Sys Rev Pharm 2020;11(10):18-21
A multifaceted review journal in the field of pharmacy
The Relationship between Chin Pressure and the Severity of
TMD in Violin Players
Mohammad Dharma Utama*, Andi Adytha M.I.R, Ike Damayanti Habar, Acing Habibie Mude, Edy Machmud, Irfan
Dammar, Vinsensia Launardo
Department of Prosthodontic, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia
ABSTRACT Keywords: Chin Pressure, Temporomandibular Disorders, Violin Players.
This research aimed to determine the relationship between playing the violin
and the severity of TMD and the maximum pressure on the chin rest within
Correspondence:
Mohammad Dharma Utama
safe limits while playing the violin, to prevent TMD occurrence. The 20 violin
Department of Prosthodontic, Faculty of Dentistry, Hasanuddin University,
players of OSUI Mahawaditra and MYSO orchestra were undergoing the
Makassar, Indonesia
examination and interview. Measurement of the pressure on the chin rest was
Corresponding Author:
[email protected]done using a Flexi force device attached to the chin, which will measure the
chin pressure on the instrument (N). The highest maximum pressure is 15.157
N, while the lowest maximum pressure is 0.126 N. The most elevated average
pressure is 6.203 N, and the most moderate average pressure is 0.025 N. There
is a strong relationship between chin pressure on the chin rest and TMD
conditions in the violinist. There is no relationship between the frequency and
duration of violin training with TMD conditions in violin players.
INTRODUCTION the other parts. A tense left shoulder with a tilted head to
Temporomandibular Joint (TMJ) is a joint formed by a hold the instrument with the chin. This gives excessive
mandibular condyle that enters the fossa in the temporal force to the motor system, especially in the dorsal
bone.1,2 Disorders of the TMJ, called Temporomandibular region13. The relationship between the occurrence of
Disorder (TMD), cause a variety of clinical problems TMD in violin players and the chin pressure is still
characterized by craniofacial pain involving the joints and unknown, as well as the amount of minimal pressure on
the muscles of mastication and innervation of the head chin rest, which can cause TMD in violin players in some
and neck, other related orofacial structures, and organizations in Indonesia. This study will analyze the
limitations of mandibular movements and clicking.3,4 TMD conditions and the amount of minimal pressure on
TMD is one of the leading causes of non-odontogenic pain the chin rest, leading to TMD in violin players in
in the orofacial area, affecting 10% -15% in adults.5,6 Indonesia. This analysis was carried out by examining the
Signs and symptoms of TMD include pain in the TMJ, TMJ, starting from history taking, clinical examination,
preauricular area, cervical spine, face and head, muscle filling in the questionnaire regarding the physical
pain mastication, limitations of jaw movement, jaw condition to the duration and frequency of exercise, and
deviation or deflection, and articular sounds7. the pressure on the chin rest measured on each player.
Violin and its effects on TMD have been studied. It was Through this research, it is expected to be able to know
found that exercise while learning the violin or playing the relationship between playing the violin and the
professionally has an impact on facial bone structure and severity of TMD, as well as the maximum pressure on the
relates specifically to the way the player holds the violin. chin rest which is within safe limits while playing the
There is a pressure of 30-70 N (5-14 N / cm2) or 220- violin, to prevent the occurrence of TMD.
2000 gr on TMJ due to pressure on the chin rest that is
channeled through the mandible during playing the violin, MATERIAL AND METHODS
which also resulted in force on the right TMJ and The subjects were 20 violin players of OSUI Mahawaditra,
subluxation on the left TMJ.8,9 String instruments, and the MYSO orchestra ranges from 18 to 35 years old.
especially violins, are prone to TMD due to repetitive The study used primary data, which was gathered
movements such as asymmetrical posture and the through an examination and interview. Measuring the
position of pinching instruments between the chin and pressure on the chin rest is done by using a Flexi force
shoulders performed for instrument stability and to device that is attached to the chin (Figure 1), which will
enhance perfect sound during rapid finger movements.7,10 measure the chin pressure on the instrument and will be
Violinists often complain of pain in some parts of their connected to USB which will later be read in the monitor
body, including the jaw, back, neck, shoulders, and hands, (LabView 2019, National Instrument).
which are related to nerves and muscles. This complaint This study uses pressure gauges made by researchers in
is caused by improper, repetitive, and pressure postures the form of pressure sensors integrated with applications
for a long time in a sitting position or while holding the in computer programs. The pressure sensor uses a device
instrument11. The neck area is the most frequently in the way of a Flexi force unit attached to the mandibular
complained of as a source of pain in string instrument corpus subject (Figures 2). The pressure applied to the
players12. In violin players, disorders generally occur chin rest is then captured by a pressure sensor forwarded
because of the monotonous and long-standing style and to the central unit. The main unit will connect to the
position. The monotonous position includes laptop via a USB cable, and the pressure value will be
asymmetrical postures, such as the position of the arms read on the program in the laptop in the form of graphics
during bowing and a higher position of the shoulder than and graphics in Newton. All violin players were
18 Systematic Reviews in Pharmacy Vol 11, Issue 10, Oct-Nov 2020
The Relationship between Chin Pressure and the Severity of TMD in Violin Players
instructed to play a classical musical composition entitled experienced pain during palpation of TMJ. Eighty percent
"La Vie en Rose" with a tempo guide using a metronome of them felt pain in the left TMJ area during palpation.
device within 60 bpm. Bowing and fingering are written Pain in the right TMJ area when palpation was felt by as
on scores and arranged so that each player will perform many as 20% of subjects at the time of clinical
the uniform bowing and fingering, without using the examination. This is following the study results described
vibrato effect. Players are asked to play the composition by Rodriguez et al., whereas many as 24.4% of subjects
four times. The first turn is intended for relaxation and experienced pain in TMJ. He also stated that the pressure
adaptation of muscles and emotions, while the next three on the left side when playing the violin would affect the
corners will be included in data retrieval. complaints of pain on the opposite side of the TMJ. This
theory is also supported by research conducted by
RESULTS Steinmetz et al., who has collected data on 31 subjects
This research uses pressure gauges made by researchers and provided results in the form of pain in TMJ with a
in the form of pressure sensors that are integrated with a percentage of 45% in violin players.16
computer program. The chin pressure on the chin rest During playing the violin, there was a pressure of 30-70 N
was measured in 20 subjects who met the inclusion on the rest of chin. In this study, the maximum average
criteria. The chin pressure on the chin rest while playing pressure value applied to the chin rest while playing the
the violin ranges from 0.025 N to 15.157 N. The highest violin was 6.203 N. Obata Satoshi et al. on the chin rest
maximum pressure is 15.157 N, while the lowest while playing the violin. The pressure is measured in 15
maximum pressure is 0.126 N. The most elevated average subjects and produces the maximum average value of
pressure is 6.203 N. The most moderate average pressure 16.2 N. This value is the pressure value applied to the rest
is 0.025 N. without the vibrato effect. This is in line with this study,
The prevalence of TMD in violin players based on DC- where all subjects were instructed not to use the vibrato
TMD examination is 80%. A total of 16 subjects effect when playing the violin when measuring pressure.
experienced TMD, while four other subjects were not The maximum pressure in Obata Satoshi et al. research
detected having TMD. This is because the conclusions showed a value of 29.6 N. In contrast, in this study the
from the clinical examination and the symptoms felt by maximum pressure value of 15.157 N.17 The difference in
the subject do not lead to the diagnosis of any TMD. In pressure from some of these studies could be due to
analyzing the data using the Spearman test, it can be seen differences in violin type and type of shoulder rest used
that the significance value of the average pressure by each player.14 Based on statistical calculations, it was
relationship with DC-TMD is 0.032 (p <0.05). The average concluded that the group of TMD conditions in the mild
pressure is related to DC-TMD. Table 1 shows the results and moderate categories were in the same group. This
of statistical data analysis with the Spearman test for the happened because there was no significant difference
two variables. Based on these tests, there is a relationship between TMD conditions in the two groups. Therefore,
between the average pressure with DC-TMD, with a the safe limit of pressure that can be applied to the rest
significance of 0.032 (p <0.05). Based on the results of the while playing the violin is set at the maximum pressure
Spearman correlation in the table above, it is known that limit in the moderate TMD group, equal to 2.687 N.
the magnitude of the Spearman correlation (rho) is 0.521.
Thus, Ho is rejected, and Ha is accepted. So, it can be CONCLUSION
concluded that there is a relationship between the The safe limit of pressure that can be applied to the chin
average pressure with TMD based on DC-TMD. According rest while playing the violin is 2.687 N. There is a strong
to Guliford, 0.521 is included in the category of significant relationship between chin pressure on the chin rest and
relationships based on high and low correlation. TMD conditions in the violinist. There is no relationship
between the frequency and duration of violin training
DISCUSSION with TMD conditions in violin players.
At first, it is estimated that the length of play or training
will be related to the TMD conditions that occur in the ACKNOWLEDGMENTS
violinist. However, in this study, it was found that the The authors gratefully acknowledge the Department of
duration of play was not associated with the incidence of Prosthodontic from Hasanuddin University Dental
TMD, both analyzed through duration and frequency of Hospital.
play. This is in line with the research conducted by
Rodriguez et al., which states that the two variables are
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20 Systematic Reviews in Pharmacy Vol 11, Issue 10, Oct-Nov 2020
The Relationship between Chin Pressure and the Severity of TMD in Violin Players
Table 1. The relationship between chin pressure and TMD
Chin pressure
DC TMD category
average value
Correlation
1.000 .521*
Coefficient
DC TMD category Sig. (2-tailed) . .032
N 17 17
Spearman's rho
Correlation
.521* 1.000
Coefficient
Chin pressure average
value Sig. (2-tailed) .032 .
N 17 17
*Correlation is significant at the 0.05 level (2-tailed).
Figure 1. Force recording unit.
Figure 2. Chin pressure recording simulation
21 Systematic Reviews in Pharmacy Vol 11, Issue 10, Oct-Nov 2020
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