THE EDITOR'S CORNER

The idea has surfaced again that certain musical instruments are more suitable to certain occlusions and malocclusions; that playing some can be beneficial to certain malocclusions and detrimental to others; that some may produce malocclusion, prevent orthodontic correction, produce correction of malocclusion without orthodontic appliances, cause relapse of a corrected malocclusion. Furthermore, the point is made that the dentist and orthodontist have an obligation to advise patients on the suitability of their occlusion to the instrument of their choice. Otherwise, the patient might select the wrong instrument and make a large expenditure of money and time on an instrument that he was foredoomed to play in a mediocre manner because of the incompatibility of his occlusion to the instrument.

Just because we are frequently asked by parents about the suitability of certain instruments or whether there is any contraindication to playing certain instruments does not mean that we have to provide an answer that is based on a musical judgment. Our knowledge of that would be based on some very limited information. Music people have the obligation to advise people on their suitability to the chosen instrument. There may be advice of that nature which might make it easier for a given individual to play one instrument better than another.

Our area of expertise is orthodontics and we should be able to respond to the question of whether the playing of a certain instrument will interfere with the correction of a given malocclusion, whether it will help the correction of the malocclusion, whether a malocclusion can be corrected with the proper musical instrument, whether the instrument will cause the orthodontic correction to relapse after treatment, whether there are any orthodontic contraindications to the instrument.

I have never seen a malocclusion improved or corrected by the playing of a musical instrument. I have never seen a malocclusion produced by the playing of a musical instrument. I have never seen an orthodontic result relapse because of the playing of a musical instrument. If there is any evidence that any of these occur, I have not seen it. There is no significant evidence in the literature on this subject. In my experience, children do not play musical instruments long enough or hard enough to have any obvious effect on their teeth.

I had one patient, a serious child musician, who suffered from loosening of his upper centrals, which seemed to be due to his trumpet playing. If loosening of teeth is an accompaniment of long hours of playing wind instruments, this may be an occupational hazard of professional musicians. I doubt that it is up to the orthodontist to make a career judgment for anyone, even if this point were substantiated.

I believe that it would be just as bad for an orthodontist to suggest that a patient not play an instrument that he desired to play, based on the evidence that we have, as it would be for that same orthodontist to suggest that his patient not participate in certain sports because of possible damage to teeth and/or appliances. Most child musicians are band players, not concert musicians or potential musical greats. Participation in school group activities is as important as their expertise, and their exposure to some musical training and interest as important as excellence in playing an instrument. The band can't be composed of piano players and drummers and we don't have substantial reasons to try to see that it is.

There are some relationships between playing certain instruments and orthodontics which I have observed, but none are substantial enough to recommend against the instrument. It seems to be true that full-banded appliances prevent the better musicians from realizing high notes on horn instruments. Those who are bothered by this are few, and the orthodontic correction is more important than the horn playing, so they suffer along. Pressure of horn mouthpieces against the lip and forcing the lip against full-banded appliances seems to have an abrasive effect on the inside of the upper lip, but this is not constant and not serious and not a contraindication to horn playing with full bands. Children who play musical instruments can make their own decisions about whether they want to continue or to start with certain wind instruments while undergoing orthodontic treatment. On the basis of available evidence, orthodontists have very little to add to the making of that decision.

Matching the mouthpieces of certain wind instruments with various tooth arrangements has seemed logical to a few authors and many orthodontists. I think that we should confine our opinions to the orthodontic aspects of the question and refer the musical ones to the music department. At the same time, I do not think that we should allow the music department to offer gratuitous opinions about the orthodontic aspects of the question.