Influence of tooth position on wind instrumentalists' performance and embouchure comfort : A systematic review

DMF scores in patients with diabetes mellitus: A systematic review and meta-analysis of observational studies

OBJECTIVE

The aim of this systematic review(SR) is to comprehensively and critically summarise and synthesise the available scientific evidence from observational studies that use the decayed-missed-filled(DMF) index to determine caries experiences among adult patients with diabetes mellitus  (DM) as compared to individuals without DM(non-DM).

DATA

Indices that present examinations of decayed-filled-surfaces(DFS), decayed-missed-filled-surfaces(DMFS), and decayed-missed-filled-teeth(DMFT) established from observational studies were considered.

SOURCES

MEDLINE-PubMed and Cochrane Central databases were searched through 1 February 2023 to identify studies that evaluate DMF indices for adult patients with DM compared to non-DM. The reference lists of the selected studies were reviewed to identify additional potentially relevant studies.

STUDY SELECTION

All studies were independently screened by two reviewers. Included papers were critically appraised using pre-designed forms, and the risk of bias was assessed. Data as means and standard deviations were extracted. A descriptive data presentation was used for all studies. If quantitative methods were feasible, then a meta-analysis was performed. It was decided 'a priori' to perform a sub-analysis on type of DM(I or II). The quality of the studies was assessed.

RESULTS

Initially 932 studies were found, and screening resulted in 13 eligible observational studies. The total number of subjects included in this SR is 21,220. A descriptive analysis of the comparisons demonstrated that eight studies provided data and demonstrated higher DFS (1/2), DMFS (2/3) and DMFT (5/8). This was confirmed by the meta-analysis difference of means(DiffM), which was 3.01([95%CI:1.47,4.54],p=0.0001) for DMFT and 10.30([95% CI:8.50,12.11],p<0.00001) for DMFS. Subgroup analysis showed that this difference is irrespective to the type of DM(DiffM=3.09;[95%CI:2.09,4.09],p<0.00001).

CONCLUSION

There is moderate certainty for a higher DMF index score in DM patients as compared to those without DM disease.

CLINICAL SIGNIFICANCE

This SR indicates a higher DMF index in DM patients. Oral disease prevention should be the focus of the dental care practitioner in this patient category.

A case series of wind instrument players with cleft lip and/or palate

It might be more difficult for patients with cleft lip and/or palate (CL/P) to generate sufficient muscle tension of the upper lip and intraoral air pressure to play a wind instrument. We aimed to explore and describe the key aspects of wind instrument playing with a repaired cleft. An in-depth interview was conducted among ten patients with CL/P and one with a functionally comparable problem and we found that: individuals with CL/P can achieve a professional level on a wind instrument; the oboe and trumpet may be less suitable for patients with CL/P because of the high lip muscle tension and intraoral air pressure that must be generated; air leakage through a fistula, unrepaired alveolus or velopharyngeal insufficiency can be troublesome; and for people with CL/P, a brass instrument with a large mouthpiece is easier than a small mouthpiece. While dentists, doctors and music teachers should discuss the probability that wind instrument playing might be more difficult for patients with CL/P, they should not discourage it.

Case Report: Dental treatment for an oboist: Post-trauma prosthetic rehabilitation and evaluation of musical performance

Introduction

The condition of teeth and function of the oral organs are important when playing wind or brass instruments. Although there are some reports on dental treatment for musicians, few studies have investigated their acoustic performance following treatment. This report describes the prosthodontic rehabilitation provided for an oboist who had lost a tooth as a result of trauma and includes an evaluation of her subsequent musical performance using acoustic analyzes.

Case description

The patient was a 63-year-old professional oboe player who fractured the upper and lower alveolar bone and avulsed the upper right central incisor during a fall due to epileptic seizure. While the alveolar fracture was healing, she sought maxillofacial rehabilitation for the missing tooth to maintain her ability to play the oboe. Her rehabilitation consisted of a provisional removable prosthesis with an acrylic base and clasps followed by a fixed implant prosthesis. A recording of her musical performance was objectively analyzed at each stage of treatment. Rhythm analysis confirmed the stability of notes played rapidly. Her performance dynamics were analyzed by psychoacoustic measurements. Her satisfaction with the prosthesis was assessed by a self-reported questionnaire. The results of the acoustic evaluation helped to adjust the provisional prosthesis so that it was suitable for playing the oboe and the final prosthesis was designed accordingly.

Conclusion

Prosthetic dental treatment for this patient included both subjective and objective evaluations that helped to ensure that she could continue playing the oboe at her previous performance level.

Is orthognathic surgery indicated for wind instrument players? A multiple case study

Introduction For the ambitious wind instrument player with severe malocclusion, the decision to undergo orthognathic surgery can be difficult.Aim To qualitatively explore and reveal key aspects of considerations for and outcomes of orthognathic surgery by interviewing a group of advanced and professional wind instrumentalists.Materials and methods One investigator, using a standardised questionnaire, interviewed seven cases. The interviews were analysed by two investigators who are knowledgeable about embouchure.Outcomes An ideal jaw relationship is not a prerequisite to achieving a professional career in music. Complete embouchure loss after surgery can be experienced due to changes in the position of incisors, lip relationship and tongue position relative to the shape of the oral cavity and as a result of neurosensory changes. Neurosensory recovery and 'wind instrument rehabilitation' takes at least six months, which was achieved in three out of five cases. The following temporary or permanent difficulties during playing after surgery were reported: onset of notes, high notes, leaps and intervals, and stable and well-tuned sound.Conclusion In view of the risks involved, orthognathic surgery in wind instrumentalists should only be considered when there is an (oral) health indication.

Case Report: Psychoacoustic Analysis of a Clarinet Performance With a Custom-Made Soft Lip Shield Worn to Prevent Mucosal Erosion of Lower Lip

Introduction

Wind instrument players sometimes suffer from erosion of the mucous membrane of the lip. This is caused by the action and pressure of the mouthpiece of the wind instrument against teeth. To address this problem, a lip shield is fitted over the dental arch to prevent direct contact between the lips and teeth. However, there are a few studies on the influence of the lip shield on the acoustics of wind instruments. The purpose of this study was to analyze the psychoacoustics of a clarinet performance with the player wearing a custom-made soft lip shield to prevent mucosal erosion of the lower lip.

Case Description

A lip shield was custom-made with a soft thermoplastic material for a female clarinetist who complained of mucosal erosion and pain of the lower lip. The psychoacoustics of her musical performance played in different dynamics, fortissimo, mezzo forte and pianissimo were analyzed, including loudness and sharpness. A self-evaluation questionnaire with items rated on a 10-point scale was administered. After wearing the lip shield, the patient reported that the mucosal erosion and pain of her lower lip when playing clarinet resolved. The lip shield had little effect on the loudness. There was a slight decrease in sharpness when the lip shield was worn compared to when it was not, describing the reduction of high frequencies. Furthermore, fewer variations in sharpness between the tones were observed.

Conclusion

The results suggest that lip shields made of soft materials can eliminate mucosal erosion and pain of the lower lip while having little effect on performance, although, a slight change in timbre is possible.

Tooth Position in Wind Instrument Players: Dentofacial Cephalometric Analysis

Background: Specific dentofacial characteristics in wind instrumentalists should be taken in consideration when analyzing physiological and anatomical issues regarding the musician’s embouchure, posture, and biomechanics during musical performance. Objectives: To compare tooth cephalometric characteristics between wind instrument players and string players (overjet, overbite, lower facial height, facial convexity, lower incisor inclination, and interincisal angle). Methods: In total, 48 wind instrumentalists (67%) and 24 string instrumentalists (33%). These musicians performed lateral tele-radiography and the correspondent linear and angular measurements of the dentofacial cephalometric analysis. Statistical comparison of wind and string instrumentalists was made by using an independent t-test. Results: Small variations on the analyzed parameters were found between the wind and string instrument groups. Based on the cephalometric analysis the variable interincisal angle was statistically significant (p < 0.05), when comparing the wind and string instrument group. Conclusions: Knowledge of the overjet and overbite value permits a substantial analysis on the tooth position of wind instrument players, where both of these parameters are increased and greater than the norm value. The cephalometry was an added value on the interpretation of possible factors that lead to the position of the central incisors of wind instruments. Till some extent in this group of musicians the applied forces during the embouchure mechanism on the anterior teeth and the existing perioral forces promote an equilibrium on the vector of forces. This study findings demonstrate that when evaluating the two samples, wind and string instruments there are different dentofacial configurations, however the only statistically significant differences that were found are related to the interincisal angle (p < 0.05).

The effect of playing a wind instrument or singing on risk of sleep apnea: a systematic review and meta-analysis

STUDY OBJECTIVES

To systematically survey the scientific literature concerning the effect of playing a wind instrument or singing on sleep, snoring, and/or obstructive sleep apnea.

METHODS

The PubMed, EMBASE, and Cochrane databases were searched up to December 2019. Observational studies and (Randomized) Controlled Clinical Trials that assessed sleep, snoring, or obstructive sleep apnea as clinical outcome or via a questionnaire were included. For the individual studies, the potential risk of bias was scored. Data between oral musicians and control participants were extracted. Descriptive analysis and meta-analysis were performed.

RESULTS

Six eligible studies (5 cross-sectional, 1 randomized controlled trial) were retrieved, with an estimated potential bias ranking from low to high. The sample sizes ranged from 25 to 1,105 participants. Descriptive analysis indicated that players of a double-reed instrument have a lower risk of obstructive sleep apnea and that singers snore less compared with control participants. Playing a didgeridoo showed a positive effect on apnea-hypopnea index, daytime sleepiness, and partner's rating for sleep disturbance. The descriptive analysis could not be substantiated in the meta-analysis. The magnitude of the effect was zero to small, and the generalizability was limited because of long (professional) rehearsal time or small sample size.

CONCLUSIONS

Playing a wind instrument and singing may have a small but positive effect on sleep disorders. Considering the practicality and investment of (rehearsal) time, didgeridoo and singing are the most promising interventions to reduce obstructive sleep apnea and snoring, respectively. However, the results of this review are based on few studies and the synthesis of the evidence is graded to have low certainty.

Does playing a wind instrument influence tooth position and facial morphology? : Systematic review and meta-analysis

PURPOSE

To systematically search the scientific literature concerning the influence of playing a wind instrument on tooth position and/or facial morphology.

METHODS

The PubMed, EMBASE and Cochrane databases were searched up to September 2019. Orthodontic journals were hand searched and grey literature was sought via Google Scholar. Observational studies and (randomized) controlled clinical trials that assessed tooth position and/or facial morphology by profile cephalograms, dental casts or clinical examination were included. The potential risk of bias was assessed. Data from wind instrument players and controls were extracted. Descriptive analysis and meta-analysis were performed.

RESULTS

In total, 10 eligible studies with a cross-sectional (n = 7) or longitudinal design (n = 3) and an estimated low to serious risk of bias were included. Sample sizes ranged from 36 to 170 participants, varying from children to professional musicians. Descriptive analysis indicated that adults playing a single-reed instrument may have a larger overjet than controls. Playing a brass instrument might be associated with an increase in maxillary and mandibular intermolar width among children. Longitudinal data showed less increase in anterior facial height among brass and single-reed players between the age of 6 and 15. Children playing a wind instrument showed thicker lips than controls. Meta-analysis revealed that after a follow-up of 6 months to 3 years, children playing brass instruments had a significant reduction in overjet as compared to controls. The magnitude of the effect was of questionable clinical relevance and the generalizability was limited.

CONCLUSIONS

Playing a wind instrument can influence tooth position and facial morphology in both children and adults. Aspects that stand out are overjet, arch width, facial divergence/convergence and lip thickness. However, evidence was sparse and the strength of the premise emerging from this review was graded to be "very low".

Craniofacial morphology of wind and string instrument players: a cephalometric study

Background

Playing an instrument may promote a parafunctional behavior within the cranio-cervical-mandibular-complex with unknown repercussions. The aim of this study was to find any association between the dental inter-arch relationship and the practice of a wind or string instrument.

Methods

A sample of 77 musicians, divided in two groups of wind (n = 50) and string instrumentalists (n = 27), had a lateral cephalogram taken to compare six cephalometric parameters following the Rickett’s analysis (maxilla position, mandible position, facial type, skeletal class, upper incisor and lower incisor inclination). The Fisher test was performed to compare, with a 95% statistical confidence, if both groups have similar frequency distributions for each cephalometric parameter.

Results

No statistical differences were found for the maxilla position, mandible position, facial type, skeletal class and upper incisor inclination. Statistical differences were found for the lower incisor inclination (p = 0.011).

Conclusions

Playing a wind instrument showed to have little orthopaedic influence at the craniofacial morphology, on contrary it may influence the lower incisor inclination with its osseous base.

Integrating piezoresistive sensors on the embouchure analysis of the lower lip in single reed instrumentalists: implementation of the lip pressure appliance (LPA)

Background

It is essential to understand, characterize, and measure the embouchure mechanism of a wind instrumentalists, where the applied forces on the perioral tissues can usually promote discomfort or pain.

Methods

The sample consisted of five clarinet players and five saxophone players. The embouchure force measurements at the lower lip area were assessed using a piezoresistive sensor (FlexiForceTM, Tekscan, Boston, USA, 0.07 kgf/cm2) placed on the lower part of the mouthpiece of the single reed instrument. Furthermore, each participant performed three times three different notes at different pitches: high, medium, and low. An intraoral device was manufactured in order to dissipate the existing pressures.

Results

The piezoresistive sensors applied to the mouthpiece of the five clarinetists presented values between 16 and 226 g of force. In the case of the five saxophonists, the values registered were between 5 and 320 g of force.

Conclusions

Piezoresistive sensors are a valid option to characterize that single reed instrumentalists apply substantial forces at the lower lip that can be equivalent to medium orthodontic forces. The implementation of the Lip Pressure Appliance can be a valid solution on the prevention of eventual lesions resulting from the embouchure forces.

Wind Instrumentalist Embouchure and the Applied Forces on the Perioral Structures

Introduction:

The wind instrumentalist embouchure is probably one of the most demanding tasks that occurs during their musical performance. It is important to quantify the forces that are applied during the wind instrumentalist embouchure on the perioral structures.

Objective:

Quantify the force on the perioral structures involved during the embouchure mechanism of wind instrumentalists.

Methods:

Piezoresistive sensors of FlexiForceTMwere placed on the mouthpiece of 28 different wind instrumentalists, in order to obtain the applied forces transmitted to the upper lip or the lower lip. The application of the sensors were done according to the particular characteristics of the different types of wind instruments, single reed, double reed or metal. Each participant performed three times three different notes at different pitches: high, medium and low. The average medium and maximum pressure was obtained from the nine essays. The sensors were connected to a data acquisition board from National Instruments and the results displayed in LabVIEW 2011.

Results:

Measurement values were obtained for the different groups of wind instruments. In an ascending order, the pressures registered where for the bassoon (6g-31g), the oboe (17g-125g), the saxophone (39g-120g), the clarinet (54g-106g), the trumpet, (63g-172g), the bisel flute (73g-245g), the French horn (56g-305g), the transversal flute (220g-305g) and the trombone (201g-325g).

Conclusion:

Metal instrumentalists seem to apply greater forces than woodwind musicians when performing the embouchure mechanism, being in this specific case the trombone the instrument from the metal group to exert more force, while on the contrary, the bassoon registered the lower values.

Improvement of embouchure after correction of irregular front teeth: the case of a professional French horn player

A professional horn player visited his dentist after experiencing pain. His protruding lower incisor was causing soreness of the lower lip, and upper anterior crowding was irritating the centre of the upper lip. These irregularities affected the patient's ability to produce an optimal sound. During treatment, the lower anterior teeth were aligned using a fixed appliance and the irregularity in the upper front teeth was reduced with a composite veneer. The hornist experienced considerable improvements after these two dental corrections.