{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:49:52Z","timestamp":1785761392313,"version":"3.56.0"},"reference-count":50,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dent. J.","Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: Professional motorsport imposes substantial biomechanical, postural, and cognitive demands that require continuous neuromuscular adaptations to ensure vehicle control and head stabilization during competition. Although the cranio-cervico-mandibular system may contribute to these adaptive responses, its role in rally performance remains poorly understood. This study aimed to investigate neuromuscular adaptations of the cranio-cervico-mandibular system in professional rally drivers under real-world racing conditions and to explore the relationship between masticatory muscle activity, cervical involvement, and jaw-clenching behavior. Methods: Twenty professional drivers and co-drivers participating in the 110th Targa Florio Rally were enrolled in the study. All participants underwent static surface electromyography (sEMG) assessment using the Teethan\u00ae system to evaluate the masseter, anterior temporalis, and sternocleidomastoid muscles. During competition, dynamic masseter muscle activity was monitored using the dia-BRUXO\u00ae system. Neuromuscular balance parameters, cervical involvement, masseter muscle activity, and clenching and grinding episodes were analyzed. Results: Participants showed a generally preserved baseline stomatognathic neuromuscular balance, with greater inter-individual variability in cervical involvement. During competition, clenching episodes were significantly more frequent than grinding episodes (p &lt; 0.001). A moderate positive correlation was observed between Cervical Load and the number of clenching episodes (rho = 0.570, p = 0.011). No significant correlations were found between stomatognathic functional indices and dynamic bruxism-related parameters. Conclusions: Professional rally drivers exhibited increased masticatory muscle activity during competition, predominantly characterized by jaw clenching. The association observed between Cervical Load and clenching episodes suggests a statistical concomitance between cervical and masticatory muscle recruitment, which reaches high levels in these elite athletes but requires further longitudinal research to confirm a directional functional interaction in cranio-cervical stabilization during high-demand driving tasks.<\/jats:p>","DOI":"10.3390\/dj14080474","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:50:21Z","timestamp":1785757821000},"page":"474","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neuromuscular Responses of the Cranio-Cervico-Mandibular System During Professional \u201c110th Targa Florio\u201d Rally Competitions: An Electromyographic Study in Real-World Racing Conditions"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0221-7020","authenticated-orcid":false,"given":"Davide Alessio","family":"Fontana","sequence":"first","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (e.PMre.C.C), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2854-7144","authenticated-orcid":false,"given":"Salvatore","family":"Nigliaccio","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (e.PMre.C.C), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6999-6493","authenticated-orcid":false,"given":"Emanuele","family":"Di Vita","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (e.PMre.C.C), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Scardina","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (e.PMre.C.C), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Cutino","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (e.PMre.C.C), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Geraci","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (e.PMre.C.C), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Pusateri","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (e.PMre.C.C), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3420-8128","authenticated-orcid":false,"given":"Enzo","family":"Cumbo","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (e.PMre.C.C), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Messina","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (e.PMre.C.C), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7305-530X","authenticated-orcid":false,"given":"Giuseppe Alessandro","family":"Scardina","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (e.PMre.C.C), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"638659","DOI":"10.1155\/2015\/638659","article-title":"Physiological and Selective Attention Demands during an International Rally Motor Sport Event","volume":"2015","author":"Turner","year":"2015","journal-title":"BioMed Res. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2548","DOI":"10.1249\/MSS.0000000000002070","article-title":"The Physiology of Auto Racing","volume":"51","author":"Reid","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"00368504231223034","DOI":"10.1177\/00368504231223034","article-title":"Heart Rate Variability, Recovery and Stress Analysis of an Elite Rally Driver and Co-Driver during a Competition Period","volume":"107","author":"Petri","year":"2024","journal-title":"Sci. Prog."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1080\/02640414.2023.2259213","article-title":"Prompted Hands-Free Drinking Improves Simulated Race Car Driving in a Hot Environment","volume":"41","author":"Ferguson","year":"2023","journal-title":"J. Sports Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"61","DOI":"10.11607\/jop.915","article-title":"Neuromuscular Interaction of Jaw and Neck Muscles During Jaw Clenching","volume":"27","author":"Giannakopoulos","year":"2013","journal-title":"J. Orofac. Pain"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1046\/j.1365-2842.1998.00333.x","article-title":"Concomitant Mandibular and Head-neck Movements during Jaw Opening\u2013Closing in Man","volume":"25","author":"Eriksson","year":"1998","journal-title":"J. Oral Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1111\/j.1365-2842.2006.01664.x","article-title":"Electromyographic Activity of the Masticatory and Cervical Muscles during Resisted Jaw Opening Movement","volume":"34","author":"Magee","year":"2007","journal-title":"J. Oral Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s007840050045","article-title":"Correlation between Cervical Spine and Temporomandibular Disorders","volume":"2","author":"Meuleman","year":"1998","journal-title":"Clin. Oral Investig."},{"key":"ref_9","first-page":"9","article-title":"The Association between Head and Cervical Posture and Temporomandibular Disorders: A Systematic Review","volume":"20","author":"Olivo","year":"2006","journal-title":"J. Orofac. Pain"},{"key":"ref_10","first-page":"e4","article-title":"Cervical Musculoskeletal Impairments and Temporomandibular Disorders","volume":"3","author":"Magee","year":"2012","journal-title":"J. Oral Maxillofac. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jbmt.2020.05.001","article-title":"Cervical Musculoskeletal Disorders in Patients with Temporomandibular Dysfunction: A Systematic Review and Meta-Analysis","volume":"24","author":"Ferro","year":"2020","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2880","DOI":"10.21037\/apm-20-1850","article-title":"Head and Neck Posture Influences Masticatory Muscle Electromyographic Amplitude in Healthy Subjects and Patients with Temporomandibular Disorder: A Preliminary Study","volume":"10","author":"Xu","year":"2021","journal-title":"Ann. Palliat. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/joor.12932","article-title":"Coherence of Jaw and Neck Muscle Activity during Sleep Bruxism","volume":"47","author":"Gouw","year":"2020","journal-title":"J. Oral Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s40279-013-0040-2","article-title":"The Case for Driver Science in Motorsport: A Review and Recommendations","volume":"43","author":"Potkanowicz","year":"2013","journal-title":"Sports Med."},{"key":"ref_15","first-page":"392","article-title":"Use of Mouth Guard in Basketball: Observational Study of a Group of Teenagers with and without Motivational Reinforcement","volume":"15","author":"Spinas","year":"2014","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Lopponi, G., Verdecchia, A., Sicca, N., Benedetti, G., Alsafadi, A., Cobo, T., and Spinas, E. (2026). Temporomandibular Joint Changes Assessed by CBCT or MRI Following Functional Appliance Therapy in Skeletal Class II Patients: A Systematic Review. Children, 13.","DOI":"10.3390\/children13050674"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Zieli\u0144ski, G., and Gawda, P. (2024). Surface Electromyography in Dentistry\u2014Past, Present and Future. J. Clin. Med., 13.","DOI":"10.3390\/jcm13051328"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Szyszka-Sommerfeld, L., Syci\u0144ska-Dziarnowska, M., Spagnuolo, G., and Wo\u017aniak, K. (2023). Surface Electromyography in the Assessment of Masticatory Muscle Activity in Patients with Pain-Related Temporomandibular Disorders: A Systematic Review. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1184036"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"763","DOI":"10.14219\/jada.archive.2006.0288","article-title":"The Clinical Usefulness of Surface Electromyography in the Diagnosis and Treatment of Temporomandibular Disorders","volume":"137","author":"Klasser","year":"2006","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_20","first-page":"81","article-title":"Surface Electromyography of the Masticatory Muscles for Application in Dental Practice. Current Evidence and Future Developments","volume":"11","author":"Hugger","year":"2008","journal-title":"Int. J. Comput. Dent."},{"key":"ref_21","first-page":"37","article-title":"Surface EMG of the Masticatory Muscles (Part 2): Fatigue Testing, Mastication Analysis and Influence of Different Factors","volume":"16","author":"Hugger","year":"2013","journal-title":"Int. J. Comput. Dent."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"419","DOI":"10.4103\/1305-7456.184156","article-title":"Uses of Electromyography in Dentistry: An Overview with Meta-Analysis","volume":"10","author":"Nishi","year":"2016","journal-title":"Eur. J. Dent."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jelekin.2016.08.004","article-title":"Normalizing Surface Electromyographic Measures of the Masticatory Muscles: Comparison of Two Different Methods for Clinical Purpose","volume":"30","author":"Mapelli","year":"2016","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_24","first-page":"9750915","article-title":"Electromyography as a Means of Assessing Masticatory Muscle Activity in Patients with Pain-Related Temporomandibular Disorders","volume":"2020","author":"Machoy","year":"2020","journal-title":"Pain Res. Manag."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Szyszka-Sommerfeld, L., Machoy, M., Lipski, M., and Wo\u017aniak, K. (2019). The Diagnostic Value of Electromyography in Identifying Patients With Pain-Related Temporomandibular Disorders. Front. Neurol., 10.","DOI":"10.3389\/fneur.2019.00180"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1111\/joor.13139","article-title":"Is Jaw Muscle Activity Impaired in Adults with Persistent Temporomandibular Disorders? A Systematic Review and Meta-analysis","volume":"48","author":"Dinsdale","year":"2021","journal-title":"J. Oral Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Dorosz, T., Ma\u0144ko, A., and Ginszt, M. (2024). Use of Surface Electromyography to Evaluate Effects of Therapeutic Methods on Masticatory Muscle Activity in Patients with Temporomandibular Disorders: A Narrative Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13030920"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1177\/00220345930720110701","article-title":"Co-Activation of Sternocleidomastoid Muscles During Maximum Clenching","volume":"72","author":"Clark","year":"1993","journal-title":"J. Dent. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/joor.12011","article-title":"Bruxism Defined and Graded: An International Consensus","volume":"40","author":"Lobbezoo","year":"2013","journal-title":"J. Oral Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1111\/joor.12663","article-title":"International Consensus on the Assessment of Bruxism: Report of a Work in Progress","volume":"45","author":"Lobbezoo","year":"2018","journal-title":"J. Oral Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1111\/joor.13626","article-title":"Five Years after the 2018 Consensus Definitions of Sleep and Awake Bruxism: An Explanatory Note","volume":"51","author":"Manfredini","year":"2024","journal-title":"J. Oral Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1111\/joor.13985","article-title":"Updating the Bruxism Definitions: Report of an International Consensus Meeting","volume":"52","author":"Verhoeff","year":"2025","journal-title":"J. Oral Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bracci, A., Lobbezoo, F., H\u00e4ggman-Henrikson, B., Colonna, A., Nyk\u00e4nen, L., Pollis, M., Ahlberg, J., Manfredini, D., and International Network for Orofacial Pain and Related Disorders Methodology (INfORM) (2022). Current Knowledge and Future Perspectives on Awake Bruxism Assessment: Expert Consensus Recommendations. J. Clin. Med., 11.","DOI":"10.3390\/jcm11175083"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Zieli\u0144ski, G., Paj\u0105k, A., and W\u00f3jcicki, M. (2024). Global Prevalence of Sleep Bruxism and Awake Bruxism in Pediatric and Adult Populations: A Systematic Review and Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13144259"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Graham, D.A., L\u00f6vgren, A., H\u00e4ggman-Henrikson, B., Peck, C.C., Manfredini, D., and Saracutu, O.I. (2026). Management of Awake Bruxism: A Systematic Review. BMC Oral Health, 26.","DOI":"10.1186\/s12903-026-07856-z"},{"key":"ref_36","unstructured":"Lal, S.J., Sankari, A., and Weber, D.D.S. (2026). Bruxism Management. StatPearls, StatPearls Publishing."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1519\/JSC.0b013e3181875117","article-title":"Jaw Clenching Results in Concurrent Activation Potentiation during the Countermovement Jump","volume":"22","author":"Ebben","year":"2008","journal-title":"J. Strength Cond. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1177\/19417381211014836","article-title":"Effects of Clenching Strength on Exercise Performance: Verification Using Spinal Function Assessments","volume":"14","author":"Hirabayashi","year":"2022","journal-title":"Sports Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1519\/JSC.0000000000002172","article-title":"Effects of Jaw Clenching and Jaw Alignment Mouthpiece Use on Force Production During Vertical Jump and Isometric Clean Pull","volume":"32","author":"Allen","year":"2018","journal-title":"J. Strength Cond. Res."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Ringhof, S., Hellmann, D., Meier, F., Etz, E., Schindler, H.J., and Stein, T. (2015). The Effect of Oral Motor Activity on the Athletic Performance of Professional Golfers. Front. Psychol., 6.","DOI":"10.3389\/fpsyg.2015.00750"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Rizzato, A., Dalla Costa, V.G., Bozzato, M., Paoli, A., and Marcolin, G. (2024). Concurrent Activation Potentiation Improves Lower-Limb Maximal Strength but Not Dynamic Balance Control in Rugby Players. Front. Bioeng. Biotechnol., 11.","DOI":"10.3389\/fbioe.2023.1270322"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Gul, J.Z., Fatima, N., Mohy Ud Din, Z., Khan, M., Kim, W.Y., and Rehman, M.M. (2024). Advanced Sensing System for Sleep Bruxism across Multiple Postures via EMG and Machine Learning. Sensors, 24.","DOI":"10.3390\/s24165426"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Fontana, D.A., Nigliaccio, S., Pusateri, F., Di Vita, E., Messina, P., Cumbo, E., Scardina, A., Raia, E., and Scardina, G.A. (2026). Assessment of Awake and Sleep Bruxism in Fibromyalgia Patients with Temporomandibular Disorders. J. Clin. Med., 15.","DOI":"10.3390\/jcm15020460"},{"key":"ref_44","first-page":"13420","article-title":"Standardised Indexes Reduce the Variability of Masticatory Muscles Electromyographic Values","volume":"35","author":"Rosati","year":"2025","journal-title":"Eur. J. Transl. Myol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1111\/j.1365-2842.2009.01970.x","article-title":"Electromyographic Standardized Indices in Healthy Brazilian Young Adults and Data Reproducibility","volume":"36","author":"Sidequersky","year":"2009","journal-title":"J. Oral Rehabil."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1249\/MSS.0000000000002507","article-title":"Responses of Driver-Athletes to Repeated Driving Stints","volume":"53","author":"Potkanowicz","year":"2021","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Holland, J., Davis, M., and Ferguson, D. (2025). Physiological Responses of Race Car Drivers in Authentic and Simulated Motor-Racing. Front. Sports Act. Living, 7.","DOI":"10.3389\/fspor.2025.1498686"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1136\/bjsports-2025-110977","article-title":"Physiological and Health Demands of Formula 1 Motor Racing: A Comprehensive Review with Driver Performance Coach Insight","volume":"60","author":"Tyler","year":"2026","journal-title":"Br. J. Sports Med."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Storari, M., Zerman, N., Salis, B., and Spinas, E. (2023). Chronic Facial Pain in Fibromyalgia: May ElectroMagnetic Field Represent a Promising New Therapy? A Pilot Randomized-Controlled Study. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20010391"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Storari, M., Zerman, N., and Spinas, E. (2022). Local Administration of ElectroMagnetic Field as Add-On Therapy in the Treatment of Chronic Facial Pain: A Pilot Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19074123"}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/8\/474\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:09:31Z","timestamp":1785758971000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/8\/474"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":50,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["dj14080474"],"URL":"https:\/\/doi.org\/10.3390\/dj14080474","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]}}}