Temporomandibular Disorders (TMD) and Sports: Trauma, Overload, and the Role of Mouthguards
DOI:
https://doi.org/10.12775/QS.2026.76.75400Keywords
temporomandibular disorders, TMD, sports medicine, mouthguards, bruxism, temporomandibular joint, OPPERAAbstract
Background: Evidence on the relationship between sports and temporomandibular disorders (TMD) is conflicting. While recent data suggest similar symptom rates between athletes and non-athletes, older reviews claimed higher risks for professionals, largely due to methodological flaws and self-reporting.
Aim: To analyze literature on TMD prevalence in athletes, identify key cofactors (trauma, bruxism, anxiety), and evaluate the biomechanical role of custom versus standard mouthguards.
Material and methods: A qualitative synthesis of 36 sources (2008–2026) from PubMed, Scopus, Web of Science, and Cochrane Library was conducted, focusing on studies utilizing DC/TMD or RDC/TMD diagnostic criteria.
Results: General sports do not inherently raise TMD risk. Strict evaluations show elite athlete prevalence at ~10%, refuting older, unstandardized claims of up to 100%. Macrotrauma and internal strains are confirmed triggers. Custom mouthguards offer superior impact absorption, whereas standard "boil-and-bite" models force continuous clenching, inducing muscle fatigue.
Conclusions: Recreational exercise may lower symptom burdens, while elite sports impose heavy mechanical and psychological loads. Custom mouthguards optimally prevent dental trauma, but their direct efficacy for TMD prevention remains a theoretical hypothesis rather than an established clinical fact.
References
Ângelo DF, Faria-Teixeira MC, Maffia F, et al. Association of Malocclusion With Temporomandibular Disorders: A Cross-Sectional Study. Journal of Clinical Medicine. 2024;13(16):4909. https://doi.org/10.3390/jcm13164909
Avgerinos S, Stamos A, Nanussi A, et al. Position Statement and Recommendations for Custom‐Made Sport Mouthguards. Dental Traumatology. 2025;41(3):246-251. https://doi.org/10.1111/edt.13019
Bal B, Koksal T, Ebeoglu B, Oral K. Retrospective analysis of trauma incidence in patients with temporomandibular disorders. Dental Traumatology. 2020;36(6):618-623. https://doi.org/10.1111/edt.12582
Belenda González I, Montero J, Gómez Polo C, Pardal Peláez B. Evaluation of the Relationship Between Bruxism and/or Temporomandibular Disorders and Stress, Anxiety, Depression in Adults: A Systematic Review and Qualitative Analysis. Journal of Dentistry. 2025;156:105707. https://doi.org/10.1016/j.jdent.2025.105707
Bonotto D, Namba EL, Veiga DM, et al. Professional karate‐do and mixed martial arts fighters present with a high prevalence of temporomandibular disorders. Dental Traumatology. 2016;32(4):281-285. https://doi.org/10.1111/edt.12238
Chattrattrai T, Aarab G, Su N, et al. The Association of Self-Reported Awake Bruxism and Sleep Bruxism With Temporomandibular Pain and Dysfunction in Adult Patients With Temporomandibular Disorders. Clinical Oral Investigations. 2023;27(12):7501-7511. https://doi.org/10.1007/s00784-023-05338-y
de Sales ADN, Almeida RAC, Barbosa ATL, et al. Prevalence of Bruxism in Athletes: A Systematic Review and Meta‐Analysis. Journal of Oral Rehabilitation. 2025;52(9):1518-1543. https://doi.org/10.1111/joor.14039
Doğan Ö, Sönmez H, Doğan SSA. Comfort and wearability properties of custom‐made and boil‐and‐bite mouthguards among basketball players: A randomized parallel arm clinical trial. Dental Traumatology. 2024;40(3):251-265. https://doi.org/10.1111/edt.12918
Ekberg E, Nilsson IM, Michelotti A, et al. Diagnostic criteria for temporomandibular disorders— INfORM recommendations: Comprehensive and short‐form adaptations for adolescents. Journal of Oral Rehabilitation. 2023;50(11):1167-1180. https://doi.org/10.1111/joor.13488
Fidancioğlu YD, Güneş M, Kayhan ZY. Pediatric TMD: Associations With Malocclusion, Parafunctions, and Symptoms: A Cross-Sectional Study. Medicine. 2026;105(4):e46115. https://doi.org/10.1097/MD.0000000000046115
Freiwald HC, Schwarzbach NP, Wolowski A. Effects of Competitive Sports on Temporomandibular Dysfunction: A Literature Review. Clinical Oral Investigations. 2021;25(1):55-65. https://doi.org/10.1007/s00784-020-03742-2
Freiwald HC, Schwarzbach NP, Wolowski A. Impact of Sports on Temporomandibular Dysfunction: A Comparison of Competitive and Recreational Female Athletes as Well as Female Non-Athletes. Clinical Oral Investigations. 2022;26(8):5313-5323. https://doi.org/10.1007/s00784-022-04499-6
Gawlak D, Mańka-Malara K, Kamiński T, Łuniewska M, Mierzwińska-Nastalska E. Comparative evaluation of custom and standard boil and bite (self‐adapted) mouthguards and their effect on the functioning of the oral cavity. Dental Traumatology. 2016;32(5):416-420. https://doi.org/10.1111/edt.12269
Herpel C, Becher H, Aarabi G, et al. Temporomandibular Disorders: Prevalence and Associated Biopsychosocial Factors. An Analysis of Data From the NAKO Health Study. Dtsch Arztebl Int. 2022;119(17):298-305. https://doi.org/10.3238/arztebl.m2025.0219
Hirose T, Ono T, Maeda Y. Influence of wearing a scuba diving mouthpiece on the stomatognathic system – considerations for mouthpiece design. Dental Traumatology. 2016;32(3):219-224. https://doi.org/10.1111/edt.12239
Ingle A, Dhawan P, Rani S, Khan U. A Comprehensive Systematic Review and Meta-Analysis Comparing the Comfort Level of Customized Mouthguards to Self-Adapted Mouthguards in Athletes. Quintessence International. 2025;56(5):382-392. https://doi.org/10.3290/j.qi.b6184319
Knapik JJ, Hoedebecke BL, Rogers GG, Sharp MA, Marshall SW. Effectiveness of Mouthguards for the Prevention of Orofacial Injuries and Concussions in Sports: Systematic Review and Meta-Analysis. Sports Medicine. 2019;49(8):1217-1232. https://doi.org/10.1007/s40279-019-01121-w
Lobbezoo F, van Wijk AJ, Klingler MC, et al. Predictors for the development of temporomandibular disorders in scuba divers. Journal of Oral Rehabilitation. 2014;41(8):573-580. https://doi.org/10.1111/joor.12178
Macías Bautista M, Soares PBF, Rondon AKA, et al. Comfort and Usability of Digital Versus Conventional Custom-Fit Mouthguards: A Randomized Clinical Trial. Dental Traumatology. 2026;42(1):70059. https://doi.org/10.1111/edt.70059
Martins APVB, Cardoso RLF, de Andrade CCFV, et al. Comparison of Temporomandibular Disorder Signs and Symptoms in CrossFit® Athletes and Sedentary Individuals. International Journal of Environmental Research and Public Health. 2025;22(5):785. https://doi.org/10.3390/ijerph22050785
Medina Flores D, Braga SP, De La Torre Canales G, Stuginski-Barbosa J, Conti PCR. Psychological Features Associated With Awake Bruxism in Painful TMD: The Role of Anxiety. Journal of Oral Rehabilitation. 2026;53(5):1009-1017. https://doi.org/10.1111/joor.70158
Merle CL, Rott TA, Rauch A, et al. Temporomandibular Disorders and the Use of Oral Splints Among Elite Sport Athletes: A Questionnaire-Based Cross-Sectional Study in Germany. Clinical Oral Investigations. 2025;29(7):369. https://doi.org/10.1007/s00784-025-06434-x
Michelotti A, Bucci R, Donnarumma V, et al. Oral Behaviors Mediate the Relationship Between Anxiety and Painful Temporomandibular Disorders. Archives of Oral Biology. 2025;177:106321. https://doi.org/10.1016/j.archoralbio.2025.106321
Murakami S, Maeda Y, Ghanem A, Uchiyama Y, Kreiborg S. Influence of mouthguard on temporomandibular joint. Scandinavian Journal of Medicine & Science in Sports. 2008;18(5):591-595. https://doi.org/10.1111/j.1600-0838.2007.00698.x
Myllymäki E, Heikinheimo K, Suominen A, et al. Longitudinal trends in temporomandibular joint disorder symptoms, the impact of malocclusion and orthodontic treatment: A 20‐year prospective study. Journal of Oral Rehabilitation. 2023;50(9):739-745. https://doi.org/10.1111/joor.13471
Nykänen L, Sipilä K, Eli I, et al. Brief Diagnostic Criteria for Temporomandibular Disorders: Sensitivity and Specificity of Clinical Diagnoses (A Multi‐Center Study). Journal of Oral Rehabilitation. 2025;52(8):1251-1258. https://doi.org/10.1111/joor.13969
Oztürk O, Tek M, Seven H. Temporomandibular Disorders in Scuba Divers-an Increased Risk During Diving Certification Training. The Journal of Craniofacial Surgery. 2012;23(6):1825-1829. https://doi.org/10.1097/SCS.0b013e3182710577
Rondon AKA, Lozada MIT, Cordeiro IB, et al. Adaptation and Biomechanical Performance of Custom‐Fit Mouthguards Produced Using Conventional and Digital Workflows: A Comparative In Vitro Strain Analysis. Dental Traumatology. 2025;41(1):59-68. https://doi.org/10.1111/edt.12985
Saini RS, Okshah A, Haneef M, et al. Evaluating the Influence of Sports-Induced Trauma on Temporomandibular Disorders: A Systematic Review and Meta-Analysis. Archives of Oral Biology. 2025;172:106168. https://doi.org/10.1016/j.archoralbio.2024.106168
Schiffman E, Ohrbach R. Executive Summary of the Diagnostic Criteria for Temporomandibular Disorders for Clinical and Research Applications. Journal of the American Dental Association. 2016;147(6):438-445. https://doi.org/10.1016/j.adaj.2016.01.007
Sharma S, Wactawski-Wende J, LaMonte MJ, et al. Incident Injury Is Strongly Associated With Subsequent Incident Temporomandibular Disorder: Results From the OPPERA Study. Pain. 2019;160(7):1551-1561. https://doi.org/10.1097/j.pain.0000000000001554
Sharma S, Ohrbach R, Fillingim RB, Greenspan JD, Slade G. Pain Sensitivity Modifies Risk of Injury-Related Temporomandibular Disorder. Journal of Dental Research. 2020;99(5):530-536. https://doi.org/10.1177/0022034520913247
Singh BP, Singh N, Jayaraman S, et al. Occlusal Interventions for Managing Temporomandibular Disorders. The Cochrane Database of Systematic Reviews. 2024;9:CD012850. https://doi.org/10.1002/14651858.CD012850.pub2
Slade GD, Ohrbach R, Greenspan JD, et al. Painful Temporomandibular Disorder: Decade of Discovery From OPPERA Studies. Journal of Dental Research. 2016;95(10):1084-1092. https://doi.org/10.1177/0022034516653743
Tribst JPM, Dal Piva AMO, Bottino MA, Kleverlaan CJ, Koolstra JH. Mouthguard use and TMJ injury prevention with different occlusions: A three‐dimensional finite element analysis. Dental Traumatology. 2020;36(6):662-669. https://doi.org/10.1111/edt.12577
Tsur N, Arbel Y, Abuhasira S, et al. A retrospective study of oral pathoses in Israeli military divers and non‐divers: 2011–2020. Dental Traumatology. 2022;38(1):48-52. https://doi.org/10.1111/edt.12704
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Stanisław Pawlak, Karolina Siatkowska, Agata Moroz
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 32
Number of citations: 0
