, Souza RA, Sales AA, Fernandes ML. Incidence of signs and symptoms of temporomandibular dysfunction in music students: a cross-sectional observational study. J Health Biol Sci 2024;12(1):1-5.
• 15.van Selms MKA, Wiegers JW, van der Meer HA et al. Temporomandibular disorders, pain in the neck and shoulder area, and headache among musicians. J Oral Rehabil 2019;00:1-11. https ://doi.org/10.1111/joor.12886.
• 16.Steinmetz A, Zeh A, Delank KS, Peroz I. Symptoms of craniomandibular dysfunction in professional orchestra musicians. Occup Med (Lond) 2014;64:17‐22.
• 17.Leaver R, Harris EC, Palmer KT. Musculoskeletal Pain in Elite Professional Musicians From British Symphony Orchestras. Occ Med (Lond) 2011;61:549-55.
• 18.Stechman Neto J, de Almeida C, Rodrigues Bradasch E et al. Occurrence of signs and symptoms of temporomandibular dysfunction in musicians. Rev Soc Bras Fonoaudiol 2009;14(3):362-6. [Article in Portuguese]
• 19.Jang JY, Choi YC, Bae JH, Kim ST. Signs and symptoms of temporomandibular disorders in instrumental performers. J Dent Rehabil Appl Sci 2015;31(2):86-95.
• 20.Ahlberg JJ, Wiegers JW, van Selms M et al. Orofacial pain experience among symphony orchestra musicians in Finland is associated with reported stress, sleep bruxism, and disrupted sleep ‐ independent of the instrument group. J Oral Rehabil 2019;46:807‐12.
• 21.Amorim MI, Jorge AI. Association between temporomandibular disorders and music performance anxiety in violinists. Occup Med (Lond) 2016;66(7):558-63. doi:10.1093/occmed/kqw080.
• 22.Rios B, Alvarelhão J, Pinheiro A. Temporomandibular Dysfunction and its relationship with Anxiety regarding musical performance in violinists - a cross-sectional study. Portug J Occ Health 2022;14:esub0362. doi:10.31252/RPSO.15.10.2022.
• 23.Rodríguez-Lozano FJ, Sáez-Yuguero MR, Bermejo-Fenoll A. Prevalence of temporomandibular disorder-related findings in violinists compared with control subjects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(1):e15-9. doi:10.1016/j.tripleo.2009.08.032.
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