The effect on an individual’s anterior teeth of playing a wind instrument is unpredictable. Generally, on a group basis, overjets may be affected, but the playing of instruments does not seem to affect an overbite.
Relation of musical wind instruments to malocclusion
Allen Pang,
D D S , R o c k f o r d , III
E ig h t y - f o u r s e v e n th g r a d e r s o f b o th s e x e s , n o t u n d e r g o in g o r t h o d o n t ic tr e a t m e n t , p a r t ic ip a t e d in a
T h e v alu e o f ca listh e n ic s and sp ec ific m u scle e x e r c is e s to im prove m u sc le to n e is w ell d o cu m en ted . A th le te s h a v e lon g u sed th e se e x e r c ise s and ca listh e n ic s to strengthen s p e c ific m u sc les o f th e b od y and to co rrect m u scu lar w e a k n e sse s. It is rea so n a b le, th erefo re, to a ssu m e that ex e r c is e o f the m u sc les o f m a stica tio n can co rrect or im p ro v e certain m a lo cc lu sio n s and lack o f m u scle to n e.
d o u b l e - b lin d s t u d y t o d e te r m in e th e e ff e c t o n th e a n t e r io r te e th o f p la y in g a m u s ic a l w in d in s tr u m e n t . T h e in s t r u m e n t p la y e rs w e r e ju s t b e g in n in g t h e ir s tu d ie s .
S e v e n th
g ra d e rs
n o t p la y in g
a
w in d in s t r u m e n t s e rv e d as th e c o n tr o l g r o u p . Im p r e s s io n s a n d p la s t e r c a s ts w e r e m a d e o f e a c h m o u th
a t th e
b e g in n in g
and
c o n c lu s io n
o f th e
s tu d y . T h e p la s t e r c a s ts w e r e m a r k e d w it h th e s a m e n u m e r ic a l c o d e a s s ig n e d t o e a c h s tu d e n t. O v e r je t a n d o v e r b it e m e a s u r e m e n ts o f th e a n t e r io r te e th w e r e ta k e n f r o m
th e p la s te r c a s ts a n d r e c o r d e d .
F in d in g s in d ic a t e t h a t, o n an in d iv id u a l b a s is , th e e f f e c t o n t h e a n t e r io r te e th o f p la y in g a m u s ic a l w in d in s t r u m e n t is u n p r e d ic ta b le . O n ly o n a g r o u p b a s is c a n a c la s s o f m u s ic a l w in d in s tr u m e n ts b e th e o r iz e d t o h a v e a c e r ta in e ffe c t o n th e a n t e r io r t e e th . T h e p la y in g
o f a m u s ic a l w in d
in s t r u m e n t
s h o u ld n o t b e u s e d a s a s u b s t it u t e f o r o r t h o d o n tic tre a tm e n t.
Historical review
m u s ic a l
T h e im portan ce o f su ch regular, p rop erly dir e c ted e x e r c ise s in the p rev en tio n o f m a lo cclu sio n and their u se during th e co r r e c tiv e p erio d , p lus th e part th ey play during th e reten tio n per iod is attributed to th e w ork o f R o g e r s .1,2 H e b e lie v ed faulty fa cia l p o stu re and m uscular m al fu n ctio n to be am ong th e m o st im portant etiolo g ic factors in m a lo c c lu sio n s .3 B rek hu s, A rm stron g, and S im o n 4 sh o w e d th e effec t o f stim ulation o f th e m a stica to ry m u sc les in co n trolled ex p er im en ts with p h y sica l ed u ca tio n stu d en ts at the U n iv ers ity o f M in n eso ta . T h ey co n clu d ed that th e strength o f th e se m u sc le s , like th o se elsew h er e in th e b o d y , is d irectly pro portional to th e u se to w h ich th ey are put, up to a p h y sio lo g ic lim it. In 1906, R o g ers5 p ro p o sed co r r e c tiv e ex e r c is e s to o v e r c o m e “ faulty facial p o stu re and m alfu n ction o f facial m u s c le s .” T h e term m y o fu n ction al therapy w as later p ro p o sed by L isch JADA, Vol. 92, M arch 1976 ■ 565
er6 for th ese exercises. T he use o f m usical wind instrum ents to treat m alocclusions is a facet o f m yofunctional therapy. D ata on the relationship o f m usical wind in strum ents and m alocclusion are needed because the dentist and the m usic instructor, on many occa sio n s, are asked to advise w hether a certain m usical instrument is suitable for a particular mouth and w hether the instrument will affect the occlusion. T o date, nothing in the scientific lit erature serves as a basis for recom m endations. A ll conclusions have been based on logic rather than scientific evidence. It may be that the play ing o f a musical wind instrument can be used only as an interceptive orthodontic procedure.7 A t present, advice for the selection o f an instrument has been based on age-old criteria. A m ong these are: all brass players need even front teeth, and irregular teeth mitigate against su ccess with a cup-shaped m outhpiece, but are not alw ays a handicap in the playing o f reed instruments. A n other is trumpet players must have thin lips and regular teeth— th ose with thick lips and irregu lar teeth can play the bass horn or baritone. Or, persons with badly overlapping teeth can play the clarinet or saxophone, but persons with good, even teeth can play the co m et, trom bone, or som e other brass instrument. T his paper concerns that part o f m yofunc tional therapy that deals with m usical wind in strum ents. T he effect o f m usical wind instru m ents on the soft tissues o f the mouth is men tioned, but no attempt is made to evaluate the effects on th ese tissues.
Em bouchure and classification of instruments T h e em bouchure and the classification o f in strum ents8,9 should be defined before further discussion. T he word, em bouchure, is o f French origin and sim ply alludes to the manner in which the lips and mouth are applied to the m outhpiece. Em bouchure can be correct or incorrect. M usical instruments are grouped in four class es. A ll instrum ents in the sam e class require the sam e em bouchure with slight adaptations be ca u se o f the various sizes o f the m outhpieces and the player’s mouth. C lass A instrum ents have cup-shaped m outh p ieces made o f m etal, which vary in size accord ing to the instrument. T he m ore familiar instru 566 ■ JADA, Vol. 92, March 1976
m ents in the group are the trumpet, bugle, French horn, trom bone, and tuba. C lass B instruments have a single reed clam ped to the m outhpiece. The m ore familiar instruments in the group are the clarinets and saxophone. C lass C instruments are double-reed instru m ents such as the ob oe, bassoon, and English horn. C lass D instrum ents have an aperture in the head o f the instrument for a m outhpiece. Exam ples are the flute and the piccolo. G enerally, the m uscles involved in playing m usical wind instruments can be divided into five groups2: the internal and external pterygoid group, the masseter-tem poral group, the tongue and its associated m uscles, orbicularis oris, and m uscles o f the neck. In the embouchure for class A instrum ents, m uscles contract and the face assum es a tense ness to form a small aperture in the lips through which a stream o f air is directed into the instru m ent. F or the higher tones, the m usculature is more tensed than for the low er tones. Em bouchure for class B instrum ents requires the m outhpiece to be placed partly in the mouth and betw een the lips. T he upper lip is wrapped around the upper surface o f the m outhpiece to prevent leakage o f air; the low er lip is curled partly over the mandibular anterior teeth to form a cushion for the reed. T he em bouchure for class C instrum ents is form ed by curling both lips over the incisal edges o f the anterior teeth to form a cushion for the double reed. T he m uscle tones are controlled by increasing or decreasing the tension o f the lips. T he em bouchure for class D instruments re quires the side o f the head o f the instrum ent to be placed against the low er border o f the low er lip. A ir is directed through this aperture into the instrument. T he upper lip is tensed more for low notes than for high notes.
Review of the literature Lamp and E pley10 attempted to determ ine som e w ay o f predicting the musical capabilities o f the pupil by type o f occlusion. T hey concluded that there w as no relationship betw een tooth even ness and aptitude on brass instrum ents. The study did not com m ent on the effect musical wind instruments had on the occlusion. Strayer8 described the treatment o f m alocclu
sions with musical wind instruments. H e at tem pted to define the u se o f m usical wind in struments as an aid in the treatm ent o f m alocclu sions and to bring about a normal condition o f the facial m usculature. N o data w ere presented in the paper to substantiate his findings. T he fol low ing lists Strayer’s findings: C lass A instru ments are indicated for persons with protruded m axillary anterior teeth and contraindicated for th o se with retruded' maxillary anterior teeth. C lass B instruments are indicated for those with retruded maxillary anterior teeth and contrain dicated for all persons with protruded maxillary anterior teeth. C lass C instruments are indicated for persons with hypotonicity and especially if the lips are short and flabby and roll away from the teeth. N o contraindications w ere given ex cept for persons with com plicated C lass I mal occlu sion s. C lass D instruments are indicated for persons with C lass I or C lass III m alocclu sions and short upper lips and a mentalis habit. T hey are contraindicated for persons with pro truded maxillary anterior teeth. Porter9 repeated som e o f Strayer’s work in 1952. H e discussed in detail the m usculature in volved in the em bouchure and how m usical wind instrum ents are classified. Porter felt that the em bouchure, as important as it is to the m usi cian, had not previously been discussed in great enough detail. H e suggested that a dentist might be able to help the experienced wind m usician and the beginner and to advise an instrument best suited to the oral condition. T he paper in cluded conclusions on correcting facial and den tal d efects with m usical wind instruments; how ever, this was not d iscussed in the paper. Parker,11 in 1957, used the cephalom etric ra diograph to determ ine the influence o f musical wind instrum ents on tooth position. H is results w ere to be used by dentists and m usicians to advise parents or pupils on the selection o f in strum ents from the dental view point. Radio graphs o f 84 students o f various ages and both sex es w ere taken with the head held in a d evice that kept it in a predetermined fixed position. T he students w ere then radiographed in the rest position, with their instruments in the playing position, and then actually playing a note. Park er’s conclusion “ that one or another instrument should be favored in different typ es o f occlu sio n s” is questionable. Hruby and K essler12 review ed Strayer’s work. On the basis o f their observations, they con cluded that the playing o f musical wind instru ments should not replace orthodontic treatment.
T hey said, “ Changes in the m esiodistal rela tionship o f the teeth should not be ex p ected .” Seid n er,13 consultant to the V ienna State A cadem y o f M usic, exam ined several hundred musical wind instrument players to establish the im portance o f the dental condition for the play ing o f various types o f wind instrum ents. T he relation betw een the jaw s, the position o f the anterior teeth, and the condition and shape o f the lips, the tongue, and the palate w ere studied and radiographed before and after the m usicians played high and low notes. Seidner then con cluded w hich instrument best suited each play er. H e was primarily interested in the quality o f m usic a m usician with a particular dental condi tion playing a specific instrum ent could pro duce, rather than the effect o f the instrument on the occlusion. H esk ia and H ospital14 said that orthodontic treatm ent in conjunction with the playing o f a m usical wind instrument will, in selected per son s, make the treatment more effective and easier. N o experim ents w ere m entioned in the paper. N o n e o f the papers considered whether the playing o f a musical wind instrument would change and affect the occlusion o f the anterior teeth. A s a test o f Strayer’s findings, a study is needed involving students at the beginning o f their m usical careers, with periodic exam ina tions thereafter, to look for changes in the occlu sion.
Study methods T he experim ent w as a double-blind study and involved only beginning m usical wind instru ment students in the seventh grade o f the R ock ford sch ool system . A ll pupils w ho had been given parental consent, but who w ere not under going orthodontic treatment participated. T he control group also was made up o f seventh-grade volunteers w ho had m alocclusions, but they w ere not wind m usical instrument players or orthodontic patients. O f the 102 pupils w ho volunteered to partici pate, 84 (41 boys and 43 girls) had im pressions taken. Seventy-six (37 boys and 39 girls) were participating at the end o f the six-m onth period. Eight did not finish the experiment: O ne girl lost her central incisors through an accident, two pupils started orthodontic treatm ent, and five pupils discontinued playing their m usical wind instrum ents. Pang: WIND INSTRUMENTS AND MALOCCLUSION ■ 567
P erm ission to visit the stu d en ts w hile they w ere in c la s s — to in vite their p articipation— w as ob tain ed through th e sc h o o l au th orities. Q u e s tionn aires w ere sen t h om e with th e pupils w ish ing to p articipate in the exp erim en t to obtain parental c o n se n t and o th er pertinent data. T h e pupils w ere ask ed to return the q u estion n a ires to sc h o o l w hen their p arents had filled in the data. F o r eth ical re a so n s, p erm ission a lso w a s o b tained from th e various p articip an ts’ d en tists b efore the exp erim en t began. Jeltrate* im p ressio n s w ere taken and plaster c a sts w ere m ade and n um bered with a num ber assig n ed to each participant. W ith the plaster c a sts in o c c lu sio n , overjet and o v er b ite w ere m easu red by a p ractition er with a h om em ad e dep th sc a le and record ed . T h e m easu rer did not k n o w if th e c a s ts w ere from a w ind instrum ent p layer or from o n e o f th e pupils in the control group. T h e o verjet w a s the d istan ce b etw e en the labial su rface o f the m andibular central in ciso rs and the labial su rface o f th e m axillary central in ciso rs at th e in cisal ed g e, m easured alon g the o c c lu sa l p lan e. T h e o v erb ite w as cla ssified into three zo n es: z o n e 1, m axillary central in ciso rs co v e re d the in cisal third o f the m andibular c e n tral in cisors; z o n e 2, m axillary central in ciso rs c o v e r e d the m iddle third o f th e m andibular c e n tral in cisors; and z o n e 3, th e m axillary central in ciso rs c o v e r e d th e gingival third o f the m andib ular centra] in ciso rs. Im p ressio n s and m easu re m en ts w er e rep eated after six m on th s. W eigh t and h eigh t o f th e p up ils w ere recorded. T h e p up ils w er e m atched as to s e x , height, w e ig h t,15 and cla ss o f w ind instrum ent p layed . E valu ation w a s b ased on the ch a n g es that o c curred in the ov erjet, o v erb ite, or b oth , b etw e en th e original recording and the data ob tain ed at th e end o f six m onths. T h e exp erim en t w a s d up licated w ith pupils in the con trol group w h o did not play a m usical w ind instrum ent and w h o w ere not undergoing o rth o d o n tic treatm en t, but w h o in ev ery oth er r e sp ec t w ere as c lo s e ly m atched to th e te st group as p o ssib le.
Findings C om p arison s (in m illim eters) in the overjet at th e start o f th e stu d y and th e overjet after six m onths w ere m ade for the 14 b o y s in the control grou p . T h e overjets ranged from + 2 .5 0 mm to 4-6.00 m m . T h e m ean o verjets and standard d e 568 ■ JADA, Vol. 92, March 1976
T a b le ■ O verjet: analysis o f va ria n ce a c c o rd in g to class o f m usical w in d in s tru m e n t(b o th sexes co m b in e d ). O v e rje t (m m ) Type o f in s tru m e n t
A t s ta rt
A t 6 m o n th s
M ean SD
M eanS D
M e an SD
+ 4 .8 0 ± 1 .8 8 + 4 .4 5 ± 1 .8 5 + 3 .8 1 ± 1 .0 7
- 0 .0 8 ± 0 .9 2 - 0.96 ± 1.26 - 0 .1 8 ± 0 .9 6
C o n tro l + 4 .8 8 ± 1.53 C la s s A + 5 .4 1 ± 1.72 C lass B + 3 .9 9 ± 0 .9 4 C la s s C (N o m ale players) C lass D (N o m ale players)
D iffe re n c e
via tio n s w ere ca lcu lated for the group at th e start and at six m onths and for th e d ifferen ce in o v er je t at the end o f six m on th s. T h e group sh o w ed + 0 .0 5 mm in crea se in overjet; this w a s not sig nifican t. A sim ilar co m p a riso n o f the overjet fo r girls in the con trol group w as m ade. T h e girls sh o w ed a w id er range in the o v e ije t at th e start o f the stu d y than did th e b o y s. T h ere w as a - 0 . 2 4 mm (n o t sign ifican t) d ecr ea se in ov erjet at th e end o f six m on th s. A t test to co m p are the m ea su re m en ts for the b o y s and girls in the con trol group sh o w e d n o sign ifican t d iffer en ce s, and th e tw o gro u p s w ere m erged (r = 1.7, P = 0.1 0 ). T h e resu lt ant m ean s and standard d ev ia tio n s are listed in th e T a b le. T h e T a b le sh o w s an a n a ly sis o f v a ria n ce o f o v erjet accord in g to m usical w in d in stru m ents w ith both se x e s co m b in ed . C la ss A p la y er s, cla ss B p la y ers, and pupils in the con trol group all sh o w e d a d e c r e a se in o verjet. S in c e there w ere no m ale instrum ent p layers in th e c la ss C or D g ro u p s, no co m p a riso n w a s p o ssib le. C o m p a riso n s w er e m ade o f the overjet m ea su rem en ts o f the b o y s and girls playin g c la s s A m u sica l w ind in stru m ents (trum pets, b u g le s, and s o forth) during the various p h a ses o f the stu d y . T h e r e w ere ten b o y s and nine girls in th e se g r o u p s. N in e o f the ten b o y s sh o w ed a redu ction in o v er je t after six m o n th s, and o n e b o y sh o w e d no ch an ge; se v e n o f the n in e girls sh o w e d a redu c tion in o v e ije t, and on ly tw o sh o w ed an in cr ea se in th e o v e ije t m ea su rem en t. M ean and standard d ev ia tio n s w ere ca lcu lated for the grou p , and a t te st to co m p a re th e m ea su rem en ts for grou p s o f b o y s and girls playin g cla ss A m u sica l wind in stru m en ts w as m ade. S in ce the resu lts w ere not sign ifican t ( /= 1 .5 3 , P = 0 . 15), the grou p s w ere co m b in ed , and the resultant m ean s and standard d ev ia tio n s are listed in th e T a b le. C o m p a riso n s o f the overjet at the start o f the stu d y and after six m onths o f in stru m ent p lay ing, and the d ifferen ce in overjet b etw e en the tw o p eriod s for b o y s and girls playing cla ss B m usical w ind in stru m ents (clarin et, sa x o p h o n e) w ere
m ade. T h e b o y s in the group sh o w ed a - 0 . 2 9 mm d ecr ea se in ov erjet, and th e girls sh o w e d an in crea se in o v e ije t o f + 0 .0 1 m m . T h e resu lts o f the t te st w e r e n ot sign ifican t (? = 1 .1 9 , P = 0 .2 0 ) , and th e resu ltan t m ean s and standard d eviation s are listed in th e T ab le. S im ilar co m p a riso n s w ere m ade for the tw o girls in th e c la ss C m usical w ind instrum ent (o b o e ) grou p . B oth girls sh o w e d a d ecr ea se in overjet. O v erjet com p arison s w ere m ade o f the fou r girls in th e cla ss D m usical instrum ent (flu te, p ic c o lo ) group. T h ree o f th e fou r girls sh o w e d an in crea se in o v e ije t, and o n e sh ow ed no ch an ge ( t = 0 .2 8 1 ). T h ere w ere no b o y s in eith er th e cla ss C or D m usical instrum ent groups. C om p arison s o f o v e ije t and o v erb ite m easu re m en ts for th e b o y s and girls accord in g to se x and co n stitu tio n a l b od y ty p e a lso w ere m ade. T h e resu lts w e r e n ot sign ifican t for correlation s by se x or co n stitu tio n a l b od y ty p e. O n ly four in th e en tire in stru m ent group sh o w ed an in crea se in o v er b ite , and an op en b ite d ev elo p e d in o n e p lay er (o b o e ). T w o o f the pupils in the con trol group sh o w ed an in cr ea se in overb ite. C h i-sq u are a n a ly se s o f o v erb ites fo r the b o y s and girls w er e com p u ted . P robability at th e 0.5 0 and 0.6 0 le v e ls , r e sp e c tiv e ly , w as con sid ered not sign ifican t. O n ly 2 o f 19 cla ss A instrum ent p layers sh o w ed an in crea se in o v e ije t, 16 sh o w e d a d ecr ea se, and 1 sh o w e d n o ch an ge. In th e cla ss B group, 8 p lay ers o f 21 sh o w e d an in crea se in o v e ije t, and 12 pupils in th e con trol group sh o w ed an in creased o verjet. N o n e o f the cla ss C p layers sh o w e d in c r ea ses in overjet. O n e cla ss B and o n e cla ss D in stru m ent p layer sh o w e d an in crease in o v er bite. T w o o f th e pupils in th e con trol group also sh o w e d in cr ea se s in o v erb ite. A n op en b ite d e v elo p e d in o n e cla ss C instrum ent p layer (o b o e).
Discussion O n a grou p b a sis, th e cla ss A m usical w ind in stru m en ts ten d ed to red u ce overjet m ore than that fo u n d for eith er th e con trol group or for th o se p layin g th e cla ss B or D in stru m ents (0.88 m m m ore than th e con trol group and 0.78 mm m ore than th e cla ss B instrum ent group). O n ly tw o c la ss A in stru m ent p layers sh o w e d an y in cr ea se in o v e ije t, w h ereas eight cla ss B p layers and 12 in th e con trol group sh ow ed in cr ea se s in o v e ije ts . It is p o ssib le that cla ss B instrum ents
d o n ot p rod u ce an o v e ije t i f the co r re ct em b o u ch ure is u sed , and m ay e v e n ca u se an im provem en t in th e ov erjet through stim u lation o f th e upper lip sin c e m ore p u p ils in th e co n tro l group sh o w ed in cr ea se s in overjet than did c la ss B p la y ers. T h e stu d y a lso sh o w ed that, o n a group b a sis, cla ss C instrum ents w ill red u ce an o v erjet and cla ss D in stru m ents w ill in crea se an o v e ije t. T h e stud y w o u ld be o f m uch g rea ter signifi c a n ce if it co u ld b e ex te n d ed for a lo n g er tim e p eriod. B oth t test and ch i-sq u a re v a lu es w ould b e a ffected . T h e m usical w ind in stru m ents did not se e m to a ffect th e o v erb ite, sin c e o n ly fo u r participants in th e en tire stu d y sh o w e d an in cr ea se in o v er b ite. P o ssib ly , th e cla ss D m u sica l w ind instru m en ts (flute) m ay b e m ore apt to c a u se a protru sio n than th e cla ss B group o f in stru m en ts (clar in et), and the c la ss C in stru m en ts (o b o e) m ay c a u se an o p en b ite. B e c a u se o f th e sm all num ber o f p up ils in th e se tw o g ro u p s, further stud y is in dicated . T h e findings for th e cla ss A and D m usical instrum ent groups agree w ith th o se o f S tra y er,8 w h erea s th e findings for th e cla ss B m u sical w ind in stru m ents d o n ot agree. M o st p rev io u s authors h a v e said that th e cla ss B m u sica l instrum ents tend to p rod u ce a p rotrusion. T h e findings in this stu d y sh o w e d that cla ss B in stru m en ts h ave little or no effec t o n p rotrusion. T h e find in gs a lso sh o w that a norm al o v e ije t d o e s n ot e x ist, and that a range o f o v erjets m ay b e norm al. O n an individual b a sis, th e e ffe c t o f m usical w in d in stru m ents on th e anterior teeth is unpre d icta b le. A sp ec ific individual w ith an overjet can n ot be told that the playin g o f a cla ss A in stru m ent w ill red u ce or correct a p rotru sion , nor can an individual w ith a p rotru sion b e told that b y playin g a cla ss B in stru m ent h is o v e ije t w ill b e in crea sed . T h e u se o f m u sica l w in d instru m en ts sh ould n o t, th erefo re, b e a su b stitu te for o rth o d o n tic trea tm en t.12
Conclusion O n a group b a sis, th e c la ss A m u sica l w in d in stru m ents red u ced the o v e ije t. O n a group ba sis , the cla ss B m u sical w in d in stru m en ts did not p ro d u ce an o v e ije t. O n an in dividu al b a sis, as m any p up ils sh o w e d an in cr ea se in o v e ije t as sh o w e d a d ecr ea se in o v erjet. C la ss C m usical w in d in stru m ents d ecr ea sed th e o v erjet, but m ay Pang: WIND INSTRUMENTS AND MALOCCLUSION ■ 569
cause an open bite; further study is indicated. C lass D m usical wind instruments caused an overjet. M usical wind instruments do not affect an overbite. On an individual basis, the effect o f musical wind instruments on the anterior teeth is unpredictable and cannot be used as a substi tute for orthodontics. The study should be car ried out for longer than a six-m onth period.
4. Brekhus, P.J.; A rm strong, W.D.; and Sim on, W.J. S tim ula tion of the m uscles of m astication. J D ent Res 20:87, 1941. 5. Rogers, A.P. Place of m yofunctional treatm ent in the cor rection of m alocclusion. JADA 23:66, 1936. 6. Lischer, B.E. Cited by S alzm ann, J.A. Principles of orthodon tics. Philadelphia, J. B. Lippincott Co., 1943, p 529. 7. G raber, T.M . Orthodontics, principles and practice. P hila delphia, W. B. S aunders Co., 1961, p 581. 8. Strayer, E.R. Musical instrum ents as an aid to the treatm ent of muscle defects and perversions. Angle O rthod 9:18 April 1939. 9. Porter, M .M . D ental aspects of orchestral wind instrum ent playing with special reference to the “ e m b ouchu re.” Br Dent J 93:66 Aug 5, 1952. 10. Lam p, C.J., and Epley, F.W. R elation of tooth evenness to
T h e assistance of- th e pedodontic departm ent, University of Illinois School of Dentistry and especially th a t of Dr. M aury M assier and Dr. Thom as B arber is acknow ledged.
perform ance on th e brass and w o odw ind musical instruments. JADA 22:1232, 1935. 11. Parker, J.H. A lam eda instrum entalist study. Am J Orthod 43:399 June 1957. 12. Hruby, A., and Kessler, H.E. Dentistry and th e musical wind
Dr. Pang is a pedodontist. His address is 975 N M ain St, R ock ford, III 61103. 1. S tran g, R .H.W . A text-b ook of orthodontia, ed 3. Philadel phia, Lea & Febiger, 1950, p 677.
instrum ent problem . Dent R adiog P hotog 32:1 No. 1, 1959. 13. S eidner, S. D ie Bedeutung des Gebisses fur Blasmusiker, Zahnartzl. Abstracted, D ent Abstr 2:68 Feb 1957. 14. Heskia, J.E., and Hospital, L. M usical wind instrum ents
2. R ogers, A.P. M yofunctional treatm ent from a practical stan d point. Am J O rthod Oral Surg 26:1131 Dec 1940.
utilized in orthodontics. Ann O dontostom atol (Lyons) 12:301 N ov-Dee 1955. 15. Silver, H.K.; Kem pe, C.H.; and Bruyn, H.B. H andbook of
3. Salzm ann, J.A. Principles of orthodontics. Philadelphia, J. B. Lippincott Co., 1943, p 529.
pediatrics, ed 4: Los Altos, C alif, Lange M edical Publications, 1961, front lining paper.
570 ■ JADA, Vol. 92, March 1976
Relation of musical wind instruments to malocclusion
Allen Pang,
D D S , R o c k f o r d , III
E ig h t y - f o u r s e v e n th g r a d e r s o f b o th s e x e s , n o t u n d e r g o in g o r t h o d o n t ic tr e a t m e n t , p a r t ic ip a t e d in a
T h e v alu e o f ca listh e n ic s and sp ec ific m u scle e x e r c is e s to im prove m u sc le to n e is w ell d o cu m en ted . A th le te s h a v e lon g u sed th e se e x e r c ise s and ca listh e n ic s to strengthen s p e c ific m u sc les o f th e b od y and to co rrect m u scu lar w e a k n e sse s. It is rea so n a b le, th erefo re, to a ssu m e that ex e r c is e o f the m u sc les o f m a stica tio n can co rrect or im p ro v e certain m a lo cc lu sio n s and lack o f m u scle to n e.
d o u b l e - b lin d s t u d y t o d e te r m in e th e e ff e c t o n th e a n t e r io r te e th o f p la y in g a m u s ic a l w in d in s tr u m e n t . T h e in s t r u m e n t p la y e rs w e r e ju s t b e g in n in g t h e ir s tu d ie s .
S e v e n th
g ra d e rs
n o t p la y in g
a
w in d in s t r u m e n t s e rv e d as th e c o n tr o l g r o u p . Im p r e s s io n s a n d p la s t e r c a s ts w e r e m a d e o f e a c h m o u th
a t th e
b e g in n in g
and
c o n c lu s io n
o f th e
s tu d y . T h e p la s t e r c a s ts w e r e m a r k e d w it h th e s a m e n u m e r ic a l c o d e a s s ig n e d t o e a c h s tu d e n t. O v e r je t a n d o v e r b it e m e a s u r e m e n ts o f th e a n t e r io r te e th w e r e ta k e n f r o m
th e p la s te r c a s ts a n d r e c o r d e d .
F in d in g s in d ic a t e t h a t, o n an in d iv id u a l b a s is , th e e f f e c t o n t h e a n t e r io r te e th o f p la y in g a m u s ic a l w in d in s t r u m e n t is u n p r e d ic ta b le . O n ly o n a g r o u p b a s is c a n a c la s s o f m u s ic a l w in d in s tr u m e n ts b e th e o r iz e d t o h a v e a c e r ta in e ffe c t o n th e a n t e r io r t e e th . T h e p la y in g
o f a m u s ic a l w in d
in s t r u m e n t
s h o u ld n o t b e u s e d a s a s u b s t it u t e f o r o r t h o d o n tic tre a tm e n t.
Historical review
m u s ic a l
T h e im portan ce o f su ch regular, p rop erly dir e c ted e x e r c ise s in the p rev en tio n o f m a lo cclu sio n and their u se during th e co r r e c tiv e p erio d , p lus th e part th ey play during th e reten tio n per iod is attributed to th e w ork o f R o g e r s .1,2 H e b e lie v ed faulty fa cia l p o stu re and m uscular m al fu n ctio n to be am ong th e m o st im portant etiolo g ic factors in m a lo c c lu sio n s .3 B rek hu s, A rm stron g, and S im o n 4 sh o w e d th e effec t o f stim ulation o f th e m a stica to ry m u sc les in co n trolled ex p er im en ts with p h y sica l ed u ca tio n stu d en ts at the U n iv ers ity o f M in n eso ta . T h ey co n clu d ed that th e strength o f th e se m u sc le s , like th o se elsew h er e in th e b o d y , is d irectly pro portional to th e u se to w h ich th ey are put, up to a p h y sio lo g ic lim it. In 1906, R o g ers5 p ro p o sed co r r e c tiv e ex e r c is e s to o v e r c o m e “ faulty facial p o stu re and m alfu n ction o f facial m u s c le s .” T h e term m y o fu n ction al therapy w as later p ro p o sed by L isch JADA, Vol. 92, M arch 1976 ■ 565
er6 for th ese exercises. T he use o f m usical wind instrum ents to treat m alocclusions is a facet o f m yofunctional therapy. D ata on the relationship o f m usical wind in strum ents and m alocclusion are needed because the dentist and the m usic instructor, on many occa sio n s, are asked to advise w hether a certain m usical instrument is suitable for a particular mouth and w hether the instrument will affect the occlusion. T o date, nothing in the scientific lit erature serves as a basis for recom m endations. A ll conclusions have been based on logic rather than scientific evidence. It may be that the play ing o f a musical wind instrument can be used only as an interceptive orthodontic procedure.7 A t present, advice for the selection o f an instrument has been based on age-old criteria. A m ong these are: all brass players need even front teeth, and irregular teeth mitigate against su ccess with a cup-shaped m outhpiece, but are not alw ays a handicap in the playing o f reed instruments. A n other is trumpet players must have thin lips and regular teeth— th ose with thick lips and irregu lar teeth can play the bass horn or baritone. Or, persons with badly overlapping teeth can play the clarinet or saxophone, but persons with good, even teeth can play the co m et, trom bone, or som e other brass instrument. T his paper concerns that part o f m yofunc tional therapy that deals with m usical wind in strum ents. T he effect o f m usical wind instru m ents on the soft tissues o f the mouth is men tioned, but no attempt is made to evaluate the effects on th ese tissues.
Em bouchure and classification of instruments T h e em bouchure and the classification o f in strum ents8,9 should be defined before further discussion. T he word, em bouchure, is o f French origin and sim ply alludes to the manner in which the lips and mouth are applied to the m outhpiece. Em bouchure can be correct or incorrect. M usical instruments are grouped in four class es. A ll instrum ents in the sam e class require the sam e em bouchure with slight adaptations be ca u se o f the various sizes o f the m outhpieces and the player’s mouth. C lass A instrum ents have cup-shaped m outh p ieces made o f m etal, which vary in size accord ing to the instrument. T he m ore familiar instru 566 ■ JADA, Vol. 92, March 1976
m ents in the group are the trumpet, bugle, French horn, trom bone, and tuba. C lass B instruments have a single reed clam ped to the m outhpiece. The m ore familiar instruments in the group are the clarinets and saxophone. C lass C instruments are double-reed instru m ents such as the ob oe, bassoon, and English horn. C lass D instrum ents have an aperture in the head o f the instrument for a m outhpiece. Exam ples are the flute and the piccolo. G enerally, the m uscles involved in playing m usical wind instruments can be divided into five groups2: the internal and external pterygoid group, the masseter-tem poral group, the tongue and its associated m uscles, orbicularis oris, and m uscles o f the neck. In the embouchure for class A instrum ents, m uscles contract and the face assum es a tense ness to form a small aperture in the lips through which a stream o f air is directed into the instru m ent. F or the higher tones, the m usculature is more tensed than for the low er tones. Em bouchure for class B instrum ents requires the m outhpiece to be placed partly in the mouth and betw een the lips. T he upper lip is wrapped around the upper surface o f the m outhpiece to prevent leakage o f air; the low er lip is curled partly over the mandibular anterior teeth to form a cushion for the reed. T he em bouchure for class C instrum ents is form ed by curling both lips over the incisal edges o f the anterior teeth to form a cushion for the double reed. T he m uscle tones are controlled by increasing or decreasing the tension o f the lips. T he em bouchure for class D instruments re quires the side o f the head o f the instrum ent to be placed against the low er border o f the low er lip. A ir is directed through this aperture into the instrument. T he upper lip is tensed more for low notes than for high notes.
Review of the literature Lamp and E pley10 attempted to determ ine som e w ay o f predicting the musical capabilities o f the pupil by type o f occlusion. T hey concluded that there w as no relationship betw een tooth even ness and aptitude on brass instrum ents. The study did not com m ent on the effect musical wind instruments had on the occlusion. Strayer8 described the treatment o f m alocclu
sions with musical wind instruments. H e at tem pted to define the u se o f m usical wind in struments as an aid in the treatm ent o f m alocclu sions and to bring about a normal condition o f the facial m usculature. N o data w ere presented in the paper to substantiate his findings. T he fol low ing lists Strayer’s findings: C lass A instru ments are indicated for persons with protruded m axillary anterior teeth and contraindicated for th o se with retruded' maxillary anterior teeth. C lass B instruments are indicated for those with retruded maxillary anterior teeth and contrain dicated for all persons with protruded maxillary anterior teeth. C lass C instruments are indicated for persons with hypotonicity and especially if the lips are short and flabby and roll away from the teeth. N o contraindications w ere given ex cept for persons with com plicated C lass I mal occlu sion s. C lass D instruments are indicated for persons with C lass I or C lass III m alocclu sions and short upper lips and a mentalis habit. T hey are contraindicated for persons with pro truded maxillary anterior teeth. Porter9 repeated som e o f Strayer’s work in 1952. H e discussed in detail the m usculature in volved in the em bouchure and how m usical wind instrum ents are classified. Porter felt that the em bouchure, as important as it is to the m usi cian, had not previously been discussed in great enough detail. H e suggested that a dentist might be able to help the experienced wind m usician and the beginner and to advise an instrument best suited to the oral condition. T he paper in cluded conclusions on correcting facial and den tal d efects with m usical wind instruments; how ever, this was not d iscussed in the paper. Parker,11 in 1957, used the cephalom etric ra diograph to determ ine the influence o f musical wind instrum ents on tooth position. H is results w ere to be used by dentists and m usicians to advise parents or pupils on the selection o f in strum ents from the dental view point. Radio graphs o f 84 students o f various ages and both sex es w ere taken with the head held in a d evice that kept it in a predetermined fixed position. T he students w ere then radiographed in the rest position, with their instruments in the playing position, and then actually playing a note. Park er’s conclusion “ that one or another instrument should be favored in different typ es o f occlu sio n s” is questionable. Hruby and K essler12 review ed Strayer’s work. On the basis o f their observations, they con cluded that the playing o f musical wind instru ments should not replace orthodontic treatment.
T hey said, “ Changes in the m esiodistal rela tionship o f the teeth should not be ex p ected .” Seid n er,13 consultant to the V ienna State A cadem y o f M usic, exam ined several hundred musical wind instrument players to establish the im portance o f the dental condition for the play ing o f various types o f wind instrum ents. T he relation betw een the jaw s, the position o f the anterior teeth, and the condition and shape o f the lips, the tongue, and the palate w ere studied and radiographed before and after the m usicians played high and low notes. Seidner then con cluded w hich instrument best suited each play er. H e was primarily interested in the quality o f m usic a m usician with a particular dental condi tion playing a specific instrum ent could pro duce, rather than the effect o f the instrument on the occlusion. H esk ia and H ospital14 said that orthodontic treatm ent in conjunction with the playing o f a m usical wind instrument will, in selected per son s, make the treatment more effective and easier. N o experim ents w ere m entioned in the paper. N o n e o f the papers considered whether the playing o f a musical wind instrument would change and affect the occlusion o f the anterior teeth. A s a test o f Strayer’s findings, a study is needed involving students at the beginning o f their m usical careers, with periodic exam ina tions thereafter, to look for changes in the occlu sion.
Study methods T he experim ent w as a double-blind study and involved only beginning m usical wind instru ment students in the seventh grade o f the R ock ford sch ool system . A ll pupils w ho had been given parental consent, but who w ere not under going orthodontic treatment participated. T he control group also was made up o f seventh-grade volunteers w ho had m alocclusions, but they w ere not wind m usical instrument players or orthodontic patients. O f the 102 pupils w ho volunteered to partici pate, 84 (41 boys and 43 girls) had im pressions taken. Seventy-six (37 boys and 39 girls) were participating at the end o f the six-m onth period. Eight did not finish the experiment: O ne girl lost her central incisors through an accident, two pupils started orthodontic treatm ent, and five pupils discontinued playing their m usical wind instrum ents. Pang: WIND INSTRUMENTS AND MALOCCLUSION ■ 567
P erm ission to visit the stu d en ts w hile they w ere in c la s s — to in vite their p articipation— w as ob tain ed through th e sc h o o l au th orities. Q u e s tionn aires w ere sen t h om e with th e pupils w ish ing to p articipate in the exp erim en t to obtain parental c o n se n t and o th er pertinent data. T h e pupils w ere ask ed to return the q u estion n a ires to sc h o o l w hen their p arents had filled in the data. F o r eth ical re a so n s, p erm ission a lso w a s o b tained from th e various p articip an ts’ d en tists b efore the exp erim en t began. Jeltrate* im p ressio n s w ere taken and plaster c a sts w ere m ade and n um bered with a num ber assig n ed to each participant. W ith the plaster c a sts in o c c lu sio n , overjet and o v er b ite w ere m easu red by a p ractition er with a h om em ad e dep th sc a le and record ed . T h e m easu rer did not k n o w if th e c a s ts w ere from a w ind instrum ent p layer or from o n e o f th e pupils in the control group. T h e o verjet w a s the d istan ce b etw e en the labial su rface o f the m andibular central in ciso rs and the labial su rface o f th e m axillary central in ciso rs at th e in cisal ed g e, m easured alon g the o c c lu sa l p lan e. T h e o v erb ite w as cla ssified into three zo n es: z o n e 1, m axillary central in ciso rs co v e re d the in cisal third o f the m andibular c e n tral in cisors; z o n e 2, m axillary central in ciso rs c o v e r e d the m iddle third o f th e m andibular c e n tral in cisors; and z o n e 3, th e m axillary central in ciso rs c o v e r e d th e gingival third o f the m andib ular centra] in ciso rs. Im p ressio n s and m easu re m en ts w er e rep eated after six m on th s. W eigh t and h eigh t o f th e p up ils w ere recorded. T h e p up ils w er e m atched as to s e x , height, w e ig h t,15 and cla ss o f w ind instrum ent p layed . E valu ation w a s b ased on the ch a n g es that o c curred in the ov erjet, o v erb ite, or b oth , b etw e en th e original recording and the data ob tain ed at th e end o f six m onths. T h e exp erim en t w a s d up licated w ith pupils in the con trol group w h o did not play a m usical w ind instrum ent and w h o w ere not undergoing o rth o d o n tic treatm en t, but w h o in ev ery oth er r e sp ec t w ere as c lo s e ly m atched to th e te st group as p o ssib le.
Findings C om p arison s (in m illim eters) in the overjet at th e start o f th e stu d y and th e overjet after six m onths w ere m ade for the 14 b o y s in the control grou p . T h e overjets ranged from + 2 .5 0 mm to 4-6.00 m m . T h e m ean o verjets and standard d e 568 ■ JADA, Vol. 92, March 1976
T a b le ■ O verjet: analysis o f va ria n ce a c c o rd in g to class o f m usical w in d in s tru m e n t(b o th sexes co m b in e d ). O v e rje t (m m ) Type o f in s tru m e n t
A t s ta rt
A t 6 m o n th s
M ean SD
M eanS D
M e an SD
+ 4 .8 0 ± 1 .8 8 + 4 .4 5 ± 1 .8 5 + 3 .8 1 ± 1 .0 7
- 0 .0 8 ± 0 .9 2 - 0.96 ± 1.26 - 0 .1 8 ± 0 .9 6
C o n tro l + 4 .8 8 ± 1.53 C la s s A + 5 .4 1 ± 1.72 C lass B + 3 .9 9 ± 0 .9 4 C la s s C (N o m ale players) C lass D (N o m ale players)
D iffe re n c e
via tio n s w ere ca lcu lated for the group at th e start and at six m onths and for th e d ifferen ce in o v er je t at the end o f six m on th s. T h e group sh o w ed + 0 .0 5 mm in crea se in overjet; this w a s not sig nifican t. A sim ilar co m p a riso n o f the overjet fo r girls in the con trol group w as m ade. T h e girls sh o w ed a w id er range in the o v e ije t at th e start o f the stu d y than did th e b o y s. T h ere w as a - 0 . 2 4 mm (n o t sign ifican t) d ecr ea se in ov erjet at th e end o f six m on th s. A t test to co m p are the m ea su re m en ts for the b o y s and girls in the con trol group sh o w e d n o sign ifican t d iffer en ce s, and th e tw o gro u p s w ere m erged (r = 1.7, P = 0.1 0 ). T h e resu lt ant m ean s and standard d ev ia tio n s are listed in th e T a b le. T h e T a b le sh o w s an a n a ly sis o f v a ria n ce o f o v erjet accord in g to m usical w in d in stru m ents w ith both se x e s co m b in ed . C la ss A p la y er s, cla ss B p la y ers, and pupils in the con trol group all sh o w e d a d e c r e a se in o verjet. S in c e there w ere no m ale instrum ent p layers in th e c la ss C or D g ro u p s, no co m p a riso n w a s p o ssib le. C o m p a riso n s w er e m ade o f the overjet m ea su rem en ts o f the b o y s and girls playin g c la s s A m u sica l w ind in stru m ents (trum pets, b u g le s, and s o forth) during the various p h a ses o f the stu d y . T h e r e w ere ten b o y s and nine girls in th e se g r o u p s. N in e o f the ten b o y s sh o w ed a redu ction in o v er je t after six m o n th s, and o n e b o y sh o w e d no ch an ge; se v e n o f the n in e girls sh o w e d a redu c tion in o v e ije t, and on ly tw o sh o w ed an in cr ea se in th e o v e ije t m ea su rem en t. M ean and standard d ev ia tio n s w ere ca lcu lated for the grou p , and a t te st to co m p a re th e m ea su rem en ts for grou p s o f b o y s and girls playin g cla ss A m u sica l wind in stru m en ts w as m ade. S in ce the resu lts w ere not sign ifican t ( /= 1 .5 3 , P = 0 . 15), the grou p s w ere co m b in ed , and the resultant m ean s and standard d ev ia tio n s are listed in th e T a b le. C o m p a riso n s o f the overjet at the start o f the stu d y and after six m onths o f in stru m ent p lay ing, and the d ifferen ce in overjet b etw e en the tw o p eriod s for b o y s and girls playing cla ss B m usical w ind in stru m ents (clarin et, sa x o p h o n e) w ere
m ade. T h e b o y s in the group sh o w ed a - 0 . 2 9 mm d ecr ea se in ov erjet, and th e girls sh o w e d an in crea se in o v e ije t o f + 0 .0 1 m m . T h e resu lts o f the t te st w e r e n ot sign ifican t (? = 1 .1 9 , P = 0 .2 0 ) , and th e resu ltan t m ean s and standard d eviation s are listed in th e T ab le. S im ilar co m p a riso n s w ere m ade for the tw o girls in th e c la ss C m usical w ind instrum ent (o b o e ) grou p . B oth girls sh o w e d a d ecr ea se in overjet. O v erjet com p arison s w ere m ade o f the fou r girls in th e cla ss D m usical instrum ent (flu te, p ic c o lo ) group. T h ree o f th e fou r girls sh o w e d an in crea se in o v e ije t, and o n e sh ow ed no ch an ge ( t = 0 .2 8 1 ). T h ere w ere no b o y s in eith er th e cla ss C or D m usical instrum ent groups. C om p arison s o f o v e ije t and o v erb ite m easu re m en ts for th e b o y s and girls accord in g to se x and co n stitu tio n a l b od y ty p e a lso w ere m ade. T h e resu lts w e r e n ot sign ifican t for correlation s by se x or co n stitu tio n a l b od y ty p e. O n ly four in th e en tire in stru m ent group sh o w ed an in crea se in o v er b ite , and an op en b ite d ev elo p e d in o n e p lay er (o b o e ). T w o o f the pupils in the con trol group sh o w ed an in cr ea se in overb ite. C h i-sq u are a n a ly se s o f o v erb ites fo r the b o y s and girls w er e com p u ted . P robability at th e 0.5 0 and 0.6 0 le v e ls , r e sp e c tiv e ly , w as con sid ered not sign ifican t. O n ly 2 o f 19 cla ss A instrum ent p layers sh o w ed an in crea se in o v e ije t, 16 sh o w e d a d ecr ea se, and 1 sh o w e d n o ch an ge. In th e cla ss B group, 8 p lay ers o f 21 sh o w e d an in crea se in o v e ije t, and 12 pupils in th e con trol group sh o w ed an in creased o verjet. N o n e o f the cla ss C p layers sh o w e d in c r ea ses in overjet. O n e cla ss B and o n e cla ss D in stru m ent p layer sh o w e d an in crease in o v er bite. T w o o f th e pupils in th e con trol group also sh o w e d in cr ea se s in o v erb ite. A n op en b ite d e v elo p e d in o n e cla ss C instrum ent p layer (o b o e).
Discussion O n a grou p b a sis, th e cla ss A m usical w ind in stru m en ts ten d ed to red u ce overjet m ore than that fo u n d for eith er th e con trol group or for th o se p layin g th e cla ss B or D in stru m ents (0.88 m m m ore than th e con trol group and 0.78 mm m ore than th e cla ss B instrum ent group). O n ly tw o c la ss A in stru m ent p layers sh o w e d an y in cr ea se in o v e ije t, w h ereas eight cla ss B p layers and 12 in th e con trol group sh ow ed in cr ea se s in o v e ije ts . It is p o ssib le that cla ss B instrum ents
d o n ot p rod u ce an o v e ije t i f the co r re ct em b o u ch ure is u sed , and m ay e v e n ca u se an im provem en t in th e ov erjet through stim u lation o f th e upper lip sin c e m ore p u p ils in th e co n tro l group sh o w ed in cr ea se s in overjet than did c la ss B p la y ers. T h e stu d y a lso sh o w ed that, o n a group b a sis, cla ss C instrum ents w ill red u ce an o v erjet and cla ss D in stru m ents w ill in crea se an o v e ije t. T h e stud y w o u ld be o f m uch g rea ter signifi c a n ce if it co u ld b e ex te n d ed for a lo n g er tim e p eriod. B oth t test and ch i-sq u a re v a lu es w ould b e a ffected . T h e m usical w ind in stru m ents did not se e m to a ffect th e o v erb ite, sin c e o n ly fo u r participants in th e en tire stu d y sh o w e d an in cr ea se in o v er b ite. P o ssib ly , th e cla ss D m u sica l w ind instru m en ts (flute) m ay b e m ore apt to c a u se a protru sio n than th e cla ss B group o f in stru m en ts (clar in et), and the c la ss C in stru m en ts (o b o e) m ay c a u se an o p en b ite. B e c a u se o f th e sm all num ber o f p up ils in th e se tw o g ro u p s, further stud y is in dicated . T h e findings for th e cla ss A and D m usical instrum ent groups agree w ith th o se o f S tra y er,8 w h erea s th e findings for th e cla ss B m u sical w ind in stru m ents d o n ot agree. M o st p rev io u s authors h a v e said that th e cla ss B m u sica l instrum ents tend to p rod u ce a p rotrusion. T h e findings in this stu d y sh o w e d that cla ss B in stru m en ts h ave little or no effec t o n p rotrusion. T h e find in gs a lso sh o w that a norm al o v e ije t d o e s n ot e x ist, and that a range o f o v erjets m ay b e norm al. O n an individual b a sis, th e e ffe c t o f m usical w in d in stru m ents on th e anterior teeth is unpre d icta b le. A sp ec ific individual w ith an overjet can n ot be told that the playin g o f a cla ss A in stru m ent w ill red u ce or correct a p rotru sion , nor can an individual w ith a p rotru sion b e told that b y playin g a cla ss B in stru m ent h is o v e ije t w ill b e in crea sed . T h e u se o f m u sica l w in d instru m en ts sh ould n o t, th erefo re, b e a su b stitu te for o rth o d o n tic trea tm en t.12
Conclusion O n a group b a sis, th e c la ss A m u sica l w in d in stru m ents red u ced the o v e ije t. O n a group ba sis , the cla ss B m u sical w in d in stru m en ts did not p ro d u ce an o v e ije t. O n an in dividu al b a sis, as m any p up ils sh o w e d an in cr ea se in o v e ije t as sh o w e d a d ecr ea se in o v erjet. C la ss C m usical w in d in stru m ents d ecr ea sed th e o v erjet, but m ay Pang: WIND INSTRUMENTS AND MALOCCLUSION ■ 569
cause an open bite; further study is indicated. C lass D m usical wind instruments caused an overjet. M usical wind instruments do not affect an overbite. On an individual basis, the effect o f musical wind instruments on the anterior teeth is unpredictable and cannot be used as a substi tute for orthodontics. The study should be car ried out for longer than a six-m onth period.
4. Brekhus, P.J.; A rm strong, W.D.; and Sim on, W.J. S tim ula tion of the m uscles of m astication. J D ent Res 20:87, 1941. 5. Rogers, A.P. Place of m yofunctional treatm ent in the cor rection of m alocclusion. JADA 23:66, 1936. 6. Lischer, B.E. Cited by S alzm ann, J.A. Principles of orthodon tics. Philadelphia, J. B. Lippincott Co., 1943, p 529. 7. G raber, T.M . Orthodontics, principles and practice. P hila delphia, W. B. S aunders Co., 1961, p 581. 8. Strayer, E.R. Musical instrum ents as an aid to the treatm ent of muscle defects and perversions. Angle O rthod 9:18 April 1939. 9. Porter, M .M . D ental aspects of orchestral wind instrum ent playing with special reference to the “ e m b ouchu re.” Br Dent J 93:66 Aug 5, 1952. 10. Lam p, C.J., and Epley, F.W. R elation of tooth evenness to
T h e assistance of- th e pedodontic departm ent, University of Illinois School of Dentistry and especially th a t of Dr. M aury M assier and Dr. Thom as B arber is acknow ledged.
perform ance on th e brass and w o odw ind musical instruments. JADA 22:1232, 1935. 11. Parker, J.H. A lam eda instrum entalist study. Am J Orthod 43:399 June 1957. 12. Hruby, A., and Kessler, H.E. Dentistry and th e musical wind
Dr. Pang is a pedodontist. His address is 975 N M ain St, R ock ford, III 61103. 1. S tran g, R .H.W . A text-b ook of orthodontia, ed 3. Philadel phia, Lea & Febiger, 1950, p 677.
instrum ent problem . Dent R adiog P hotog 32:1 No. 1, 1959. 13. S eidner, S. D ie Bedeutung des Gebisses fur Blasmusiker, Zahnartzl. Abstracted, D ent Abstr 2:68 Feb 1957. 14. Heskia, J.E., and Hospital, L. M usical wind instrum ents
2. R ogers, A.P. M yofunctional treatm ent from a practical stan d point. Am J O rthod Oral Surg 26:1131 Dec 1940.
utilized in orthodontics. Ann O dontostom atol (Lyons) 12:301 N ov-Dee 1955. 15. Silver, H.K.; Kem pe, C.H.; and Bruyn, H.B. H andbook of
3. Salzm ann, J.A. Principles of orthodontics. Philadelphia, J. B. Lippincott Co., 1943, p 529.
pediatrics, ed 4: Los Altos, C alif, Lange M edical Publications, 1961, front lining paper.
570 ■ JADA, Vol. 92, March 1976
