The effect of singing on pain and psychological well‐being in a patient population with pain‐related temporomandibular disorders

• Published in: Journal of oral rehabilitation Vol. 49; no. 9; pp. 841 - 848
• Main Authors: Selms, Maurits K. A., Reda, Bachar, Visscher, Corine M., Manfredini, Daniele, Lobbezoo, Frank
• Format: Journal Article
• Language: English
• Published: Chichester Wiley Subscription Services, Inc 01-09-2022
• Subjects: Anxiety; Jaw; Mental depression; oral behaviours; Pain; pain intensity; psychological well‐being; singing; temporomandibular disorders; Temporomandibular joint disorders
• ISSN: 0305-182X; 1365-2842
• DOI: 10.1111/joor.13339

Background
Even though singing is regarded as potential jaw‐overuse behaviour, the actual evidence that underlines the idea of singing as a predisposing factor for pain‐related temporomandibular disorders (TMD) is very limited.
Objectives
The objectives were to examine if a dose–response relationship exists between the frequency of singing and TMD pain intensity, and if singing is associated with psychological well‐being.
Methods
The records of 1467 adult patients with functionally aggravated TMD pain were examined. Partial Spearman correlations were used to explore for associations between singing frequency and Characteristic Pain Intensity (CPI), somatic symptoms, depression and anxiety.
Results
The mean age of all participants was 42.8 years (±15.3), of which 79.2% were female. Contrary to the male–female ratio, no difference was found in the mean age between the response options with regard to the frequency of singing. Controlled for the influence of gender, the Spearman correlation between the frequency of singing and CPI appeared to be significant and indicated a negative association. In addition, somatic symptoms appeared to be positively associated with the frequency of singing. However, the observed correlation coefficients (ρ = −.073 and ρ = .067, respectively) imply that these are only very weak or negligible correlations. No significant associations with the frequency of singing were found for depression and anxiety.
Conclusions
The alleged negative influence of singing on TMD pain intensity was found to be virtually absent. Patients with TMD pain who sing frequently have almost equal scores on psychological well‐being compared to those who sing less.
Since vocalists frequently hold their mouth in an unnatural position, singing is regarded as potential jaw‐overuse behaviour. Following the physiological concept that performing more oral behaviours leads to more overloading of the masticatory system, it can be expected that patients with TMD pain, who sing frequently, report more pain compared to those who don’t sing at all.