Is playing string or wind musical instruments a risk factor for temporomandibular dysfunction? A Systematic Review.

Alessandro Leite Cavalcanti, José Márcio Vasconcelos Souto, Lorenna Mendes Temoteo Brand, Liege Helena Freitas Fernandes, Catarina Ribeiro Barros de Alencar, Alidianne Fabia Cabral Cavalcanti


Aim. Medical problems specifically affecting professional musicians are commonly mentioned in the literature. The present study is aimed to evaluate, through a systematic review, the possible association between the practice of string with bow and wind musical instruments and the occurrence of Temporomandibular Dysfunction (TMD). Methods. The search for articles was conducted in PubMed/Medline, Web of Science, Scopus, Lilacs, Cochrane Library, and Open Gray databases, and there was no restriction on language or date of publication. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The MeSH terms used were: "music"; "temporomandibular joint"; "temporomandibular joint disorders"; "temporomandibular joint dysfunction syndrome"; and "occupational diseases". Cross-sectional studies, case-control, cohort and clinical trials were included that involved the practice of string with bow and wind musical instruments and the occurrence of Temporomandibular Dysfunction (TMD). Articles were previously selected by title and abstract. Qualitative evaluation was done through the Newcastle-Ottawa Scale. Results. The literature search identified 732 studies, of which 10 met the inclusion criteria, nine of them cross-sectional studies and one a clinical intervention study. The TMD prevalence ranged from 47.0% to 89.0%. Recruitment of participants took place in professional schools and orchestras, and in bands of professional musicians. All studies reported associations between TMD and the practice of musical instruments, and violinists presented higher prevalence rates when compared to other instrument groups. Conclusion. All studies pointed to a possible association between TMD and the practice of string and wind musical instruments. More longitudinal and clinical trials studies are needed to verify any possible interrelationship.


Music; Temporomandibular Joint; Temporomandibular Joint Disorders; Masticatory Muscles; Occupational Risks.


Bejjani FJ, Stuchin S, Brown P. Occupational disorders of string players, pianists, harpist and guitarists. J Bone Joint Surg Orthopaedic Transactions. 1984;8:133.

Ziporyn T. Pianist's cramp to stage fright: the medical side of music-making. JAMA. 1984;252:985–9.

Bejjani FJ, Kaye GM, Benham M. Musculoskeletal and neuromuscular conditions of instrumental musicians. Arch Phys Med Rehabil. 1996;77(4):406–13.

Stechman Neto J, de Almeida C, Rodrigues Bradasch E, Corteletti LC, Silvério KC, de Aguiar MM, Mendes J. Rev Soc Bras Fonoaudiol. 2009;14(3):362–6.

Pampel 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.

Głowacka A, Matthews-Kozanecka M, Kawala M, Kawala B. The impact of the long-term playing of musical instruments on the stomatognathic system - review. Adv Clin Exp Med. 2014;23(1):143–6.

Lacerda F, Barbosa C, Pereira S, Conceição Manso M. Estudo de prevalência das disfunções temporomandibulares articulares em estudantes de instrumentos de sopro. Rev Port Estomatol Med Dent Cir Maxi. 2015;56(1):25–33.

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.[PubMed]

Ajanović M, Tosum S, Kamber-Ćesir A, Đonlagić A, Kazazić L, Hamzić A. Prevalence of signs and symptoms of temporomandibular disorder in patients with posttraumatic stress disorder. Pesq Bras Odontoped Clin Integr. 2014;14(1):43–8.

Pereira KNF, Andrade LLS, Costa MLG, Portal TF. Sinais e sintomas de pacientes com disfunção temporomandibular. Rev CEFAC. 2005;7(2):221–8.

Steinmetz A, Zeh A, Delank KS, Peroz I. Symptoms of craniomandibular dysfunction in professional orchestra musicians. Occup Med. 2014;64(1):17–22.[PubMed]

Taddey JJ. Musicians and temporomandibular disorders: prevalence and occupational etiologic considerations. Cranio. 1992;10(3):241–4.

Yeo DK, Pham TP, Baker J, Porters SA. Specific orofacial problems experienced by musicians. Aust Dent J. 2002;47(1):2–11.

Wells GA, Shea B, O'Connell D, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Canada: Department of Epidemiology and Community Medicine, University of Ottawa; 2003.

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.

Yasuda E, Honda K, Hasegawa Y, Matsumura E, Fujiwara M, Hasegawa M, Kishimoto H. Prevalence of temporomandibular disorders among junior high school students who play wind instruments. Int J Occup Med Environ Health. 2016;29(1):69–76.

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.

Kovero O, Könönen M. Signs and symptoms of temporomandibular disorders and radiologically observed abnormalities in the condyles of the temporomandibular joints of professional violin and viola players. Acta Odontol Scand. 1995;53(2):81–4.

Kovero O, Könönen M. Signs and symptoms of temporomandibular disorders in adolescent violin players. Acta Odontol Scand. 1996;54(4):271–4.[PubMed]

Steinmetz A, Ridder PH, Methfessel G, Muche B. Professional musicians with craniomandibular dysfunctions treated with oral splints. Cranio. 2009;27(4):221–30.

Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6(4):301–55.

Câmara-Souza MB, Figueredo OMC, Maia PRL, Dantas IS, Barbosa GAS. Cervical posture analysis in dental students and its correlation with temporomandibular disorder. Cranio. 2017:1–6.

Bertero CO. Orquestras Sinfônicas: uma Metáfora Revisitada. Rev Adm Empres. 2001;41(3):84–8.

Kozmhinsky VMR, Heimer M, Goes PSA. Sociodemographic factors and oral health conditions related to the impact on the quality of life of adolescents. Pesq Bras Odontoped Clin Integr. 2016;16(1):35–42.

Samohyl M, Nadazdyova A, Hirjak M, Stanciak J, Argalasova L, Vondrova D, Hirosova K, Jurkovicova J. Impact of Orthodontic Treatment on Oral Health-Related Quality of Life in the Slovak Republic: A Cross-Sectional Study. Pesq Bras Odontoped Clin Integr. 2017;17(1):e3773.

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