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 the risks of TMD in sporting patients is crucial.
The peak incidence of TMD occurs in adults between 20 and 40 years old, and 60 to 70 per cent of the population show signs of it, though only five to 12 percent receive treatment. TMD has multiple symptoms, including pain around the jaw, ear, and temple, headache, jaw clicking and popping noises, and jaw locking.
It is multi-factorial, and isolating a single main cause can prove difficult for practitioners. Common causes include bruxism, wear and tear of the joint, stress, and trauma, often from a hard impact to the head or face. Patients who participate in sport or other intense physical activities are at more risk of TMD.
Rough and tumble
Contact sports are any games in which physical contact between competitors is an integral part. They carry a high risk of injury –18 per cent of sports-related injuries are in the maxillofacial area, with sports like basketball having high rates of orofacial injury. 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 per cent of boxers have at least moderate TMD, sustained from regular traumas to the head. Whilst boxers wear headguards 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 neck and face muscles, or lead to joint hypermobility. Both of which may be risk factors for TMD.
Among field hockey players, prevalence of TMD is at 11.7 per cent. 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 per cent, whereas the incidence rate in those with mouthguards was 18.6 per cent, highlighting the effectiveness of mouthguards to limit TMD symptoms.
Deep breaths
Non-sporting physical activities can also have a high risk of developing TMD. Prevalence among scuba divers is 20 per cent, with barotrauma contributing to an increased likelihood of TMD. Despite the common suggestion of using cold water to treat jaw pain, long underwater exposure can accelerate mandibular stiffness. The tightening of headgear 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 per cent) may be due to similar factors around water and pressure.
Sporting stress
Psychological conditions like depression and stress can lead to bruxism, increasing the activity of the muscles and, therefore, the risk of TMD. 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.
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. 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.
Therefore, it is crucial that practitioners recommend a physical hobby to patients with stress and/or TMD and encourage education on the activity and its impact on the 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 to prevent and treat 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.
References available on request.