[Hora est. Malocclusion and playing a wind instrument]. / Serie: Hora est. De invloed van de tandstand en het bespelen van een blaasinstrument.

The interplay of all the muscles around the mouth when playing a wind instrument is called 'embouchure'. The teeth also play an important role, as they support the lips against which the mouthpiece is placed. Even a small dental procedure can have a major positive or negative impact on the performance of a wind instrumentalist. Severe malocclusions or craniofacial deformities (such as an oral cleft, large sagittal overbite, or severe crowding) should not discourage one from playing a wind instrument. Wind instrumentalists appear to be able to adapt to a sub-optimal condition, and even reach a (semi) professional level. While orthodontic treatment may offer improvement, it is difficult for a patient and the treating specialist to predict precisely what the effect will be on the playing ability. On the other hand, to estimate the effect of changing a tooth shape on musical performance, a mock-up can be made as a trial. Oral osteotomy poses a risk of nerve damage and change in sensibility of the lips, which can be disastrous for a wind instrumentalist.

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".

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

PURPOSE: To systematically search the scientific literature concerning the influence of tooth position on wind instrumentalists' performance and embouchure comfort. METHODS: The PubMed, Cochrane, and Embase databases were searched up to November 2017. The main orthodontic journals were searched for papers older than the inception date of PubMed. Grey literature was sought via Google Scholar. Eligible studies were critically appraised and analysed. RESULTS: The searches retrieved 54 papers. Only two met the inclusion criteria. Searching the orthodontic journals and Google Scholar resulted in two additional eligible studies. All four studies had a cross-sectional design. The sample sizes ranged from 20-100 participants, varying from children to professional musicians. Because of a large heterogeneity in outcome variables, no meta-analysis could be performed. Descriptive analysis shows that there are indications that tooth irregularities have a negative influence on embouchure comfort and performance of a wind instrument player. A large overjet may impede the embouchure of brass musicians and may have a negative influence on trumpet player performance. A wide jaw form seems more beneficial to trumpet player performance than a small jaw form. Furthermore, players of all types of wind instruments can experience embouchure difficulties from extreme spacing or an open bite. CONCLUSION: Tooth position can influence musical performance and embouchure comfort of wind instrumentalists. A Class I relationship without malocclusion seems appropriate for every type of wind instrument. The more extreme the malocclusion, the greater the interference with wind instrumentalists' performance and embouchure comfort. Evidence however is limited.

[Preventive dentistry 4. Prevention and treatment of dentine hypersensitivity]. / Preventieve tandheelkunde 4. Preventie en behandeling van dentine-overgevoeligheid.

Many people sometimes experience pain when they inhale breath across the cingula or when they consume, for example, cold drinks. The most important method of prevention is to ensure that the dentine does not become exposed. If the dentine is exposed, both chemical and mechanical damage to the surface of the tooth must be prevented. Optimal treatment should be minimally invasive and primarily consist of advising the patient to brush his or her teeth and/or rub the sensitive area with a toothpaste especially developed to ease the pain of hypersensitive teeth. As an additional support a mouth rinse can be used. If this approach provides insufficient relief, professional measures can be deployed. Here, too, the least invasive treatment approaches ought to be treatment of first choice before moving on to more invasive therapies.

[Preventive dentistry 3. Prevalence, aetiology and diagnosis of dentine (hyper)sensitivity]. / Preventieve tandheelkunde 3. Prevalentie, etiologie en diagnostiek van dentine-over­gevoelig­heid.

Many people sometimes experience pain when they inhale breath across the cingula, or sensitivity and/or pain when they eat ice cream, for example. In some cases, however, this can become seriously unpleasant. In those cases, one can speak of dentine hypersensitivity. In Europe, an average of 27% of the population suffers from this. Dentine hypersensitivity is characterised by a short, sharp pain reaction after a warm or cold sensation. The external sensation causes an accelerated or converse flow of fluid in the dentinal tubules that excites the extremities of the nerve cells, which results in the sensation pain. For the external sensation, it is necessary that the cingula are exposed and the dentinal tubules are open. Dentine hypersensitivity is diagnosed after other possibilities have been eliminated.