Temporomandibular disorders: Prevalence in musicians

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A recent review (Dental Elf – 3rd Feb 2021) indicated that the overall prevalence of temporomandibular disorders in adults was around 31%. Symptoms of temporomandibular disorders include temporomandibular joint pain and noise, fatigue of the masticatory muscles, facial muscle pain, restricted mouth opening, headache and functional difficulties. Musicians have been reported to have a high prevalence of playing-related musculoskeletal disorders including temporomandibular disorders.

The aim of the review was to determine the prevalence of temporomandibular disorders (TMD) in musicians.

Methods

Searches were conducted in the Latin American and Caribbean Centre on Health Sciences (LILACS), LIVIVO, Medline/PubMed, SCOPUS, Web of Science, Google Scholar, Open Grey and ProQuest databases with no restrictions on language or date of publication.  Studies evaluating the prevalence of temporomandibular disorders in musicians (professional and non-professional musicians); studies that used recognised criteria for diagnosis of temporomandibular disorders were considered.  Two reviewers independently searched and selected studies then extracted data and assessed study quality using the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies . The prevalence of temporomandibular disorders in musicians was ex- pressed by means of relative or absolute frequencies and their 95% confidence intervals (95% CI).

Results

  • 13 studies involving a total of 2443 patients were included.
  • Studies were conducted in Brazil (2), Chile (1), Germany (1), Holland (1), Japan (1), Korea (1), Nigeria (1), Poland (1), Portugal (3), Spain (1).
  • 2 studies were considered to be at high risk of bias, 5 at moderate risk and 6 at low risk of bias.
  • Prevalence in the individual studies ranged from 29% – 89%.
  • Meta-analysis showed a
    • Pooled prevalence = 53.9% (95%CI; 36.6% to 70.7%) [13 studies].
    • Wind Instruments = 8% (95%CI; 33.4% to 71.7%) [4 studies].
    • String Instruments = 53.9% (95%CI; 42.4% to 65.2%) [4 studies].
  • The average time of use of the musical instrument explained the majority (82.38%) of the heterogeneity between the studies.
  • The overall certainty of the evidence using the GRADE criteria was very low.

Conclusions

The authors concluded: –

The results of this systematic review and meta-analysis provide an estimate of the overall combined prevalence of TMD in musicians: approximately 53.9%. However, meta-regression and subgroup analysis showed that the average time of instrument use and the type of instrument can influence the prevalence of TMD. The average time of instrument use was the factor that mostly influenced the heterogeneity observed in the results. Thus, musicians using their instruments daily and for long periods of time may have a higher prevalence of TMD.

Comments

The authors have followed PRISMA guidelines and registered their protocol on PROSPERO and searched a good range of databases including 13 cross-sectional studies. In total the sample included 2443 patients a proportion of which were controls with 8 studies involving fewer than 100 patients. A review of the prevalence on TMD in the general population by Valesan et al (Dental Elf – 3rd Feb 2021) found the overall prevalence of TMD for adults was 29.3% using the Research Diagnostic Criteria/ Temporomandibular Disorders (RDC/TMD) and 38.8% with the Diagnostic Criteria/ Temporomandibular Disorders (DC/TMD), and 31.1% for the grouped criteria (RDC + DC). In this review only 4 studies used either the RDC/TMD (3 studies) or DC/TMD criteria (1 study).   The findings suggest a higher prevalence of TMD in musicians with an increase with longer use however there are concerned regarding the quality of the studies, and they are all cross-sectional in design. Well-designed and reported prospective studies would be helpful to clarify whether musicians have a higher prevalence of TMD.

Links

Primary Paper

Campos LGN, Pedrosa BH, Cavalcanti RVA, Stechman-Neto J, Gadotti IC, de Araujo CM, Taveira KVM. Prevalence of temporomandibular disorders in musicians: A systematic review and meta-analysis. J Oral Rehabil. 2021 May;48(5):632-642. doi: 10.1111/joor.13150. Epub 2021 Mar 7. PMID: 33474771.

Review protocol in PROSPERO

Other references

Dental Elf – 3rd Feb 2021

Prevalence of temporomandibular joint disorders

Photo Credits

Photo by Diogo Nunes on Unsplash

 

 

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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