 The Clarinet BBoard
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Author: orchestr
Date: 2015-06-24 01:30
I am teaching a student who complained a few months ago that playing the clarinet hurt his teeth, and after about 30 minutes they felt "loose". He saw a dentist, and she told him to stop playing clarinet for a month. Sure enough, his teeth stopped hurting/moving. As soon as he started again, they started moving again.
Has anyone heard of this or had this experience themselves or with a student? I have had him playing double-lip, and have tried adjusting the angle of the clarinet a little so it doesn't put as much pressure on his teeth, but he said they still feel loose after about 30 minutes. It's sad, he really likes the clarinet and doesn't want to quit or switch to another instrument, but his dentist is recommending that.
If it matters, he's 13 years old, and said when he was young and still had baby teeth he fell and hit his mouth on a table. Since he's grown a whole set of teeth since then, I assume that's not the issue.
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Author: MSK
Date: 2015-06-24 02:52
I am an adult in my 40s. I had orthodontic braces as a child of 11-13. My dentist has told me that my front teeth roots are shorter than normal. I still have to wear my retainer every other night regardless of playing time and all nights that I play for more than 30 minutes. It is an inconvenience rather than a problem, but undoubtedly it would be better for my teeth if I played a different instrument. I've tried playing with the retainer on, but I don't play as well.
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Author: EaubeauHorn
Date: 2015-06-25 00:10
A retainer is something to be considered although it is expensive. I have a "flipper" because of a missing tooth right next to my incisors; it's like a retainer except with a tooth on it to fill the gap. I haven't had an implant because of contact allergies to materials. I find I was able to adjust to playing with the flipper in and it works just fine. It does take an adjustment but a retainer would keep his teeth from moving around.
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Author: clarinetguy ★2017
Date: 2015-06-25 10:08
You're doing the right thing by having him play double lip. I hope his band director doesn't try to change it.
A neck strap might help. Although its connection to embouchure is debatable, your student might be less likely to bite (if he does that) if he doesn't have to worry about supporting the weight of the clarinet with his right thumb.
Does he feel comfortable with his mouthpiece/reed combination? Is he using a tiring setup that is possibly causing him to bite? Due to cost issues, many young students have less than desirable setups. I remember shopping once for a new mouthpiece, and was trying to decide between two that were excellent. After doing the usual mouthpiece tests, which included playing scales and familiar passages, the choice was difficult. After playing some etudes, it all became obvious. My embouchure muscles were sore after 16 measures on the first mouthpiece, and I could feel myself starting to bite. The second mouthpiece was much more comfortable, and I was able to get through an entire page easily.
One last thought: Does your student know how to adjust and balance reeds? Does he frequently have reed issues? Good reeds might not stop his teeth from shifting, but if his embouchure muscles are strong and if he doesn't have to bite to compensate for poor reeds, it's a step in the right direction.
Post Edited (2015-06-25 10:12)
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Author: fernpod
Date: 2015-06-29 21:15
I have been a long-time reader of the Clarinet Bboard. I thank all you brilliant clarinetists for the slew of insights into the playing of the clarinet. I am a clarinet hobbyist who also happens to be a dentist.
With regard to the 13-year-old's complaint of his teeth moving, I am going to assume that the concern is for the upper, central incisors. Employing the single-lip embouchure means that the clarinet mouthpiece beak engages the edges of these incisors. If one looks at the physics, the fulcrum of the lower lip serves the lever of the mouthpiece directing a minor vector of force forward.
The tooth supporting bone of the upper jaw in a 13-year-old is rather pliable (orthodontists can move teeth faster in an adolescent than an adult) compared to an adult's supporting bone in the front of the upper jaw. Additionally, teeth are in bone due to a ligament that fuses to the tooth root and socket. In an adolescent, this ligament occupies a wider space than in an adult. This ligament, sort of a "shock absorber" will "give" more easily thus allowing the looseness of our young clarinetist's complaint.
As far as recommendations, I would not discourage the young player from charging forth, but limit dedicated playing sessions to no more than an hour a day with the mouthpiece in place. That leaves 23 hours for the ligament to recover and respond to the other balancing forces of a person's bite, and the forces of the facial musculature and tongue.
Again, thanks for the terrific amount of information all of you brilliant musicians share.
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Author: clarinetguy ★2017
Date: 2015-06-30 05:00
Fernpod, thank you for your comments. A lot of teeth questions come up on this board, and it's nice to hear from a dentist.
I have a question for you since you described the situation with single lip embouchure. Do you think the student would be better off playing double lip?
Do you think double lip is more teeth-friendly?
I was a single lip player for many years, but switched to double lip several years ago and have no plans to go back. Many students naturally seem to take to double lip, but most band directors discourage it. For this reason, I generally teach single lip, but if a student seems more comfortable with double lip, I don't fight it.
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Author: orchestr
Date: 2015-06-30 08:41
Thank you all for your comments, it's a lot of food for thought. Thank you as well, fernpod, for your firsthand knowledge.
The student feels movement in the top front two AND bottom front two teeth, but this still makes sense if the bottom teeth are the fulcrum. He is already playing with a double-lip embouchure, and still has some problems, but not as much as when he played single-lip. I've thought about the fulcrum idea as well and suggested he experiment with the angle of the clarinet, since the more it sticks straight out, the more diametrically opposed the teeth will be. Usually we try to specifically avoid this because that makes it easier to bite the reed closed, but in this case, I'd rather have him playing a little wrong than quitting altogether. Then hopefully, as he gets older, his jaw will become less pliable and his ligament will shrink.
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Author: fernpod
Date: 2015-06-30 16:33
Dear clarinetguy:
In response to your question regarding single lip embouchure v. double lip, I can only answer as a dentist. I play single lip with my maxillary incisors squarely securing the top of the mouthpiece's beak and have not been able to switch to the Clarinet Bboard's often recommended double lip technique.
If our student in question finds that s/he can master double lip, certainly the soft tissue cushion of the lip musculature would dampen the forward vector of force directed to the upper central incisor teeth as a seat cushion disperses our body weight when sitting. However, unless our clarinetist is extremely dedicated and spends more than an hour each day with the clarinet fixed in embouchure, it is very unlikely that s/he would suffer any untoward effect on the maturing bone of the front of his upper jaw.
Among my patient family have been a fair number of student clarinet players. As they passed through their teenage years and continued playing, I cannot recall even one case of tooth misalignment or upper incisor tooth mobility that one could incontrovertibly attribute to clarinet embouchure.
I do not wish to imply that our 13-year-old's report of teeth looseness is not fact, but I would like mention that how a person might perceive a tooth to be loose can be misleading. If one pinches a tooth between thumb and index finger, applies a forward/backward force, one can sense that the tooth in fixation moves. Alas, many times, I have heard this complaint only to find the suspect, mobile tooth was normally mobile (all teeth are a little mobile due to the ligament in which they are fixed to bone). Our finger pads "give" and this compression can be interpreted as tooth mobility.
To orchestr: having your student hold the clarinet out at a greater angle to the floor makes one wonder if Artie Shaw ever mentioned to his dentist concerns for maxillary incisor looseness. Maybe encourage that instrument position. Lands sakes, we could use another Artie!
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Author: clarinetguy ★2017
Date: 2015-06-30 17:30
Thanks for your interesting response, Fernpod! Your common sense answer reminds me of a conversation I had with our orthodontist when my kids were in their teens. They enjoyed their instruments, and didn't want to stop when it was time for braces. The orthodontist, a very kind man, told us not to worry. He said that if they played for a reasonable amount of time each day, it would be fine. On the other hand, if they practiced for hours, there could be problems. We shared a good laugh because we all know that most young teens don't practice that
much.
There has been a lot of discussion here about double lip, and I'm sure there will continue to be. I naturally started playing that way as a beginner in the 60s because it felt very comfortable, and switched when told it wasn't the right way to play. It bothers me that there are some who are so dogmatic about things--you must play single lip, you must hold your clarinet at such and such an angle, you must use the ______ mouthpiece, etc. Every player is different, and there isn't just one correct way to do everything.
Orchestr, it sounds like you're doing things right, trying to find common sense solutions that work for your student instead of taking a dogmatic approach.
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Author: ClaireAnnette
Date: 2015-07-06 14:10
SOLUTION: Thin hard plastic tooth cover from premolar to premolar both upper and lower. Essex. (similar to popular invisiline but very thin plastic, about thickness of plastic used in many packaged products we use.) Double lip will not reduce potential musculature induced orthodontic (tooth moving) forces. We recommend long term use of retainers following orthodontics and this is one reason. He should not be pushing clarinet forward against back of teeth anyway. Possible incisors had already erupted at time of trauma as they are first to erupt. Ensure he is PROPERLY brushing and flossing. If not, could be early periodontal disease. Using tooth covers like this should allow either embouchure technique. No need for complex alterations. Some people do have this problem of tooth movement.
PS clean this appliance after each use so bacteria will not thrive there, consider spraying with anti-microbial periodically, leave in sufficient time, rinse off. No eating or drinking other than water while in place.
There is some literature on this. It would take more than maybe 8hrs a day per literature I have read.
No reason to stop playing clarinet. Find a dentist that understands what is required for playing wind instruments.
From: A clarinetist trained as dentist. Worked a lot with young people. Involved in 'music medicine' .
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Author: clarinetguy ★2017
Date: 2015-07-06 19:49
ClaireAnnette, thanks for responding. This is interesting information.
Are you referring to Essix Thermoformed Appliances? I've never used them, but just read about them. I've had students with braces who sometimes complain about wires cutting their lips, etc. while playing. Can they be used over braces?
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Author: j8649
Date: 2015-07-07 07:12
Hello orchestr, As an orthodontist, the tooth looseness after 30 minutes of playing that you have described seems really unusual to me. For teeth to move in response to forces usually takes weeks to occur unless something else is going on. Shortening of the front teeth roots is a define possibility. You reported that your student ran into a table when he was younger. This could cause resorption (shortening) of the tooth roots. It is a reaction to the previous trauma. Impacted upper canine teeth can also cause resorption of the upper incisor tooth roots. Periodontal disease is a degeneration of the bone surrounding the teeth and can result in loose teeth also. However, it would be unusual for a 13 year old to have any significant periodontal disease unless something else systemically (like diabetes) was going on. I would suggest that your student see his dentist for a full mouth (panoramic) x-ray to see if there is a dental reason for the loose teeth. I hope this helps!
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Author: ClaireAnnette
Date: 2015-07-07 17:41
Attachment: image.jpg (840k)
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Yes, we have said that. 😊
Some references:
Current article on forces:
Yes. We are saying that.
Current article on forces and instruments.
http://paginas.fe.up.pt/clme/icem15/ICEM15_CD/data/papers/3169.
I had a scanned article that would not load...
Solutions for wind players with braces:
https://www.orthomechanic.com/store/product.php?productid=145&cat=14&page=1
http://m.dentakit.com/brgulippr.html
http://m.dentakit.com/snshlipprfor.html
https://www.orthomechanic.com/store/product.php?productid=143&cat=14&page=1
http://www.ortho-direct.com/details.php?prodId=32
http://www.familyorthodonticcare.com/retention.asp
Web page underconstruction, currently updating, please be patient.
Problem with web design software, being corrected at this time.
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Author: ClaireAnnette
Date: 2015-07-07 17:45
Last bit of scanned article:
Web page underconstruction, currently updating, please be patient.
Problem with web design software, being corrected at this time.
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Author: ClaireAnnette
Date: 2015-07-07 17:46
Attachment: image.jpg (593k)
Attachment: image.jpg (593k)
Last bit of scanned article:
Web page underconstruction, currently updating, please be patient.
Problem with web design software, being corrected at this time.
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