Jaw problems in musicians

Dominik Ettlin - The lower jaw is a horseshoe-shaped bone. Its two ends form the temporomandibular joints with the base of the skull. The position and movements of the lower jaw are regulated by the activity of the masticatory muscles. Disorders in the temporomandibular joints or muscles usually manifest themselves with clicking or rubbing noises accompanying movement and/or pain, for example when chewing or yawning. Occasionally, the opening of the mouth is restricted (temporomandibular joint blockage). The symptoms typically fluctuate over time and depending on the position of the lower jaw.

The lower jaw is in a relaxed or physiological floating position when the upper and lower teeth do not touch when the lips are closed. Unphysiological movements or postures such as excessive gum chewing, frequent teeth clenching or night-time teeth grinding can promote overloading of the masticatory system. The lower jaw also adopts a persistently unphysiological position when playing certain wind instruments or singing. Popular expressions such as "doggedly approaching a task" or "gritting your teeth and getting through it" or "chewing on a problem" reveal the close link between chewing muscle tension and emotions. Accordingly, emotional stress can also lead to tension and discomfort in the masticatory apparatus.

Good quality scientific studies on the subject of temporomandibular joint complaints in musicians are few and far between. In a Dutch study, music students complained more frequently than medical students of complaints in the areas of hands, shoulders, neck and jaw. A survey of 210 students found a significantly higher risk of developing temporomandibular joint complaints in those who played wind instruments compared to musicians of other instruments. An even more detailed analysis of the distribution of complaints by instrument was provided by a survey of 408 professional musicians from two classical orchestras in Germany. Because making music with woodwind instruments (flute, bassoon, clarinet and oboe) requires a persistently unphysiological lower jaw posture, it is not surprising that functional disorders and pain in the temporomandibular joint were described more frequently in this group. What is surprising, however, is that similar complaints were experienced just as frequently by people who played stringed instruments.

Other risk factors such as night-time teeth grinding and persistent jaw clenching could at least partially explain this observation. This is because these risk factors frequently describe people under stress, which in turn is associated with increased chewing muscle tone and jaw and facial pain. Around half of 93 professional violinists in Portugal reported suffering from stage fright, with a clear correlation with jaw joint pain. Excessive singing is also thought to be a possible cause of TMJ, but reliable data is not available.

In summary, musicians complain of jaw complaints with variable frequency. According to currently known data, these cannot be clearly attributed to playing a particular type of instrument. However, the impairment is highest for singers and wind instrument players. Health-promoting training is now recommended at music training centers. Instruction on recognizing stress and tension during training is useful, as young musicians, for example, suffer more from stage fright than experienced musicians. It also makes sense to impart knowledge about tinnitus and other hearing disorders, which are frequently associated with jaw problems, at an early stage. Both preventively and therapeutically, the focus is on dealing with emotional stress, optimizing body awareness and learning relaxation techniques.

PD Dr. med., Dr. med. dent. Dominik Ettlin Interdisciplinary pain consultation

Center for Dentistry,

University of Zurich Plattenstrasse 11, 8032 Zurich

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