Mouth and Dental problems
- a) Embouchure collapse and Satchmo’s syndrome
The term embouchure collapse is used to describe a group of conditions that lead to dysfunction of the embouchure (the purposeful arrangement of facial muscles needed to make a sound on a brass or wind instrument.)
- i) Focal dystonia
Although not the commonest cause of embouchure collapse, focal dystonia affecting the mouth has no definitive treatment, and often terminates careers. It can present with very subtle symptoms, with difficulty playing high or loud passages, or even being unable to play at all.
- ii) Embouchure overuse syndrome
This is common in brass players, and often starts with swelling of the lips after a prolonged period of playing. If appropriate rest is not undertaken and the player persists in performing or practising, embouchure collapse can result. This condition can be avoided with adequate rest periods and with appropriate warming up before playing.
- iii) Mouthpiece pressure
Trumpet and horn players in particular play instruments with small mouthpieces, leading to an increase in the pressure involved in playing the instrument. Good playing technique can help to alleviate this.
- iv) Satchmo’s syndrome
This is rupture of the orbicularis oris muscle, occurs particularly in trumpeters, and is named after Louis Armstrong who suffered from the condition, and whose nickname was ‘Satchmo.’ It can be treated by surgical repair.
- b) Dental problems
Musicians develop their oral musculature in unusual and specific ways, by exerting prolonged and repeated pressure on their teeth and TMJs. Any change in the teeth, for example due to trauma or orthodontic treatment, can have a large effect on a brass or woodwind player’s performance. A survey of 158 musicians 28 showed that 26% had discomfort relating to dental, joint or muscle problems associated with the head, neck or teeth, 28% had problems related to orthodontic conditions or tooth movement, 22% had TMJ dysfunction, and 6% had bruxism. Tooth loss can also cause problems with a player’s performance.
Treatment to improve the bite, chin rests for upper string players and customised mouthpieces and lip shields have all been shown to be helpful.
It is important for musicians to make their dentist aware of the instrument that they play and of any dental problems that they are having, and it is worth wind players considering asking their dentist to make a model of their bite so that in the event of tooth loss or damage, the bite and thus the sound that they make can be preserved.
- c) TMJ dysfunction
Dysfunction of the TMJ is common in upper string (violin and viola) players and is increasingly being recognised in woodwind players. This is due to the position in which the instrument is held between the shoulder and the jaw.