Following a summer of sport driven by the mass appeal of the UEFA European Championship 2024 and the Olympic and Paralympic Games in Paris, people will be inspired to get involved. Sport has many physical and psychological benefits, but one aspect for practitioners to consider is its complicated relationship with temporomandibular disorder (TMD). Identifying risks of TMD in sporting patients is crucial.
Peak incidence of TMD occurs in adults between 20-40 years old, and 60-70% of the population show signs of it, though only 5-12% receive treatment.[i] TMD has multiple symptoms: pain around the jaw, ear and temple, headache, jaw clicking and popping noises, and jaw locking.[ii] It is multi-factorial, and isolating a single main cause can prove difficult for practitioners.[iii] Common causes include bruxism, wear and tear of the joint, stress, and trauma, often from a hard impact to the head or face.ii Patients who participate in sport or other intense physical activities are more at risk of TMD.
Rough and tumble
Contact sports are any where physical contact between competitors is an integral part of the game. They carry a high risk of injury – 18% of sports-related injuries are in the maxillofacial area, with sports like basketball having high rates of orofacial injury.[iv] Patients who regularly engage in contact sports may be more at risk of tooth or jaw trauma.
Boxing has a strong correlation with TMD. Studies have shown that 77.77% of boxers have at least moderate TMD, sustained from regular traumas to the head.[v] Whilst boxers wear head guards and mouthguards, the impact of a hit still sends powerful jolts that can damage the jaw and mastication muscles. Injuries may impact posture, straining the muscles of the neck and face, or lead to joint hypermobility, both of which may be risk factors for TMD.[vi]
Among field hockey players, prevalence of TMD is at 11.7%. Practitioners should identify sporting patients and, for sports like field hockey, strongly recommend mouthguards to deter TMD risk. It has been shown that the incidence of TMD in individuals who did not use mouthguards was 81.4%, whereas the incidence rate in those with mouthguards was 18.6%, elucidating the effectiveness of mouthguards to limit TMD symptoms.[vii]
Deep breaths
Non-sporting physical activities can also have a high risk of developing TMD. Prevalence among scuba divers is 20%, with barotrauma contributing to an increased likelihood of TMD.iv Despite the common suggestion of using cold water to treat jaw pain, long underwater exposure can accelerate mandibular stiffness.iv The tightening of head gear and the biting on the mouthpiece can also stress the jaw, impacting TMD development. The equally high rate of TMD in water polo players (20.2%) may be due to similar factors around water and pressure.v
Sporting stress
Psychological conditions like depression and stress can lead to bruxism, increasing the activity of the muscles and therefore the risk of TMD.i For TMD patients who may be affected by stress, sport is recommended to compensate for daily stressors, offering escapism that should minimise the chance of teeth-grinding.iv
However, for professional or competitive athletes, sport may increase stress, with the risk of TMD being much higher than for people who don’t play a sport.iv The correlation between an athlete’s emotional stress and TMD can be attributed to the demands of their daily training and the pressure and intensity of competitions.
Whilst professional athletes have a high risk of TMD, they are still lower than the risk of TMD among recreational athletes. A study on female athletes noted that recreational athletes suffered more than professionals, with a consensus that professional athletes have superior access to physiotherapists and qualified trainers, ensuring that their health is prioritised.v It is therefore crucial that when practitioners recommend a physical hobby to patients with stress and/or TMD, that they encourage education on the activity and the impact it can have on their mouth and jaw.
Treating TMD
For patients suffering from TMD, finding a reliable rehabilitation system is a must to promote their comfort. The OraStretch® Press Jaw Rehab System from Total TMJ is a user-operated device that stretches the orofacial tissues and mobilises the temporomandibular joint. Designed for the prevention and treatment of trismus and jaw dysfunction, the OraStretch® Press extends the jaw when the user squeezes the handles, strengthening the muscles and restoring function. By using the OraStretch® Press, patients can improve their quality of life and comfortably eat, sleep and live without jaw pain.
With sport surrounding us, identifying the risks that physical activities can have on our oral health is essential.
For more details about Total TMJ and the products available, please email info@totaltmj.co.uk
Author: Phillip Silver
Founded in 2018, Total TMJ was created by Phil Silver, after a long career in medical devices, which gave him the knowledge to set up in his own right. The Dorset company is a specialist provider of medical devices. It distributes innovative technologies from leading healthcare manufacturers to dentists and clinicians around the UK. Their vision is to combine a portfolio of complimentary medical devices that both help the clinician and improve the outcome for their patients.
The privately-owned family business Total TMJ in Bournemouth fully supports the clinicians it works with through educational support by offering local and international surgeon peer to peer led courses. If you would like to find out more about their courses, please click here.
Total TMJ also supplies innovative medical devices offering solutions for temporomandibular joint disorders (TMD) & trismus within the healthcare sector.
[i] Maini, K. and Dua, A. (2020). Temporomandibular Joint Syndrome. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551612/.
[ii] NHS Choices (2020). Temporomandibular disorder (TMD). [online] NHS. Available at: https://www.nhs.uk/conditions/temporomandibular-disorder-tmd/.
[iii] Li, D.T.S. and Leung, Y.Y. (2021). Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management. Diagnostics, 11(3), p.459. doi:https://doi.org/10.3390/diagnostics11030459.
[iv] Starr, C.L. and McGrew, C. (2023). TMJ Disorders in Athletes. Current Sports Medicine Reports, 22(1), pp.10–14. doi:https://doi.org/10.1249/jsr.0000000000001026.
[v] Freiwald, H.C., Schwarzbach, N.P. and Wolowski, A. (2020). Effects of competitive sports on temporomandibular dysfunction: a literature review. Clinical Oral Investigations, 25(1), pp.55–65. doi:https://doi.org/10.1007/s00784-020-03742-2.
[vi] Healthline. (2015). TMJ (Temporomandibular Joint) Disorders. [online] Available at: https://www.healthline.com/health/tmj-disorders#outlook [Accessed 18 Jun. 2024].
[vii] Singarapu, R., Panneerselvam, E., Balasubramaniam, S., Nakkeeran, K.P., Ramanathan, M. and VB, K.R. (2023). The Role of Mouthguards in Preventing Temporomandibular Joint Injuries During Contact Sports: A Prospective Study. Frontiers in Dentistry, [online] 20, p.12. doi:https://doi.org/10.18502/fid.v20i12.12661.
