Association of temporomandibular disorders and other jaw anomalies in chewing gum users—a systematic review

Background: The relationship between chewing gum and the development of temporomandibular disorders (TMD) and other jaw anomalies presents a contentious topic within dental and orthodontic research communities. This systematic review aimed to synthesize the available evidence regarding the association of gum chewing with the incidence of TMD and jaw anomalies. Methods: Adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a comprehensive review across six electronic databases—PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and PsycINFO. The studies were chosen based on predetermined inclusion and exclusion criteria, with quality and bias assessments performed on each included investigation. Data extraction and synthesis focused on the relationship between gum chewing habits and the occurrence of TMD symptoms. Results: The review included 8 investigations, yielding mixed outcomes. Some studies within this review indicated no direct causative link between the act of gum chewing and the development of TMD-related symptoms, suggesting that symptoms were transient and subsided with the cessation of gum chewing. Conversely, other research suggested a dose-response relationship where increased frequency and duration of gum chewing were associated with escalated TMD symptoms, such as muscle discomfort and hypertrophy. Notably, several studies highlighted the resilience of jaw musculature to adapt to the stress of chewing in individuals without pre-existing TMD, which might be indicative of a protective adaptive response. Conclusion: The association between gum chewing and TMD is complex and multifaceted. Evidence from this systematic review suggests a spectrum of effects, from negligible impact to a dose-dependent relationship between gum chewing and TMD symptomatology. The PROSPERO Registration: CRD42024553227.

Temporomandibular disorders; Gum chewing; Jaw anomalies; Masticatory muscle; Systematic review; Muscle stiffness

[1] Andrade RA, Cunha MD, Santos Reis AMC. Morphofunctional analysis of the stomatognathic system in conventional complete dentures users from the integrated health center. Revista CEFAC. 2017; 19: 712–725.

[2] Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, et al. Anatomy of the temporomandibular joint. Seminars in Ultrasound, CT and MRI. 2007; 28: 170–183.

[3] Klasser GD, Goulet JP, Moreno-Hay I. Classification and diagnosis of temporomandibular disorders and temporomandibular disorder pain. Dental Clinics of North America. 2023; 67: 211–225.

[4] Prakash J, Ranvijay K, Devi LS, Shenoy M, Abdul NS, Shivakumar GC, et al. Assessment of symptoms associated with temporomandibular dysfunction and bruxism among elderly population: an epidemiological survey. The Journal of Contemporary Dental Practice. 2022; 23: 393–398.

[5] Schappo C, Garanhani RR, Cordeiro MEW, Oppitz LR, Schneider NÁ, Tanaka OM, et al. Assessment of awake bruxism and oral mucosa indentation in adolescents. Journal of Oral Rehabilitation. 2023; 50: 671–678.

[6] Reda B, Lobbezoo F, Contardo L, El-Outa A, Moro L, Pollis M, et al. Prevalence of oral behaviours in general dental patients attending a university clinic in Italy. Journal of Oral Rehabilitation. 2023; 50: 370–375.

[7] Ma Y, Yu M, Gao X. Role of craniofacial phenotypes in the response to oral appliance therapy for obstructive sleep apnea. Journal of Oral Rehabilitation. 2023; 50: 308–317.

[8] Li K, Tan K, Yacovelli A, Bi WG. Effect of botulinum toxin type A on muscular temporomandibular disorder: a systematic review and meta-analysis of randomized controlled trials. Journal of Oral Rehabilitation. 2024; 51: 886–897.

[9] Lippi G, Cervellin G, Mattiuzzi C. Gum-chewing and headache: an underestimated trigger of headache pain in migraineurs? CNS & Neurological Disorders—Drug Targets. 2015; 14: 786–790.

[10] Pelivan I, Šeparović I, Vuletić M, Dulčić N, Gabrić D. Radiological and periodontal evaluation of stock and custom CAD/CAM implant abutments—a one-year follow-up study. Prosthesis. 2023; 5: 437–542.

[11] Tanaka T, Hara S, Hendawy H, El-Husseiny HM, Tanaka R, Asakura T. Development of small-diameter artificial vascular grafts using transgenic silk fibroin. Prosthesis. 2023; 5: 763–773.

[12] Choi S, Kang YS, Yeo ISL. Influence of implant–abutment connection biomechanics on biological response: a literature review on interfaces between implants and abutments of titanium and zirconia. Prosthesis. 2023; 5: 527–538.

[13] Hernández-Ortega MF, Torres-SanMiguel CR, Alcántara-Arreola EA, Paredes-Rojas JC, Cabrera-Rodríguez O, Urriolagoitia-Calderón GM. Numerical assessment of interspinous spacers for lumbar spine. Prosthesis. 2023; 5: 939–951.

[14] Peck CC, Goulet JP, Lobbezoo F, Schiffman EL, Alstergren P, Anderson GC, et al. Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders. Journal of Oral Rehabilitation. 2014; 41: 2–23.

[15] Henein P, Ziccardi VB. Temporomandibular disorders: surgical implications and management. Dental Clinics of North America. 2023; 67: 349–365.

[16] Al-Jundi MA, John MT, Setz JM, Szentpétery A, Kuss O. Meta-analysis of treatment need for temporomandibular disorders in adult nonpatients. Journal of Orofacial Pain. 2008: 22: 97–107.

[17] Minervini G, Franco R, Marrapodi MM, Fiorillo L, Cervino G, Cicciù M. The association between parent education level, oral health, and oral-related sleep disturbance. An observational crosssectional study. European Journal of Paediatric Dentistry. 2023; 24: 218–223.

[18] Uzunçıbuk H, Marrapodi MM, Meto A, Ronsivalle V, Cicciù M, Minervini G. Prevalence of temporomandibular disorders in clear aligner patients using orthodontic intermaxillary elastics assessed with diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: a cross-sectional study. Journal of Oral Rehabilitation. 2024; 51: 500–509.

[19] Antonelli A, Bennardo F, Brancaccio Y, Barone S, Femiano F, Nucci L, et al. Can bone compaction improve primary implant stability? An in vitro comparative study with osseodensification technique. Applied Sciences. 2020; 10: 8623.

[20] Minervini G, Romano A, Petruzzi M, Maio C, Serpico R, Di Stasio D, et al. Oral-facial-digital syndrome (OFD): 31-year follow-up management and monitoring. Journal of Biological Regulators and Homeostatic Agents. 2018; 32: 127–130.

[21] Franco R, Francesco G, Michele M, Alberta B, Patrizio B. The hemostatic properties of chitosan in oral surgery. Biomedical and Biotechnology Research Journal. 2020; 4: 186–188.

[22] Dental Supplement; Minetti E, Palermo A, Savadori P, Barlattani A Jr, Franco R, Michele M, et al. Autologous tooth graft: a histological comparison between dentin mixed with xenograft and dentin alone grafts in socket preservation. Journal of Biological Regulators and Homeostatic Agents. 2019; 33: 189–197.

[23] Cervino G, Fiorillo L, Laino L, Herford AS, Lauritano F, Giudice GL, et al. Oral health impact profile in celiac patients: analysis of recent findings in a literature review. Gastroenterology Research and Practice. 2018; 2018: 7848735.

[24] Laino L, Cicciù M, Fiorillo L, Crimi S, Bianchi A, Amoroso G, et al. Surgical risk on patients with coagulopathies: guidelines on hemophiliac patients for oro-maxillofacial surgery. International Journal of Environmental Research and Public Health. 2019; 16: 1386.

[25] Mariani P, Menditti D, Russo D, Laino L. Evaluation of the effectiveness of tube drain on postoperative discomfort in mandibular third molar surgery: prospective randomized split-mouth study. Acta Odontologica Scandinavica. 2023; 81: 528–533.

[26] Santosh V, Hinduja S, Manoj R, Waghmare M. Overlaid temporomandibular joint disorders and otology symptoms—a diagnostic approach and management considerations for otolaryngologists and dentists. Eastern Journal of Medical Sciences. 2020; 5: 25–29.

[27] Tabrizi R, Karagah T, Aliabadi E, Hoseini SA. Does gum chewing increase the prevalence of temporomandibular disorders in individuals with gum chewing habits? Journal of Craniofacial Surgery. 2014; 25: 1818–1821.

[28] Santana-Mora U, López-Cedrún J, Mora MJ, Otero XL, Santana-Penín U. Temporomandibular disorders: the habitual chewing side syndrome. PLOS ONE. 2013; 8: e59980.

[29] Radke JC, Kamyszek GJ, Kull RS, Velasco GR. TMJ symptoms reduce chewing amplitude and velocity, and increase variability. CRANIO®. 2019; 37: 12–19.

[30] Arya S, Kaji AH, Boermeester MA. PRISMA reporting guidelines for meta-analyses and systematic reviews. JAMA Surgery. 2021; 156: 789–790.

[31] Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. The BMJ. 2019; 366: l4898.

[32] Bero L, Chartres N, Diong J, Fabbri A, Ghersi D, Lam J, et al. The risk of bias in observational studies of exposures (ROBINS-E) tool: concerns arising from application to observational studies of exposures. Systematic Reviews. 2018; 7: 242.

[33] Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology. 2011; 64: 401–406.

[34] Al Sayegh S, Vasilatou I, Kumar A, Al Barwari C, Fredriksson L, Grigoriadis A, et al. Experimental pain and fatigue induced by excessive chewing. BMC Oral Health. 2020; 20: 179.

[35] Christensen LV, Tran KT, Mohamed SE. Gum chewing and jaw muscle fatigue and pains. Journal of Oral Rehabilitation. 1996; 23: 424–437.

[36] Correia D, Real Dias MC, Castanho Moacho A, Crispim P, Luis H, Oliveira M, et al. An association between temporomandibular disorder and gum chewing. General Dentistry. 2014; 62: e33–e36.

[37] Farella M, Bakke M, Michelotti A, Martina R. Effects of prolonged gum chewing on pain and fatigue in human jaw muscles. European Journal of Oral Sciences. 2001; 109: 81–85.

[38] Matsuda S, Yamaguchi T, Mikami S, Okada K, Gotouda A, Sano K. Rhythm and amplitude of rhythmic masticatory muscle activity during sleep in bruxers—comparison with gum chewing. CRANIO®. 2016; 34: 234–241.

[39] Olchowy C, Grzech-Leśniak K, Hadzik J, Olchowy A, Łasecki M. Monitoring of changes in masticatory muscle stiffness after gum chewing using shear wave elastography. Journal of Clinical Medicine. 2021; 10: 2480.

[40] Watemberg N, Matar M, Har-Gil M, Mahajnah M. The influence of excessive chewing gum use on headache frequency and severity among adolescents. Pediatric Neurology. 2014; 50: 69–72.

[41] Yashiro K, Takada K. Model-based analysis of jaw-movement kinematics using jerk-optimal criterion: simulation of human chewing cycles. Journal of Electromyography and Kinesiology. 2005; 15: 516–526.

[42] Douglas CR, Avoglio JL, de Oliveira H. Stomatognathic adaptive motor syndrome is the correct diagnosis for temporomandibular disorders. Medical Hypotheses. 2010; 74: 710–718.

[43] Gavish A, Winocur E, Astandzelov-Nachmias T, Gazit E. Effect of controlled masticatory exercise on pain and muscle performance in myofascial pain patients: a pilot study. CRANIO®. 2006; 24: 184–190.

[44] Kim HJ, Lee JY, Lee ES, Jung HJ, Ahn HJ, Jung HI, et al. Simple oral exercise with chewing gum for improving oral function in older adults. Aging Clinical and Experimental Research. 2021; 33: 1023–1031.

[45] Olchowy A, Wieckiewicz M, Winocur E, Dominiak M, Dekkers I, Łasecki M, et al. Great potential of ultrasound elastography for the assessment of the masseter muscle in patients with temporomandibular disorders. A systematic review. Dentomaxillofacial Radiology. 2020; 49: 20200024.

[46] Olchowy C, Więckiewicz M, Sconfienza LM, Łasecki M, Seweryn P, Smardz J, et al. Potential of using shear wave elastography in the clinical evaluation and monitoring of changes in masseter muscle stiffness. Pain Research and Management. 2020; 2020: 4184268.

[47] Ariji Y, Nakayama M, Nishiyama W, Ogi N, Sakuma S, Katsumata A, et al. Can sonographic features be efficacy predictors of robotic massage treatment for masseter and temporal muscle in patients with temporomandibular disorder with myofascial pain? CRANIO®. 2016; 34: 13–19.

[48] Jabr L, Altuhafy M, Barmak AB, Rossouw PE, Michelogiannakis D. Sugar-free chewing gum versus conventional analgesic drugs for pain relief with fixed orthodontic appliances. A systematic review and meta-analysis. Journal of Orthodontics. 2023; 50: 215–228.