title: Association between temporomandibular disorders and music performance anxiety in violinists.
abstract: BACKGROUND
  Professional violin playing has been associated with a predisposition to develop temporomandibular disorder (TMD). There are a number of risk factors, including physical trauma from the playing posture and the presence of parafunctional habits. Music performance anxiety (MPA) may also be a factor, as it has been associated with playing-related musculoskeletal disorders (PRMD).
  
  
  OBJECTIVE
  To evaluate a possible association between the presence of TMD and the level of MPA in violin players.
  
  
  METHODS
  An observational study using a written questionnaire that retrieved data related to TMD symptoms (Fonseca Anamnestic Questionnaire), MPA level (Kenny Music Performance Anxiety Inventory, K-MPAI), instrument practice time, chinrest type, sex and age. Descriptive, bivariate and logistic regression analyses were conducted.
  
  
  RESULTS
  Ninety-three professional or semi-professional violinists performing in and around Lisbon, Portugal, completed the questionnaire (73% response rate). TMD was present in 50 violinists (58%). There was a statistically significant association between the presence of TMD and high MPA levels (P < 0.001) and the most anxious violinists were six times (95% confidence interval 2.51-15.33; P < 0.001) more likely to report TMD symptoms when compared with the least anxious players.
  
  
  CONCLUSIONS
  Violin players had a high prevalence of reported TMD symptoms, which was significantly associated with high MPA levels. It may therefore be necessary to address psychological and physical factors simultaneously in musicians who do not improve with physical therapy alone.
authors.affiliation: Integrated Clinic of Dentistry Post-graduation, Faculdade de Medicina Dentária da Universidade de Lisboa, Cidade Universitária, 1649-003 Lisboa, Portugal, monica.amorim92@yahoo.com.
authors.forename: M I T
authors.initials: MI
authors.lastname: Amorim
authors.affiliation: Department of Occlusion, Faculdade de Medicina Dentária da Universidade de Lisboa, Cidade Universitária, 1649-003 Lisboa, Portugal .
authors.forename: A I L
authors.initials: AI
authors.lastname: Jorge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001244:Association; D004867:Equipment Design / Q000009:adverse effects / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009146:Music / Q000523:psychology*; D060805:Performance Anxiety / Q000209:etiology* / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000150:complications*
keywords: Music performance anxiety; temporomandibular disorder; violin players.; violinists