Care and embouchure problems: the malocclusion

ISSN: 2254-8521


Care and embouchure problems: the malocclusion


A dental problem affects more musicians of wind instruments than we think. If you like the articles from our odontology specialist for musicians, you’re going to love this one.

Alexandre de Alcântara

A dental surgeon with over 20 years of experience and attends to the specific needs of musicians that play wind instruments. He is certified through the Brazilian Musicians Order and was responsible for a proposal (717/2012) that was approved by the Federal Council of Odontology, by unanimous vote, that recognized musicians of wind instruments as patients that needed specialized treatment. He is also a columnist for the Portal Educação, and author of various articles on websites and magazines dealing with the special needs of musicians and music.

Many wind instrumentalists might say that their dental arch plays an important role in respect to their sound production (and, in many cases, I would say they are correct in their assumption). So, why are we talking about teeth? It’s because whether or not that plays a role, the teeth play an influential part that affects many different aspects of playing, especially the aspects of articulation, flexibility and the sound emission itself, among others.

Imagine that, after many years, you have formed the perfect embouchure — you have practiced, studied, and you don’t have any issues with sound production. One day, you suffer a fall in the street full of potholes and you, unfortunately, break one or several of your upper teeth (part of the famously named “palette”). What would happen afterwards? Surely, you would look for a dentist to immediately fix your teeth, any way possible, right? So, would you say that the teeth have a secondary role? No, you wouldn’t. At that moment, they form a priority for you. Without your teeth, you would not be capable of playing throughout the range of your instrument perfectly; without your teeth, you would lose your embouchure or your embouchure would be profoundly altered, and it is even more possible that other problems would arise that may not even occur to you right now.

The purpose of this article is to remind you, the wind instrumentalist, that the maintenance of your teeth — and I am not just referring to oral hygiene — is an integral part of your musical day to day life. And because of this, you should not, at any point, neglect them.

Try to have a biannual check of your teeth, maintain proper oral hygiene, and ask your trusted dentist to take molds of your dental arch. Keep them at home for an emergency or for preventive purposes (in case of suffering an accident). Because without a mold, it is very difficult for a dental surgeon to reconstruct your dentures as anatomically correct as possible to their former position and/or correcting them for an improved musical functional.

There are other issues that we could address in this article that may not seem so obvious, but we will discuss them at another time. What we will talk about here is a problem that affects more musicians than you might think: the malocclusion.

What is a dental malocclusion?

The malocclusion is a maxillomandibular deformity — a deformity by which one jaw is greatly receded with respect to the other. Therefore, this deficiency prevents the upper and lower teeth from coming into together or lining up properly.

Studies [1] have shown that an individual with maxillomandibular disproportion has, throughout their entire life, made changes to the position of their jaw in the way of eating, drinking, breathing and speaking. For this person, the only possible way to perform these daily functions is the only the way they know how, through these adaptations. It's the only way with which they actually feel comfortable and capable.

In addition to the obvious aesthetic alterations to the face of this person, the malocclusion causes serious functional problems such as lack of contact of the upper and lower teeth, a modification of the anatomical space of the oral cavity, and poor position of the tongue — producing changes in the voice and pronunciation. It will also alter breathing and even contribute to snoring or sleep apnea.

This malocclusion is the result of a deficiency in the development of the jaw. With the lips open, the upper lip are too thin due to the pressure of the mouthpiece, compensating for the lower jaw position and the musician uses more pressure to compensate, while the lower lip ends up occupying the space where the teeth do not meet due to the receded lower jaw. The lips simply do not close completely.

As for speech, there are distortions of sibilant or fricative phonemes, which are accompanied by excessive mandibular (jaw) slippage. The person will articulate with the projected tongue between the teeth, instead of remaining in contact with the alveolar ridge region of the lower incisors, which is frequently associated with swallowing. That is, the interior position of the tongue [2] [3].

The embouchure of a musician with malocclusion

The difficulty of playing an instrument with a mouthpiece, in the case of malocclusion, is not so much the mouthpiece itself, but in how little the upper lip vibrates.

When preparing to blow/buzz through a mouthpiece, the mouth needs to open slightly.  As the air enters the mouthpiece (generally of a larger size than the aperture), the mouthpiece position is tilted downwards slightly (or may be straight) and the musician can play without too much trouble. But when the mouthpiece is much larger (for example, that of a tuba), then the space between the teeth makes it difficult to play in the lower range due to the position of the tongue and the need to push the jaw forward, forcing the embouchure muscles to move the jaw towards the mouthpiece.

An analysis of the movement of the lips during vibration (a video realized with a digital microscope in dental offices of Dr. Alcântara).

There are vibrations, but this is usually aided by the cheek muscle (the buccinator muscle). That is to say, the musician is forced to complement the vibration with the muscle of the cheeks in order to reach certain notes, and to vary the position of the instrument for better comfort.

We must remember that the image here is a simple illustration. The musician will adapt to different situations in order to be able to play, and there are also different degrees of malocclusion, where some patients will have little and other patients will have enough horizontal space between the upper and lower teeth (called an overjet).

The most appropriate treatment for the most serious cases is surgery, accompanied by orthodontics. Although, in our dental office in São Paulo (Brazil), we are currently testing an acrylic device that fills this space, helping the musician to support the mouthpiece without having the need for surgery.

Notes and references:

  1. Kasai RCB, Portella MQ. Intervenção fonoaudiológica em pacientes submetidos ao tratamento ortodôntico-cirúrgico. Rev Dent Press Ortodon Ortopedi Maxilar. 2001;6(2):79-84. [SUBIR]
  2. Felício CM. Fonoaudiologia nas desordens temporomandibulares: uma ação educativa-terapêutica. São Paulo: Pancast; 1994. [SUBIR]
  3. Silverman ET. Reabilitação da fala, hábitos e terapia miofuncional nos processos restauradores. In: Seide LJ. Método dinâmico para a odontologia restauradora. São Paulo: Panamericana; 1984. p. 650-715. [SUBIR]