Nigerian Postgraduate Medical Journal

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 26  |  Issue : 3  |  Page : 152--157

The effects of playing wind musical instruments on the occlusal characteristics in a Northern Nigerian Population


Tope Emmanuel Adeyemi1, Olayinka Donald Otuyemi2,  
1 Department of Child Dental Health, Aminu Kano Teaching Hospital and Bayero University, Kano, Nigeria
2 Department of Child Dental Health, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria

Correspondence Address:
Dr. Tope Emmanuel Adeyemi
Department of Child Dental Health, Aminu Kano Teaching Hospital and Bayero University, Kano, 2 Zaria Road, Tarauni, Kano
Nigeria

Abstract

Introduction: Dentists are often questioned on whether playing a wind musical instrument can adversely affect dental occlusion. This study compared the occlusal characteristics in wind instrument players (WIPs) and non-WIPs. Materials and Methods: This was a cross-sectional comparative study comprising a group of fifty males aged 18–45 years that had been playing wind instruments for a minimum of 2 years, whereas the control group were non-WIPs in the same environment. All the participants had full complement of dentition. The occlusal characteristics of overjet, overbite, anterior open bite and Little's irregularity were assessed for both groups. Excellent intra-examiner reliability was observed (Cronbach's alpha – 0.997). The Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 17 was used for data analysis, and statistical significance level was set at P < 0.05. Results: The number of years of playing wind musical instrument ranged from 2 to 25 years. The mean overjet was 3.46 ± 1.49 mm and 3.18 ± 1.27 mm in the WIP and non-WIP groups, respectively (P > 0.05). The maxillary anterior segment showed statistically significantly higher Little's Irregularity Index score in the WIP group (3.18 ± 3.73 mm) than that in the non-WIP group (1.87 ± 2.21 mm) (P < 0.05). The maxillary Little's Irregularity Index score in trumpet and trombone players (3.55 ± 3.93 mm) was significantly higher than that in saxophone and clarinet players (1.69 ± 2.39 mm). Both the maxillary and mandibular anterior-segment alignments were neither influenced by the number of years nor the frequency of play. Conclusions: Playing wind musical instruments significantly affects the maxillary anterior-segment alignment.



How to cite this article:
Adeyemi TE, Otuyemi OD. The effects of playing wind musical instruments on the occlusal characteristics in a Northern Nigerian Population.Niger Postgrad Med J 2019;26:152-157


How to cite this URL:
Adeyemi TE, Otuyemi OD. The effects of playing wind musical instruments on the occlusal characteristics in a Northern Nigerian Population. Niger Postgrad Med J [serial online] 2019 [cited 2019 Nov 13 ];26:152-157
Available from: http://www.npmj.org/text.asp?2019/26/3/152/264391


Full Text

 Introduction



Medical and dental practitioners are often engaged and questioned by certain group of the society as to whether playing a wind musical instrument can adversely affect their dental occlusion.[1] This concern has increased over the years as orthodontists continue to manage an increasing number of musicians of all ages with occlusal challenges.[2]

In general, changes in the dental occlusion occur as a result of the interplay between a variety of different environmental and genetic factors.[3] Nevertheless, these factors may manifest during the playing of musical instruments to alter the equilibrium between dental and musculoskeletal structures which may, in turn, aggravate the development of malocclusion. The causes of malocclusion that have been suggested include a disproportion in the size of the maxilla and mandible;[4],[5] abnormality in the shape and number of the teeth;[5],[6] dentoalveolar discrepancy;[5] soft-tissue nature, for example, lip trap;[5] localised dental trauma or pathology;[5] early loss of deciduous dentition;[5] absence of attrition in the soft diet;[7] various muscular dystrophies;[5] mouth breathing;[8],[9] habits, for example, tongue thrust and thumb sucking[10] and playing a wind instrument.[11],[12],[13] The type of instrument mouthpiece, number of hours of playing, tooth position and the forces introduced by the tongue and facial muscles contribute to the occlusal changes during playing of wind instruments.[14],[15],[16] There is a large range of expert opinions on the effects of playing wind musical instruments in published literature;[11],[17],[18],[19] one suggests that playing a wind instrument may adversely affect or delay orthodontic treatment.[20] Certain malocclusions and occlusal traits are said to be more compatible with playing some types of wind instruments.[21] Most of these views were based on logic, anatomical suppositions and unscientific evidence rather than evidence-based research. Some authors concluded that playing a wind instrument at professional level requires a sound dentition with minimal malocclusion in order to maintain the position of the teeth and occlusion.[11],[12],[13],[22] One can question whether long-term playing of wind instrument may interfere with the dental equilibrium balance and influence the alignment of teeth with its attendant malocclusion. Therefore, this study was conducted to assess and compare the occlusal characteristics of overjet, overbite, anterior open bite and anterior arch irregularity in wind instrument players (WIPs) and non-WIPs.

 Materials and Methods



This study was approved by the Research Ethics Committee of Aminu Kano Teaching Hospital, Kano state, Nigeria (NHREC/21/08/2008/AKTH/EC/1442) dated 6 July, 2015, prior to its commencement in September, 2015, and completion in July, 2018. Informed consent was also obtained from individual participants.

The study participants were Nigerians whose vocations were related to the playing of wind musical instruments in Nigeria's northern region of Kano state. It was a cross-sectional comparative study comprising a group of fifty males aged 18–45 years that had been playing wind musical instruments for a minimum of 2 years. The control group was another fifty male Nigerian individuals matched for age who were non-WIPs in the same environment.

No previous studies have been carried out on WIPs in Nigeria. The sample size was calculated based on the prevalence of severe symptoms of temporomandibular disorder of 2.9% among young Nigerian adults.[23] The sample size was calculated using the Fisher's formula as follows:[24]

[INLINE:1]

where n = minimum sample size, z = the standard normal deviate corresponding to 95% confidence level = 1.96 (obtained from the normal distribution table) and p = the prevalence of severe symptoms of temporomandibular joint (TMJ) dysfunction obtained from a previous study.[23]

2.9% =0.029; q = complementary probability of p = 1.0 − p, which is 1.0 − 0.029 = 0.97.

d = 0.05, which is the degree of accuracy desired.

Therefore, n = (1.96)2 × 0.029 × 0.97/(0.05)2 = 43.

To adjust for none response, the estimated sample size was increased by 10% = 0.10.

Thus, adjusted sample size = n/(1 − non-response rate) =43/(1 − 0.10) =47.8 ≈ 48.

The sample size was then rounded up to 50 for each group.

All the participants had full complement of dentition. Individuals with a history of orthodontic treatment, previous surgery to the TMJ and trauma or fracture of the jaws and a previous history of tooth extraction, periodontal disease with mobility, dental restorations and oral habits were excluded from this study. A pilot study was undertaken to establish reliability of the instrument used. Ten participants were re-assessed after 2 weeks by one of the investigators (ATE). Excellent intra-examiner reliability was observed (Cronbach's alpha – 0.997). The questionnaire for data collection was coded and used to obtain information concerning sociodemographics, history of wind instrument play and the assessment of occlusal characteristics.

The occlusal characteristics were assessed for both groups of participants by taking alginate impressions of the upper and lower dentition under good illumination on a dental chair, and dental casts were fabricated at the Child Dental Health Department of Aminu Kano Teaching Hospital, Kano. The occlusion of each participant was registered using a wax wafer. The study models were then trimmed according to the registered occlusion. The study casts and the wax for bite registration were then stored in individually labelled airtight plastic bags. The study casts were coded to tally with the number on the questionnaire filled for each participant in order to preserve anonymity and ensure that there was no examiner's bias during the assessment of the casts.

While an orthodontic stainless steel ruler was used to measure the overjet, a digital caliper (Mitutoyo Corporation, Tokyo, Japan) with accuracy set at 0.05 mm was used to measure the overbite, anterior open bite and the Little's irregularity.[25]

Overjet

This was the maximum horizontal distance from the most prominent point on the labial surface of the incisal edge of the upper central incisors to the labial surface of the corresponding lower central incisors, measured parallel to the upper occlusal surface to the nearest 0.5 mm.[26],[27]

Overbite

This was the maximum vertical overlap involving the maxillary and mandibular central incisors. The incisal edge of the maxillary central incisor was projected onto the labial surface of the corresponding mandibular central incisor parallel to the upper occlusal surface and marked with a sharp pencil. The length from the incisal edge of the mandibular central incisor to the marked point was measured to the nearest 0.5 mm.[26],[27]

Anterior open bite

This was the maximum vertical separation between the incisal edges of the maxillary central incisors and the mandibular central incisors measured to the nearest 0.5 mm when in centric occlusion.[26],[27]

The Little's Irregularity Index score[25] was the sum of the contact point displacement in the six lower anterior teeth (canine to canine); five linear displacements of adjacent contact points starting from the mesial of the right canine to the mesial of the left canine were recorded. The sum of the five displacements represents the Little's Irregularity Index score/value which was used to assess the mandibular labial segment crowding. The Little's Irregularity Index was adapted for the assessment of maxillary labial segment crowding. All the casts were measured twice within a 24-hour period, and the average was taken; measurements that differed by > 0.5 mm were measured a third time and the two closest measurements were taken.

Statistical analysis

The Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 17 was used for data analysis. Data were summarised using measures of central tendencies (mean), dispersion (standard deviation), independent t-tests and analysis of variance to compare means and standard deviations. Statistical significance level was set at p < 0.05.

 Results



The mean age of the participants in WIP and non-WIP groups and their overall mean age were 28.00 ± 7.64, 28.10 ± 7.55 and 28.05 ± 7.56 years, respectively (p > 0.05). The number of years of playing wind musical instruments ranged from 2 to 25 years, with a mean of 9.26 ± 6.21 years. Trumpet was the most commonly played instrument among the WIPs (72.0%) [Table 1].{Table 1}

[Table 2] shows that the mean overjet was 3.46 ± 1.49 mm and 3.18 ± 1.27 mm in the WIP and non-WIP groups, respectively, and the difference was not statistically significant (p > 0.05). Similarly, the mean overbite was 2.08 ± 1.44 mm and 2.19 ± 0.99 mm in the WIP and non-WIP groups, respectively (p > 0.05).{Table 2}

The mean size of anterior open bite in the WIP group (1.30 ± 0.91 mm) was larger than that of the non-WIP group (1.25 ± 0.35 mm), and the difference was also not statistically significant (p > 0.05).

While the mean Little's Irregularity Index score of the mandibular anterior segment was lower in the WIP group (2.90 ± 2.97 mm) than that of the non-WIP (3.11 ± 2.56 mm) group (p > 0.05), the maxillary anterior segment showed statistically significantly higher index score in the WIP group (3.18 ± 3.73 mm) than that of the non-WIP group (1.87 ± 2.21 mm) (p < 0.05).

[Table 3] shows that trumpet/trombone (Class A instruments) players had greater mean overjet (3.54 ± 1.56 mm) than either the clarinet/saxophone (Class B instruments) (3.13 ± 1.21 mm) or non-WIPs (3.18 ± 1.27 mm). However, the non-WIPs had greater mean overbite (2.19 ± 0.99 mm) than any of the WIPs (trumpet/trombone, 2.16 ± 1.58 mm; clarinet/saxophone players, 1.80 ± 0.75 mm). The differences in the mean overjet and overbite according to the class of instrument played, number of years and frequency of play were not statistically significant (p > 0.05).{Table 3}

[Table 4] shows that the maxillary Little's Irregularity Index score in Class A instrument players (3.55 ± 3.93 mm) was statistically significantly higher than either the Class B instrument players (1.69 ± 2.39 mm) or non-WIP group (1.87 ± 2.21 mm) (p < 0.05). Tukey's post hoc test revealed statistically significant difference between the maxillary irregularity score only in the non-WIP group and players of Class A instruments (P < 0.05). No significant differences were observed in the mandibular anterior-segment alignment between the various groups. Both the maxillary and mandibular anterior-segment alignments were neither influenced by the number of years nor the frequency of play.{Table 4}

 Discussion



This investigation was the first of its kind on the effect of playing wind musical instruments on the occlusion of individuals in Nigerian environment. This study provided more insight on the relationship between wind musical instrument playing and the development of malocclusion.

The baseline characteristics of the individuals in this study were similar with regard to age and sex, and the matching for age was necessary in order to eliminate possible confounders of occlusal characteristics that tend to occur with advancing age.[28],[29],[30] Second, the sample was restricted to male participants which was deliberate because females in the northern part of Nigeria do not usually engage in professional wind instrument playing and could be seen as a limitation.

The average age of the participants in our study was similar to a cross-sectional study by Grammatopoulos et al.[31] which was conducted among professional musicians in the United Kingdom. Our findings showed that the occlusal characteristics of individuals were not significantly affected by playing wind musical instruments though WIPs demonstrated slightly higher prevalence of increased overjet and reduced overbite values. This is consistent with the studies conducted in the United Kingdom and Switzerland[31],[32] that reported insignificant overbite reduction in WIPs when compared with control groups, but differs from some other related studies.[11],[12],[13],[16],[17],[18],[19] The divergent views may be due to differences in study designs and sociodemographic variations amongst the various study populations. Most of the reported studies on WIPs in the literature were confined to non-African populations with possible soft- and hard-tissue variations from other populations, especially Africans with different lip frameworks[33] and protrusions in the maxillary and mandibular arches.[34]

In our study, there was no clear difference in overjet and overbite values between Classes A and B instrument players, and this is in contrast with the study by Brattström et al.[11] who reported retroclination of upper incisors in players of trumpet/trombone and proclination in clarinet/saxophone players among a Norwegian population. This observation may probably be due to differences in age group and ethnicity of the Nigerian and Norwegian studies. This Nigerian study was cross-sectional and comparative and was reported in an adult population, whereas the Norwegian investigation was a longitudinal report among children and adolescents. In this particular study, wind instrument characteristics including the musical instrument type, number of years of play, frequency and duration seem not to have any significant effects on the mean overjet and overbite values unlike the suggestion in the study by Guzmán-Valderrábano et al.[35]

The significantly greater maxillary Little's Irregularity Index score recorded in players of trumpet/trombone is in contrast with the United Kingdom study[31] in which no significant difference was reported in the maxillary anterior-segment alignment between players of different classes of wind instruments and a control group. The possible reason for the more maxillary anterior segment irregularities in this study might be related to the considerable pressure on the upper rather than the lower labial segment during the playing of Class A wind instruments. Players are also trained to rest the trumpet's mouthpiece more on the upper than the lower lip. The lingual force applied on the lips during playing of trumpet is hypothesised to have various effects including causing tooth movement leading to lingual displacement of maxillary incisors and increased irregularities in the maxillary anterior segment as corroborated by other studies.[2],[12],[13],[15],[16],[21],[36],[37],[38],[39],[40] Fuhrimann et al.[37] assessed the framework of the face, dentition and lip muscle (strength, pressure and activity) in WIPs and reported that the pressure from the soft tissues on the teeth was lesser during natural lip function than during playing wind instruments. In addition, the irregularity of teeth was more marked in the maxilla than in the mandible, and this could probably be due to the anterior anatomically positioned upper incisors. The constant exposure to lingual forces on the upper lip may be responsible for the significantly higher anterior irregularity in the Class A WIPs.

When the long-term effect of playing was considered, there was a progressive decrease in the incisor crowding after the initial increase in maxillary irregularity score of WIPs. This may be due to a subsequent reduction in lingually directed pressure exerted on the anterior region as the proficiency of the WIPs improved. This assumption was earlier reported by Fletcher and Tarnopolsky[41] in a study amongst trumpet players who sustained labial muscle injury from the chronic pressure applied through the mouthpiece leading to orbicularis oris muscle rupture, a condition known as Satchmo's syndrome. This syndrome usually presents as weakness of the lips, thereby causing a reduction in the lingual pressure exerted, and this leads to a resultant reduction in irregularities as the number of years of playing the wind instruments increases.[42]

The insignificant changes seen in the mandibular anterior alignment in WIPs are in agreement with the study of Grammatopoulos et al.[31] which reported a similar finding in the mandibular anterior irregularity between the test and control groups. The slight improvement in Little's Irregularity Index score noticed in the mandibular anterior segment in WIPs, though not significant, may probably be due to an increase in arch length as a result of growth of the jaw following forward posturing of the mandible when playing wind instruments by those that might have started playing much earlier in life during growth spurts,[43] thus reducing the mandibular anterior-segment irregularities in the WIPs.[13],[32],[36] This may also explain why there was lower irregularity score in the mandibular anterior region of trumpet/trombone players and 'regular' WIPs, though not statistically significant.

Dearth of studies in this area makes it difficult for easy comparison. Further studies, especially longitudinal studies, would be necessary to provide more information on the long-term effects of playing a wind instrument on the occlusal characteristics. Professional advice and counselling is very important for individuals who intend to engage in wind instrument playing.

 Conclusions



It can be concluded that:

Playing a wind musical instrument did not significantly affect the occlusal characteristics except the maxillary anterior segment alignmentIncreased irregularity of the maxillary anterior segment was significantly pronounced in trumpet/trombone players.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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