Corine M Visscher

• Prof, PhD
• Managing Director at Academic Center for Dentistry Amsterdam

Background Temporomandibular disorders (TMDs) are conditions that involve the temporomandibular joints, masticatory muscles, and associated tissues, causing orofacial pain. Central sensitisation (CS) is a relevant part of the TMD pathophysiology. Migraine, psychological aspects, parafunctional oral habits and widespread pain are commonly associated...

Background Chronic painful temporomandibular disorders (TMD), awake bruxism and sleep bruxism are often comorbid with post‐traumatic stress disorder (PTSD), but the implications for treatment are unknown. Objective(s) To explore the effects of PTSD treatment on these conditions. We hypothesized that chronic painful TMD, pain intensity, pain interf...

Coding errors were found during preparations for another study. These errors involved mistakenly coding some female participants as male. Further investigations showed that this coding error also affected some of the data used in this study. Although quite a number of women were coded as male (n = 154), this does not change the outcomes of the stud...

Background: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed. Objective: To present comprehensive and short-form adaptations of Axis I and II of the DC/TMD for adults that are appropriate for use with children in clinical and research set...

Background: Post-traumatic stress disorder (PTSD) is associated with painful Temporomandibular Disorder (TMD), and may be part of the aetiology of awake bruxism (AB) and sleep bruxism (SB). Investigating the associations between PTSD symptoms on the one hand, and painful TMD, AB, and SB on the other, can help tailoring treatment to the needs of th...

Purpose: To assess the experience and perceived added value of an e-Health application during the physical therapy treatment of patients with temporomandibular disorders (TMD). Materials and methods: A mixed-methods study including semi-structured interviews was performed with orofacial physical therapists (OPTs) and with TMD patients regarding...

Objectives: Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain. Materials and methods: Individuals a...

Background The Headache Screening Questionnaire (HSQ) was created and validated to enable health professionals to screen for migraine and tension-type headaches. Objectives The objective of this study was to translate and cross-culturally adapt the HSQ, creating the Brazilian version of the HSQ (HSQ-BR). Design This was a cross-sectional study....

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: To examine if a dose-response relationship exists between the frequency of singing and TMD pain intensity,...

Background: Successful orofacial treatment can reduce tinnitus severity in patients with somatic tinnitus (ST). However, it is still unclear to what extent the degree of reduction in temporomandibular disorders (TMD) actually contributes to the decrease in tinnitus severity after orofacial treatment. Therefore, the aim of this study was to analyze...

Objectives To evaluate oral health-related quality of life (OHRQoL) in early rheumatoid arthritis (ERA) patients and individuals at risk of rheumatoid arthritis (RA) compared to healthy controls, and to explore possible associated factors. Materials and methods Fifty ERA patients, 50 at-risk individuals, and 50 age and gender matched healthy contr...

Aims: To assess differences in catastrophizing and kinesiophobia in relation to areas of pain and somatic symptoms among participants with temporomandibular disorders (TMDs) and controls. Methods: In total, 401 participants (333 women, 68 men, mean age: 45.8 years) in the TMJ Impact Project were examined in accordance with the Diagnostic Criteri...

Background Unlike the psychosocial assessment established for adults in the diagnostic criteria for temporomandibular disorders (DC/TMD), a standardized psychosocial assessment for children and adolescents with TMD complaints has not yet been established. Objectives To develop a new standardized instrument set to assess the psychosocial functionin...

Aim To understand whether the self-efficacy of novice dentists in Endodontics changes within the first year following their graduation, and to reveal factors related to a possible change. Methodology Data were obtained from dental graduates from Aarhus University, Denmark or from the Academic Centre for Dentistry Amsterdam, the Netherlands. The 60...

Aims Temporomandibular disorders (TMD) are often associated with psychological comorbidities. One such comorbidity is pain catastrophizing, i.e., exaggeration of negative consequences of a painful event. The aim was to investigate catastrophizing in individuals with painful TMD compared to controls and the association between catastrophizing and pa...

Featured Application Due to the close relationship between painful TMD and migraine, changes in one of the disorders, for example after treatment, may have a positive effect on the other disorder. Physiotherapists can use this knowledge to apply a more personalized intervention aimed at both disorders, and possibly collaborate with other health pro...

Background : OHIP's original seven-domain structure does not fit empirical data, but a psychometrically sound and clinically more plausible structure with the four OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact has emerged. Consequently, use and scoring of available OHIP versions needs to be revisited...

Management of patients with temporomandibular disorders (TMD) appears to be more challenging than for other dental conditions. This study aimed to explore the decision-making process in TMD management, and thereby to conceptualize the decision-making process in dentistry. Individual semi-structured interviews were conducted during 2018 and 2019 wit...

Aim To develop new instruments and to adapt the diagnostic criteria for temporomandibular disorders (DC/TMD) for the evaluation of TMD in children and adolescents. Method A modified Delphi method was used to seek international consensus among TMD experts. Fourteen clinicians and researchers in the field of orofacial pain and TMD worldwide were inv...

Background Clinically, sleep bruxism is considered to be associated with the presence of tooth wear, but strong evidence is still lacking. Objective To examine whether an association exists between polysomnographic parameters, recorded from patients with possible sleep bruxism, and tooth wear. Methods Sixty‐three possible sleep bruxers (19 males...

Objective To evaluate the prevalence of temporomandibular disorders (TMD) in patients with early rheumatoid arthritis (ERA) and individuals at-risk of RA. Methods 150 participants were recruited in three groups (50 per group): (1) patients with ERA (2010 EULAR criteria) (2) at-risk individuals and (3) healthy controls. All participants were tested...

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-the dimensions of oral health-related quality of life-capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project...

Background Physical therapy is regarded an effective treatment for temporomandibular disorders (TMD). Patients with TMD often report concomitant headache. There is, however, no overview of the effect of physical therapy for TMD on concomitant headache complaints. Objectives The aim of this study is to systematically evaluate the literature on the...

Aims: To assess the prevalence of catastrophizing in patients with temporomandibular disorders (TMD) and the possible associations between catastrophizing and treatment outcome. Methods: This review was registered in the Prospero database (CRD42018114233). Electronic searches were performed in PubMed, Scopus, and PsycINFO from the inception of e...

Introduction Subjective tinnitus that is influenced by the somatosensory system is called somatosensory tinnitus (ST). When ST is related to the temporomandibular area, multidisciplinary orofacial treatment can reduce tinnitus severity. It is, however, unknown if we can predict this positive outcome. The aim of this study is to look for prognostic...

The aim was to perform a translation, cross-cultural adaptation, and psychometric evaluation of the Spanish version of the Tampa Scale of Kinesiophobia for Temporomandibular Disorders (TSK-TMD-S). The study sample included 110 patients with TMD. We translated and cross-culturally adapted the TSK-TMD-S using standard methodology and analysed its int...

Aims: To examine if the existence of an association between self-reported awake oral behaviors and orofacial pain depends on the belief of patients that these behaviors are harmful to the jaw and to investigate if an additional variable (ie, somatic symptoms, depression, and/or anxiety) indirectly affects the association between the causal attribut...

Background Psychosocial wellbeing is an important determinant for patients` oral health‐related quality of life (OHRQoL). Psychosocial Impact (PI), together with the dimensions Oral Function, Orofacial Pain, and Orofacial Appearance, have been proposed to cover the different areas of OHRQoL. Objective The objective of the study was to collect furt...

Background: Treatment of temporomandibular disorder (TMD) currently consists of a combination of noninvasive therapies and may be supported by e-Health. It is, however, unclear if physical therapists and patients are positive towards the use of e-Health. Purpose: To assess the needs, facilitators and barriers of the use of an e-Health application f...

Although a fluctuating pattern of orofacial pain across the life span has been proposed, data on its natural course is lacking. The longitudinal course of orofacial pain in the general population was evaluated using data from routine dental check-ups at all Public Dental Health services in Västerbotten, Sweden. In a large population sample, two scr...

Background: Tinnitus, or ringing in the ears, is a perception of sound in the absence of overt acoustic stimulation. In some cases, tinnitus can be influenced by temporomandibular somatosensory input, then called temporomandibular somatosensory tinnitus (TST). It is, however, not entirely known if orofacial treatment can decrease tinnitus severity...

Background: It is important to know how easy or difficult it is to use an ambulatory electromyographic (EMG) device for sleep bruxism assessment, and how this might affect its future utilization. Objective: To explore the experience of individuals using an EMG device that pairs with a smartphone app, in order to detect factors that could facilit...

Objective: To report and discuss the lessons learned from the conduct of a clinical study on the associations between sleep bruxism and (peri-)implant complications, the protocol of which has been pre-published. Materials and methods: A single-center, double-blind, prospective cohort study with a 2 year follow-up was performed in the Academic Ce...

None: This case report describes a rare side effect associated with nasal continuous positive airway pressure (nCPAP), viz., masticatory muscle myalgia. A 69-year-old man was referred to a clinic specializing in orofacial pain and dysfunction with complaints of pain in the area of the masseter muscles. He was diagnosed with severe obstructive slee...

Objective Pain in the orofacial region may originate from different structures, and one challenge for the clinician is to determine the primary origin of pain reported by the patient. In clinical practice, it is important to discriminate between a temporomandibular joint (TMJ) pain disorder and jaw muscle pain; therefore, tests that are proposed fo...

Objectives Sleep bruxism (SB) is considered to play an important role in the provocation of temporomandibular disorder (TMD) pain. However, clinical studies investigating this relation yielded contradictory results. These contradictory results can, at least in part, be explained by a possible influence of TMD pain on SB activity. The aim of this ex...

Background: Uncertainties still exist about the role of playing musical instruments on the report of musculoskeletal complaints and headache. Objectives: To evaluate the prevalence of and risk indicators for symptoms of temporomandibular disorders, pain in the neck or shoulder, and headache among musicians.

Background: Uncertainties still exist about the role of playing musical instruments on the report of musculoskeletal complaints and headache. Objectives: To evaluate the prevalence of and risk indicators for symptoms of temporomandibular disorders, pain in the neck or shoulder, and headache among musicians. Methods: A questionnaire was distrib...

Background: As vocalists demand high physical strains of the masticatory system, singing is frequently mentioned as a risk factor for temporomandibular disorders (TMDs). Objectives: This study investigated whether vocalists report a higher prevalence of two types of TMDs (viz., TMD pain and temporomandibular joint sounds) compared with instrumen...

Aims: To investigate the associations between signs of painful temporomandibular disorders (TMD) and number of tender points (TPs) and fibromyalgia in adolescents, as well as the relationship between TPs and pressure-pain threshold (PPT) in individuals presenting with local, regional, or widespread pain as a way to investigate the presence of cent...

Background The oral health of community dwelling frail older people is poor, and depends on the oral health care provisions available within their own community. The implementation project ‘Don’t forget the mouth!’ (i.e., the intervention) was created with the aim of maintaining and improving the oral health and the general health of community dwel...

Aim: To systematically review the available literature on the diagnostic accuracy of questionnaires and measurement instruments for headaches associated with musculoskeletal symptoms. Design: Articles were eligible for inclusion when the diagnostic accuracy (sensitivity/specificity) was established for measurement instruments for headaches associa...

Background Obesity is a chronic and prevalent disorder, affecting individuals of all age. Previous evidence suggests that it is associated with some types of chronic pain, especially musculoskeletal pain. In addition, sedentarism is also associated with an increase of the inflammatory factors and chronic pain. So, we conducted a cross‐sectional stu...

Objective To explore how bruxism is dealt with by accredited oral implantologists within daily clinical practice. Materials and methods Nine semi-structured interviews of oral implantologists practicing in non-academic clinical practices in the Netherlands were performed, and thematic analysis was conducted using a framework-based approach. Resul...

Background Tinnitus is a highly prevalent symptom affecting 10–15% of the adult population. It often affects patient quality of life and frequently causes distress. When subjective tinnitus can be elicited by the somatosensory system of the cervical spine or temporomandibular area it is termed somatic tinnitus. The first aim of the current study is...

Background Studies exploring interventions targeting the cervical spine to improve symptoms in patients with temporomandibular disorders (TMD) are limited. Objectives To determine whether mobilization of the upper cervical region and craniocervical flexor training decreased orofacial pain, increased mandibular function and pressure pain thresholds...

The biopsychosocial model is advocated as part of a more comprehensive approach in both medicine and dentistry. However, dentists have not traditionally been taught psychosocial screening as part of their predoctoral education. The aim of this systematic review was to provide an overview of published studies on the implementation of screening for p...

Objectives: The aim was to assess the added diagnostic value of ultrasonography (US) for establishing the presence or absence of disc displacements (DDs) in temporomandibular joints (TMJs). Materials and methods: Pubmed and EMBASE were searched electronically to identify diagnostic accuracy studies that assessed the diagnostic value of US for th...

Aims: To develop models for prognostic prediction of oral health-related quality of life (OHRQoL) for patients with temporomandibular joint osteoarthritis (TMJ OA) at 1- and 6-month follow-ups after arthrocentesis treatment with hyaluronic acid (HA) injections once a week for 4 weeks. Methods: From a cohort of 522 adult patients with TMJ OA trea...

Aims: To identify potential predictors of types of treatment indicated for patients with temporomandibular disorders (TMD) and to develop, validate, and calibrate a prediction model for type of treatment. Methods: The derivation cohort at baseline was comprised of 356 adult patients with TMD. Patient and disease characteristics were recorded at...

Background: Evidence in the field of dentistry has demonstrated the importance of pain-related disability and psychological assessment in the development of chronic symptoms. The Diagnostic Criteria for Temporomandibular Disorders offer a brief assessment for the diagnostic process in patients with orofacial pain (Axis II). The authors describe re...

Aims: (1) To examine the heritability of TMD pain and of neck pain; and (2) to estimate the potential overlap in genetic and environmental factors influencing TMD pain and neck pain. Methods: Data from 2,238 adult female twins who completed a survey on TMD pain and neck pain were analyzed. The total variance of TMD pain and neck pain was decompo...

Objective: To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic. Material and methods: Consecutive patients, >18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre fo...

Background: Sleep bruxism (SB) and psychological stress are commonly considered as contributing factors in the etiology of temporomandibular disorder (TMD) pain. However the lack of longitudinal studies and fluctuating nature of SB, psychological stress and TMD-pain have led to contradictory results regarding the association between the possible e...

Aims: To investigate whether pain-related temporomandibular disorders (TMD) are the product of an interaction between psychological factors and self-reported bruxism activities. Methods: Patients referred to a specialized clinic for complaints of orofacial pain and dysfunction completed a digital questionnaire prior to the first clinical visit....

Background: Headache is a common disorder which may lead to substantial socio-economic loss. Treatment options include self-management strategies, medication and physiotherapy. Physiotherapists need to be able to screen for the presence of migraine and tension-type headache (TTH), so they can adjust their treatment strategies to the type of headac...

Aims: To assess the prevalence, 3-year course, and associated factors of temporomandibular joint (TMJ) pain in patients with newly diagnosed rheumatoid arthritis (RA). Methods: A total of 264 patients with newly diagnosed RA were included. Patients were assessed after 3 months, 6 months, 9 months, 1 year, 1.5 years, 2 years, and 3 years. TMJ pai...

Background: Playing a musical instrument that loads the masticatory system has frequently been linked to temporomandibular disorders (TMDs). Previous literature reviews on this topic do not conform to the current standards of evidence-based medicine. Aims: To investigate the effects of playing a musical instrument (i.e. violin/viola and wind ins...

Objectives: To evaluate the outcome of 3Q/TMD on the clinical decision-making, and to analyse if gender, age, and the fee-system the individual was assigned to, were related to prescribed TMD treatment. Methods: This cohort study was carried out within the Public Dental Health service in Västerbotten, Sweden. As part of the routine dental check-...

There is limited empirical information as to whether or how stimuli associated with dental fear can be classified into distinct subtypes. The purpose of the current study was to develop a descriptive framework for the classification of dental fear. Data were collected using a survey among Dutch twin families (n = 11,771). The sample was randomly di...

Background: Fear of movement (kinesiophobia) seems to play an important role in the development of chronic pain. However, in Temporomandibular Disorders (TMD) there is a scarcity of studies about this topic. The Tampa Scale for Kinesiophobia for TMD (TSK/TMD) is the most widely used instrument to measure fear of movement and it is not available in...

Objectives/Aims To describe the protocol of a prospective cohort study designed to answer the question: ‘Is sleep bruxism a risk factor for (peri-)implant complications?’. Materials and Methods Our study is a single-centre, double-blind, prospective cohort study with a follow-up time of 2 years. Ninety-eight participants fulfilling inclusion crite...

Aims: To determine possible predictive factors for long-term temporomandibular joint (TMJ) degeneration and dysfunction in juvenile idiopathic arthritis (JIA) patients. Methods: A total of 94 patients (77% female) who had received a JIA diagnosis in an outpatient rheumatology clinic from 1993 to 1994 at a mean ± standard deviation age of 8.3 ± 4...

Objectives: The objective of this observational study was to establish the possible presence of confounders on the association between temporomandibular disorders (TMD) and headaches in a patient population from a TMD and Orofacial Pain Clinic. Methods: Several subtypes of headaches were diagnosed: self-reported headache, (probable) migraine, (p...

The study assessed whether psychological and socio-demographic factors, including somatization, depression, stress, anxiety, daytime sleepiness, optimism, gender and age are associated with pain intensity and pain-related disability in patients with temporomandibular disorders (TMD). In total, 320 TMD patients were involved in the study. The psycho...

Background: Tinnitus is a very common symptom that often causes distress and decreases the patient's quality of life. Apart from the well-known causes, tinnitus can in some cases be elicited by dysfunctions of the cervical spine or the temporomandibular joint (TMJ). To date however, it is unclear whether alleviation of these dysfunctions, by physic...

This study aimed to assess the prevalence of tooth wear in different age groups of the Dutch adult population and to determine this tooth wear distribution by gender, socioeconomic class, and type of teeth. Results were compared with the outcomes of a previous study in a comparable population. As part of a comprehensive investigation of the oral he...

Background: We conducted a clinical cross-sectional study to evaluate the association between obesity and the presence of painful temporomandibular disorders (TMD), controlling for age, gender, presence of migraine, depression, non-specific somatic symptoms and obstructive sleep apnea syndrome (OSAS) in an adult population METHODS: A total of 299...

The aim of this study was to explore the association between the presence of comorbidities and the pain experience in individual patients with temporomandibular disorder (TMD). This clinical trial comprised 112 patients with TMD pain. For all participants the presence of the following comorbid factors was assessed: pain in the neck; somatization; i...

Temporomandibular disorders (TMD) are common but seem to be largely undetected within general dental care. To improve dentists' awareness of these symptoms, three screening questions (3Q/TMD) have been introduced. Our aim was to validate 3Q/TMD in relation to the diagnostic criteria for TMD (DC/TMD), while taking into account the severity level of...

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues. Many grading scales are available to assess the amount of tooth wear, one of which is the tooth wear evaluation system (TWES). A grading scale can be used chairside, on casts and on photographs. The aim was to test whether the grading scales of the TWES, used on c...

Objectives . The aim of this study was to establish the reliability of the “chewing” subscale of the OPS-NVI, a novel tool designed to estimate presence and severity of orofacial pain in nonverbal patients. Methods . The OPS-NVI consists of 16 items for observed behavior, classified into four categories and a subjective estimate of pain. Two observ...

Aims: (1) To determine the prevalence of temporomandibular disorder (TMD)-pain complaints in the general Dutch population; (2) to investigate its relationship with age, sex, educational attainment, and country of birth; (3) to determine its association with other pain complaints; and (4) to determine whether there are TMD subgroups (ie, with regar...

Every dentist has observed the fact that pain symptoms and responses are different among the patients in his or her practice. This is especially true for patients who seek treatment for temporomandibular disorders (TMD), because some of these patients do well when appropriately treated, whereas others continue to have pain. Also, some patients in t...

Temporomandibular pain and jaw dysfunction can have a negative effect on daily life, but these conditions are not well recognized in the health care systems. The general aim was to examine the cross-sectional prevalence of frequent temporomandibular pain and jaw dysfunction in men and women across the lifespan. The analysis was based on data from 1...

Background Adults with Down syndrome (DS) are at risk for age-related painful physical conditions, but also for under-reporting pain. Pictograms may facilitate self-report of pain, because they seem suitable for the global visual processing in DS and for iconic representation of abstract concepts.Method Participants (N = 39, M age = 41.2) assigned...

The aim of this study was to test the psychometric properties of the Dutch version of the Orofacial Esthetic Scale (OES) in dental patients with and without self-reported tooth wear. The English version of the OES was translated into Dutch, following established guidelines for cross-cultural adaptation of health-related quality of life measures. Th...

Many methods are available for the grading of tooth wear, but their ability to assess the progression of wear over time has not been studied frequently. The aim was to assess whether the occlusal/incisal grading scale of the Tooth Wear Evaluation System (TWES) was sensitive enough for the detection of tooth wear progression from 14 to 23 years of a...

Masticatory performance has been positively associated with cognitive ability in both animals and healthy humans. We hypothesised that there would also be a positive correlation between masticatory performance and cognition in older persons suffering from dementia. Older persons suffering from dementia (n = 114) and receiving institutionalised care...

Dit hoofdstuk geeft inzicht in de processen die een rol spelen bij het stellen van een diagnose bij patiënten met een temporomandibulaire aandoening. Aan de hand van de anamnese en het klinische onderzoek wordt de lezer geleerd om eenvoudig herkenbare temporomandibulaire aandoeningen te diagnosticeren. Samen met de etiologische factoren, de behande...

Dit hoofdstuk beschrijft een aantal aandoeningen die een rol spelen bij de differentiële diagnostiek van TMD-pijn. Tevens wordt nader ingegaan op de problematiek van de persisterende idiopathische aangezichtspijn.

Temporomandibulaire disfuncties worden vooral behandeld als pijn deel uitmaakt van het klachtenpatroon of in geval van hinderlijke functieproblemen. De behandelaar kan een keuze maken uit één of meer, vooral reversibele behandelvormen, zoals counseling, farmacotherapie, stabilisatieopbeetplaattherapie, fysiotherapie, psychosociale therapie en – in...

Dental phobia is part of the Blood-Injection-Injury (B-I-I) phobia subtype of specific phobia within DSM-IV-TR. To investigate the conceptual validity of this classification, the purpose of the present study was to determine the co-occurrence of dental phobia, typical dental (and B-I-I related) fears, vasovagal fainting, and avoidance of dental car...

The aim of this study was to describe the current knowledge on the role of heritability in TMD pain through a systematic review of the literature, including familiar aggregation studies and genetic association studies. For the systematic search of the literature, the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidel...

Unlabelled: Most studies on pain focus on specific disorders, which makes it difficult to compare characteristics across different types of pain symptoms. In this large population-based study, we examine the prevalence and comorbidity patterns among pain symptoms across a wide range of anatomic sites (back, neck, head, abdomen, joints, chest, face...

The aim of the study was to compare the thickness and cross-sectional area (CSA) of masseter and medial pterygoid muscles in young patients with long-standing bilateral temporomandibular joint ankylosis (bTMJA) in relation to controls. Axial sections of computed tomography scans of patients with bTMJA from two tertiary care university hospitals wer...

Oral health-related quality of life (OHRQoL) is associated with tooth wear and tooth loss. This study investigated the association between OHRQoL and dental status (in terms of natural dentition, partial or complete dentures, or edentulism). Sixteen hundred and twenty-two persons who participated in a large-scale Dutch dental survey were interviewe...

Temporomandibular disorders (TMDs) have a multifactorial etiology. Among others, parafunctions and oral habits have been suggested as important initiating and perpetuating factors. Playing a musical instrument that loads the masticatory system, like wind instruments and the violin or viola, has been suggested to be part of this group of etiological...