Characteristics of temporomandibular disorders in instrumentalists

Abstract

It has been reported that many musicians who play musical instruments exhibit signs and symptoms of temporomandibular disorders (TMD). However, most previous studies of the association between playing instruments and TMD have considered only subjective symptoms or been limited to small populations. Furthermore, studies that employed clinical examinations and radiography only involved specific instrument groups, such as violinists, violists, or wind instrumentalists. This study therefore investigated the characteristics of TMD in instrumentalists by evaluating both subjective symptoms and clinical diagnoses in a large number of instrumentalists. Musicians from a diverse range of instrument groups completed a TMD questionnaire and underwent clinical examinations and radiography.

After excluding subjects with a history of orthodontic treatment or jaw trauma, and those who failed to complete the questionnaire, 739 instrumentalists were included in the analysis. Among those who reported at least 1 symptom of TMD, 71 subjects volunteered to visit the dental clinic (Department of Orofacial Pain and Oral Medicine, College of Dentistry, Yonsei University, Seoul, Korea) to undergo clinical examinations and radiography for the clinical diagnosis. Clinical examinations, radiographic analysis, and analysis of variables associated with TMD symptoms and clinical diagnoses were performed by an orofacial pain specialist.

Based on the obtained results, we report the following findings:

1. 76.6% of the 739 instrumentalists reported having 1 or more symptoms of TMD.

2. The most frequently reported subjective symptom in instrumentalists was a clicking or popping sound.

3. Clicking or popping sound, temporomandibular joint (TMJ) pain, muscle pain, symptoms of suspected tension-type headache (S-TTH), and symptoms of suspected migraine (S-migraine) were more common in female instrumentalists than in their male counterparts.

4. Clicking or popping sound was frequently reported by instrumentalists aged 20？29 years. Muscle pain and symptoms of S-TTH were frequently reported by instrumentalists aged 20？29 years, and 30？39 years,

5. Clicking or popping sound was frequently reported by woodwind and brass instrumentalists. TMJ pain was reported more often by upper strings and brass instrumentalists.

6. Muscle pain was more common in those with an elevated arm position (40° elevation of the arm while playing) than in those with a neutral arm position (<40° elevation of the arm while playing).

7. Instrumentalists with oral parafunctional habits frequently experienced TMJ pain and S-migraine.

8. The most common clinical diagnosis in instrumentalists was myalgia or myofascial pain.

9. Compared to those with <14 years of experience, instrumentalists with 14 years of playing experience had a higher frequency of disk displacement with reduction but a lower frequency of TMJ arthralgia.

10. Myalgia or myofascial pain was more common in instrumentalists who practiced 3.5 hours daily compared to those who practiced <3.5 hours daily.