Prevalence of Temporomandibular Disorders in Military, Police, and Firefighter Personnel: A Systematic Review and Meta-Analysis.

INTRODUCTION: Military, police, and firefighter personnel routinely face extreme physical and psychological stress, potentially increasing their vulnerability to Temporomandibular Disorders (TMD). While emerging evidence suggests elevated TMD rates in these professions, the collective burden across these services has remained poorly understood, hindering targeted occupational health initiatives. This systematic review and meta-analysis is the first to synthesize global evidence on TMD prevalence in these high-stress uniformed professions. Our primary objectives were to establish a pooled prevalence estimate and investigate sources of heterogeneity to better address this significant occupational health issue.

MATERIALS AND METHODS: Adhering to PRISMA/MOOSE guidelines and a registered protocol (PROSPERO: CRD420251025070), we systematically searched databases through April 2025 for observational studies reporting TMD prevalence in adult military, police, or firefighter personnel. Eligible studies were required to use standardized clinical diagnostic criteria (e.g., DC/TMD) or validated symptom questionnaires (e.g., Fonseca Anamnestic Index). Two reviewers independently assessed full-text articles for eligibility and appraised the methodological quality of included studies using the Joanna Briggs Institute (JBI) checklist. A random-effects meta-analysis was performed using R software to derive the pooled prevalence with 95% confidence intervals (CIs). Subgroup analyses were employed to explore sources of heterogeneity.

RESULTS: The search yielded 14 unique studies for inclusion, encompassing a total of 4,011 individuals. Our random-effects model revealed that the estimated prevalence of TMD across these professions ranges widely, from 37.8% to 55.1% (95% Confidence Interval), with a pooled point estimate of 46.4%. This wide interval is reflective of substantial between-study heterogeneity (I2 = 92.5%; P < 0.0001). Subgroup analyses identified the diagnostic tool used (P = 0.0076) and the continent of study origin (P < 0.0001) as statistically significant sources of this variability. Significant differences were noted by continent, with South American studies reporting the highest rates. No significant difference in TMD prevalence was observed among military, police, and firefighter subgroups (P = 0.3772).

CONCLUSIONS: The evidence indicates a substantial health burden from TMD among military, police, and firefighter personnel, establishing it as a significant occupational health concern with nearly one in two individuals potentially affected. Although the considerable heterogeneity across studies underscores the influence of methodological and geographical factors, the overall finding of a widespread problem is robust and contextually plausible given the high-stress nature of these professions. These findings should prompt increased clinical vigilance and inform the development of targeted screening and management strategies to safeguard the well-being and operational readiness of these vital public service populations.