Background <p>Professional musicians are exposed to occupational stressors that may affect oral health. Data on oral health awareness, preventive behavior, and instrument-related complaints among professional musicians in Germany are limited. This study aimed to investigate oral health awareness, behaviors, risk perception, and orofacial pain among orchestra musicians in Germany and to identify differences between instrument groups (woodwind, brass, string, percussion, and other instruments).</p> Methods <p>An online questionnaire was sent in November 2025 to all 129 German professional orchestras. The questionnaire collected sociodemographic data, self-reported oral health, awareness of instrument-related oral health risks, professional dental care, dental care behaviors, and orofacial pain. Statistical analysis was performed by Kruskal-Wallis-tests with post-hoc Dunn’s-tests, and chi-square-tests. Multiple backward-regression models were performed for orofacial pain and awareness of instrument-related risks (<i>p</i> &lt; 0.05).</p> Results <p>494 musicians (52.8% male) were included. Most participants reported good or very good self-rated oral health (75.2%). Orofacial pain was reported by 37.1%, with significant differences between instrument groups, as string players reported pain more frequently than percussion and other instrumentalists (<i>p</i> = 0.006). Awareness of instrument-related oral health risks was high (74.2%) but varied across groups, while 79.0% felt poorly informed. 53.2% considered oral health important for professional performance. Annual dental visits and professional cleanings were reported by 44.7% and 39.1%, respectively. Preventive behaviors like toothbrushing and fluoride use were common, whereas the use of mouthguards differed by instrument, being higher among woodwind players than brass players (<i>p</i> = 0.002). Awareness of instrument-related risks was strongly associated with orofacial pain (OR = 5.41, 95%-CI:3.11–9.42) and ≥ 10 years of service (OR = 1.97, 95%-CI:1.20–3.25). Orofacial pain was associated with female gender (OR = 1.91, 95%-CI:1.28–2.86), poor self-rated oral health (OR = 2.60, 95%-CI:1.64–4.12), and awareness of instrument-related risks (OR = 6.20, 95%-CI:3.45–11.12), while musicians with ≥ 10 years of service had a lower risk (OR = 0.44, 95%-CI:0.27–0.71).</p> Conclusions <p>German professional orchestra musicians report good or very good self-rated oral health and high awareness of instrument-related oral health risks, while frequently experiencing orofacial pain and feeling insufficiently informed about instrument-related oral health risks. Structured, career-long education and targeted preventive interventions are needed to reduce orofacial pain and support musicians’ long-term performance.</p> Trial registration <p>ClinicalTrials.gov-NCT07008677, 28.05.2025.</p>