Study examines oral health of German orchestra musicians

Iveta Ramonaite, Dental Tribune International

Wed. 26. August 2026

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GÖTTINGEN, Germany: Professional musicians are exposed to a range of occupational factors that may affect their oral and orofacial health. A large number of musicians are employed in Germany’s professional orchestras, but little is known about their knowledge and behaviours regarding these work-related risks. A recent study examined these aspects among orchestra musicians and compared the results across instrument groups. The findings provide one of the first comprehensive insights into oral health and related concerns within this professional population.

Commenting on his recent study of German orchestra musicians, Dr Felix Marschner said that instrument use should be covered during history taking and considered alongside other occupation-related risk factors when assessing orofacial health. (Image: Dr Felix Marschner)

“Germany has the highest orchestra density worldwide, yet almost no data existed on its orchestra members’ oral health. For musicians, the mouth is part of their professional equipment, so instrument-related risks are a real occupational health issue,” lead author Dr Felix Marschner, who works in the Department of Preventive Dentistry, Periodontology and Cariology at the University Medical Center Göttingen, told Dental Tribune International.

For the study, the researchers distributed an online survey to all 129 professional orchestras in Germany, and 494 musicians participated. They were grouped by instrument into woodwind, brass, string, and percussion and other instruments, such as piano, harp or celesta.

Most of the musicians rated their oral health as good or very good. However, more than one-third reported orofacial pain, and of those half reported some effect of this on their performance. The highest rates were among string players and very low in the group who played percussion or other instruments.

Awareness of instrument-related oral health risks was generally high, yet a large majority of musicians felt that they did not have adequate knowledge about these risks. Risk awareness was associated with reporting orofacial pain, whereas greater professional experience was associated with less reported pain. The researchers suggested that musicians who experience pain may become more attentive to potential risks, and this could explain the association between risk awareness and pain.

Most of the musicians considered oral health important for their professional performance. Most brushed their teeth several times a day, and just over half of the participants used fluoride products every time they brushed. Most participants reported dental visits and professional dental cleaning at least annually. The group who played percussion or other instruments underwent professional dental cleaning least often, and they also regarded oral health as less critical for professional performance, highlighting differences in oral health practices and attitudes between instrument groups.

The use of mouth guards varied by instrument type, and woodwind players were more likely to use them than brass players. The literature suggests that playing wind instruments—such as flutes, clarinets, trumpets and trombones—may be associated with specific oral consequences. These include malocclusion, changes in dentofacial morphology, displacement of anterior teeth, temporomandibular disorder and root resorption. Therefore, the researchers suggested that this may explain why wind instrument players exhibited high risk awareness and preventive behaviour.

The survey also found that orofacial pain was more common among those who perceived their oral health as poor and among female musicians. This last finding is consistent with other studies reporting a higher prevalence of orofacial pain and temporomandibular disorder among women. Proposed explanations include hormonal influences on pain perception, as well as differences in coping and other biological and psychosocial factors

Based on their findings, the researchers emphasised the need for music health education as part of professional training, as well as targeted preventive measures aimed at reducing orofacial pain and helping musicians maintain their performance over the course of their careers. These include the use of instrument-specific protective devices, a recommendation supported by other studies.

“Oral health should be integrated into musicians’ training from conservatory level onwards, just like hearing protection,” said Dr Marschner.

“Ask patients about their profession—musicians’ instrument use belongs in the dental history, like any other occupational exposure. Screen for orofacial pain and temporomandibular disorder,” Dr Marschner advised. “About half of the musicians explicitly wanted preventive guidance from their dentist.”

The study, titled “Oral health awareness and behaviors in professional orchestra musicians in Germany: findings from an online survey study”, was published online on 21 July 2026 in BMC Oral Health.