 The Clarinet BBoard
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Author: Jonathan
Date: 2001-05-19 12:43
G,day,
I've been having a bit of trouble lately with my jaw clicking every time I open my mouth(mainly on the left side). This doesn't really affect my playing clarinet normally, but after doing more than 6 hours playing a day for more than about 3 days in a row, it starts to get somewhat painfull. Mostly, I try not to play any more than that normally anyway, but in the last week my con orchestra has been having 6 hours of rehearsals a day, and some days I also had additional rehearsals after which my jaw was not too good. We were playing Takemitsu - Dreamtime, Bartok - Hungarian Pictures (I've still got the solo from the 5th Mvmnt going round and round in my head), and Sibelius 2(which was a really great program)(Also a harp piece by Debussy - but no clarinets in that). But, in the last mvmnt of Sibelius 2 my jaw almost fell off in the concert last night. And every morning when I open my mouth for the first time, it makes a very loud crunching noise - but instead of being on the left side as is usual throughout the day, it is on the right side. So anyway, I was wondering if anyone has either experienced something like this, or knows someone who has, that can give adivice.
At first I thought it may be that I was biting too hard on the mouthpiece/reed and didn't realise it because I use Leukosilk to cover my lower teeth. I had a talk to my teacher about this and I don't think that this is the cause.
I've also spent a fair amount of time working out what my jaw is doing when i play.
As far as i can tell it is in the 'natural position' (not in the clicked position) (this has been hard to tell).
Occasionally my jaw does move while playing although i don't notice it.(looking in mirror and teachers comments observe that this happens when playing pp and then immediately ff) - in studies such as Uhl 10 (if memory serves correct) where first note is forte second two are piano etc.
Another explanation might be something to do with my wisdom teeth??? I've got my top two but not yet the bottom two - I've heard some people don't get the two bottom ones??
Anyway i should see a doctor --- I know.... but you know how it is - one thing after the other no time to do anything --- and i'm only still in uni. So, if any one has any ideas, they would be much appreciated.
Thankyou,
Jonathan
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Author: Irwin
Date: 2001-05-19 12:48
Go see a dentist who specializes in TMJ disorders (I think TMJ means temporomandibular jaw).
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Author: jerry
Date: 2001-05-19 12:54
My daughter had this problem and she is not a musician. See your dentist.
~ jerry
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Author: Terry Horlick
Date: 2001-05-19 14:06
I am one of the dentists who lurk on this board. Jerry and Irwin are right on. Get yourself to your dentist and ask there. It sounds like you are at risk for TMD. This is Tempro-mandibular, myo-facial disfunction. Most folks know it as Temporal-mandibular joint disfunction (think of it as jaw-joint-muscle disorder).
TMD is often prgressive and rarely goes away on it's own. Middle age females make up the bulk of the folks who <b>suffer</b> with this. Early signs are joint sounds (clicking and grinding), deviation of the jaw when opening, and muscle (chewing muscle) tenderness. This problem can worsen and end up causing severe headache, back aches, ringing in the ears and other fine things.
In it's early stages treatment may be as simple as wearing a mouth guard type appliance at night. Perhaps getting a different mouthpiece which allows you to position your jaw differently. Treatment can range from appliances through grinding on the surface of the teeth to change your bite, or placing crowns on the teeth to change the bite. It may also range all the way to surgery on your jaw.
The condition is just a bother now, but it can develop into a chronic debilitating condition, I urge you to see your dentist. What you should be asking after presenting your problem is if your dentist has a specialist who deals with TMJ problems to whom you can be referred. Perhaps your dentist specializes in this difficult subject, more likely a referral will be made. Your dentist is not admitting that he/she cannot handle the problem, but rather that you warrant the best care available.
BTW, I am a children's dentist and therefore rarely see TMD in my office. The rare case I do see get's referred out. The fellow I send to knows his stuff and every patient who walks in has a set of TMJ tomograms (expensive jaw x-rays) done. Do look into this so that it won't get worse and ruin your playing carreer.
Respectfully submitted, Terry Horlick
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Author: Bob Arney
Date: 2001-05-19 14:38
"I'm not a doctor,but I play one on TV." Jonathan, I'm sure you have heard that commercial. Be very careful with getting too excited about this condition. Going to a TMJ specialist may be a bit premature at this point. Ask your dentist, although be careful there also. Those of us who suffer from fibromyalgia know that there are about six or seven muscle trigger points that can bring on this condition because one muscle is being subjected to stress and another muscle group is not compensating. I am sure that six hours of practicing can contribute to this situation. Try slacking off a little, breaking up your sessions with rest periods between practice sessions. That will help relax and condition the masseter muscle group..
I think you will find that the simple diagnosis from a dentist is, "see a TMJ specialist." and the TMJ specialist ultimtely thinks in terms of surgery. Avoid this at all cost.
Bob A
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Author: Mark Charette
Date: 2001-05-19 16:01
Bob Arney wrote:
> I think you will find that the simple diagnosis from a dentist
> is, "see a TMJ specialist." and the TMJ specialist ultimtely
> thinks in terms of surgery. Avoid this at all cost.
Bob,
I think that your statement here is highly irresponsible. We cannot diagnose at a distance, and telling someone to "avoid at all cost" is doing just that.
Jonathan, follow the other advice here, get checked by your dentist, and see what comes of it. Make intelligent choices based on real information, not our guesses.
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Author: Todd
Date: 2001-05-19 16:31
FYI, not all TMJ specialists think in terms of surgery. I'm a dentist and the ones I refer to in my area do not recommend surgery. The patients of mine they have seen have been treated successfully with non-invasive therapy.
I agree--Jonathan, go see your dentist
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Author: Bob Arney
Date: 2001-05-19 17:13
Mark and Todd. What don't you understand about the word "ultimately." After throwing away a bunch of money at a TMJ "specialist" shop (and I used the term shop advisedly) I elected not to have the surgery. You will also note that I said to be careful.
Bob A
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Author: Mark Charette
Date: 2001-05-19 17:17
Bob - your intent was very clear to me - don't try & play some semantic game. "Ultimately" we will all die, and perhaps no surgery will be performed.
Surgery is not to be "avoided at all cost". The cost, in terms of success rates, financial, pain, and quality of life, need to be weighed. <b>You</b> may be able to avoid the knife, but it doesn't mean what's right for you is right for all.
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Author: Leanne
Date: 2001-05-19 19:01
I don't have that problem exactly, but when I play for too long my jaw gets excrusatingly sore. My jaw doesn't click, but I have a feeling my problem isn't far off from yours.
I saw a dentist, he sent me to an orthodontist, he told me that at this point my only opinion to fully nullify the pain was surgery.
The major down fall of the surgery is that sometimes they can damage the nerve in your lower lip so that your lip is numb for the rest of your life. For me, this is not an option. Also, it only cost $20,000 USD, so maybe if I drop out of music and marry a millionare...
Your case is probably different, but I thought I'd let you know about my experience. Good luck!
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Author: beth
Date: 2001-05-20 01:18
I wasn't initially going to respond to this posting; some good advice has been given. But, after going through my first major flare up of TMJ this fall.... 1st: a clicking or popping jaw doesn't necessarily, in of itself, indicate TMJ. Several other indicators such as heiredity(sp), jaw size, bite, locking jaw, etc. also are factors of TMJ. The only way to know for sure is to see a specialist. 2nd: see your regular dentist 1st. He/she will give you referrals to oral surgeons if its prudent. 3rd: usually you'll be given more than one referral - check them out before making an appointment, different Docs have different approaches. Find one that you're comfortable with. 4th: check with your insurance to see if it's covered. TMJ can fall under dental or medical ins. coverage, my dental ins. didn't cover it, but my medical did. That may also factor who you see. 5th. IF ITS TMJ, its not necessairly means surgery is the way to solve it, in fact, most docs take a conservative approach. My flare up was so bad that I was having trouble chewing without pain. My course of treatment was non-invasive; a pain in the *** for sure because I had to make some life style changes besides treating the immediate problem. Treatment involved a soft diet, heat packs and advil for about a month. I could keep playing the clarinet though through the treatment period. My Doc advocated this, an it worked. Only if it continues, and the above doesn't help, then will devices be explored (a pad inserted in the "hinge") or some other device. And if that doesn't work, then and only then will surgery be even discussed. I guess the upshot is go to your dentist, if you need a specialist find one you trust and will respect your wishes as far as treatment goes, follow the course of treatment and if any habits must be changed DO IT (ie, no more chewing gum, chewing ice, holding a pen/pencil between your teeth etc.. the list goes on) and TMJ, if that's what it is, isn't a "death sentence" you can continue to play, flare-ups can be as long as years apart, and just look at it as one of those chronic things that you adjust living with like ulnar tunnel syndrome, heel spurs, arthritis etc...
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Author: KayR
Date: 2001-05-20 01:56
I was diagnosed with TMJ problems way back when I was in high school. My father and uncle also had similar problems, and we were all treated with multiple years of braces. Surgery was never mentioned, but this was in the mid 1970s. At the time, I went to a specialist at Temple who also had me do a series of exercises designed to strengthen specific jaw muscles. During the treatment, I continued playing clarinet, and played it afterwards throughout college. It was painful to play when the flare ups started, but with treatment, the pain went away. In my father and uncle's cases, they were treated too late, and also suffered nerve damage which is currently treated with medication. I'd strongly second the opinion of those who recommended going to a dentist for an initial opinion, and then on to a specialist if the problem persists. Good luck!
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Author: Terry Horlick
Date: 2001-05-20 03:44
Bob,
I really disagree with you. First you have fibromyalgia, and it is really unlikely that is what Jonathan has. The clicking in the jaw is from the condyle (the rounded top part of the jaw) slipping off of the temporal mandibular disc (think of it as a tough cushion between the cartillage of the condyle and that of the base of the skull). As you open your mouth that disc is supposed to glide forwards and stay between your skull and jaw. The disc fails to move far enough forward and then as the jaw continues to open it clicks off of the front of the disc the disc gets mashed into the space created behind the condyle of the opened jaw.
The point of all this is we were not presented with trigger points but rather clicking followed by progressive pain. The pain may be from the joint or the muscles trying to compensate. I still think Jonathan needs to consult his dentist and seek referral. The picture you paint of the TMD specialist hovering over every paitent with a scalpel in one hand and an insurance form in the other is unfair and incorrect. I don't know anyone who would consider surgery until <B>all</b> other aproaches were considered.
With regards to permanent lip numbness, I have never heard of this from this type of surgery. The trigeminal nerve exits the jaw far below the TMJ, maybe an inch or an inch and a half, and doesn't course through the joint capsule. I suppose a complication is possible with a raging infection causing damage, but it is not likely. If surgery is eventuated, be sure and pick a surgeon who knows how to perform sterile surgery, can prescribe apropriate antibiotcs and responds to you if you are running a fever! I think that pretty well applies to all folks who treat TMJ problems. (BTW, most TMD specialists dont jump in to doing surgery, in fact most will refer the patient to an oral surgeon if surgery is needed.)
With all that said, I do agree with you on your suggestion of a more sane practice schedule. If playing is causing this problem to flare up then it really makes sense to use moderation on practice time. If pain is encountered stop playing. Also you might consider a week or two off. Practice fingering or study harmony and chord construction while your jaw rests.... and do ask your dentist for a professional evaluation.
Respectively submitted, Terry (Horlick, D.M.D.)
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Author: Jonathan
Date: 2001-05-20 12:14
Thankyou all so much for your advice. I will go and see my dentist sometime soon when I have a day off. And I will try not to do so much playing if possible. I'll also try to take a week or so off over the June/July holidays. Thankfully orchestra is almost finished for the semester so at least thats one thing out of the way. Again, many thanks for all your comments,
Jonathan Farquhar
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