Tag Archives: health

Dentistry for Musicians

by Caroline Blouin, DDS and Member of AFM Local 406 (Montreal, PQ)

Your passion for playing your instrument or singing means that you practice every day, year after year. Then, suddenly, nothing feels right. Changes in sensation or “feel,” over-development of the muscles of the mouth, constant, prolonged pressure on the mouthpiece—or chin rest in the case of violin and viola players—and tooth movement can lead to physical problems that compromise playing technique, sound, or the formation of the embouchure in wind instrument players.

Musicians are likened to high performance athletes, using as many muscles and anatomic structures as a marathon runner. But, musicians are more than high performance athletes. They develop oral musculature in unusual and specific ways by exerting prolonged, repetitive pressure on the teeth and temporomandibular joint (TMJ), often from an early age. In the event of pain or injury, a musician must be able to regain his full ability to play or sing.

When providing oral/dental, head, and neck care to musicians, especially wind players, the dental surgeon must be especially attentive. The doctor should have an understanding of the importance of the teeth, the TMJ, and the specific musculature involved in playing the instrument, in order to provide care that is tailored to each musician patient’s condition.

The Incidence of Oral Problems in Musicians

In order to profile the incidence of oral problems in musicians, a questionnaire was submitted to 158 musicians. Responses showed that 26% of the musicians surveyed experienced discomfort and problems. Some reported being unable to play their instrument due to dental, joint, or muscle problems related to the teeth, head, or neck.

Types of Dental Problems Are Encountered

Among musicians who reported discomfort and problems, 28% experienced problems related to wearing orthodontic appliances or tooth movement. Pain in the mandible (lower jaw) and TMJ affected 22% of respondents. Tooth and gum pain affected 11% of respondents, while 6% were bothered by tooth wear and grinding of the teeth (bruxism). Mouth ulcers accounted for 6% of the problems encountered, while muscle strain or focal dystonia (failure of a muscle to respond) affected 3% of musicians surveyed. Twenty-four percent of musicians reported other various types of problems, including tension migraines, hyperacusis (lack of tolerance to normal environmental sounds), recovery time after oral surgery (transplant, implants, or tooth extractions), replacement of one or more teeth that are vital for forming the embouchure (fixed or removable prosthetic appliances and dental implants), aphonia (loss of voice), sore throat (pharynx, larynx), soft palate, pain and cracks in the teeth caused by the instrument vibrating against the teeth, and temporary loss of feeling or sensitivity in the lips.

Based on the results of the questionnaire, we conclude that musicians are affected by specific dental problems that can interfere with their ability to play, either temporarily, or for an extended period of time. These findings are consistent with those of other studies conducted on various origins of the dental problems encountered by musicians, which are often related to performing repetitive movements for long hours in stressful performance situations.

Perfect Harmony Between Musician and Dentist

While most respondents told their dentists that they played an instrument, few had asked their dentists to make a model by taking a digital or physical impression of their mouth, an essential precaution in the event of an accident (for example, a recent model of the teeth could be used to reconstruct a fractured tooth as accurately as possible). The slightest change in the position, shape, and location of the teeth could alter airflow or even the position of the tongue or mandible, which would alter how the embouchure feels and, consequently, the sound produced by the musician. Providing dental treatment without taking a musician’s unique features and specific needs into account, may mean that the mouth simply doesn’t close the way it did before. This could be detrimental to playing and even threaten or end an instrumentalist’s career.

Preventive Dental Care and Treatment

There are various ways to prevent or treat the different dental problems faced by musicians. These include lip shields, therapeutic aids to minimize discomfort during orthodontic treatment, treatment to improve occlusion (bite), chin rests for a violinists, or customized mouthpieces for trumpet players. Musicians should complete personalized questionnaires with their dentists to identify needs, expectations, and deficiencies so that the facility in playing and sound are optimal, comfortable, and easy. As often as possible, musicians should bring their instrument to the dentist’s office for consultation and treatment. This allows the dentist to help pinpoint problems and create a prosthetic appliance tailored to instrumentalists’ specific needs.

Wind players, consider this: having a model made of your dental arches every year is an inexpensive way of safeguarding your sound. And, it might be a good idea to entrust your preventive dental care and treatment to dentists with interest and expertise in conditions affecting your profession.

Dr. Caroline Blouin has her own private practice (www.centredentairecharest.com) in Quebec City. She also holds a Diploma of Advanced Studies (1st Prize for Violin) from the Conservatoire de musique de Québec, as well as a Post-Master’s Professional Studies Certificate from Temple University in Philadelphia. She is completing training in Paris and Montauban to obtain a European Diploma in Performing Arts Medicine (Music). She is studying under the mentorship of Dr. Pierre Dana, renowned Parisian doctor of dental surgery, and specialist in the treatment of wind players. Please address your questions and comments to: drecblouindentimusi@gmail.com or (418) 647-4238.

How to Take Care of Your Eyes

EDITOR’S NOTE: The following article is a result of research conducted across a number of health-related Web sites. The AFM does not endorse any specific remedy for eye problems and urges members to consult a medical practitioner before deciding on a course of action.

Eye problems are an often-overlooked health issue for professional musicians. The effort eyes make to read sheet music or follow the conductor while peering around an instrument can lead to a number of common, but treatable, complaints.

Unfortunately, opticians aren’t always sensitive to the specific concerns musicians have with their eyes. For instance, a one-size-fits-all approach to correcting vision may not work when there are so many different tasks eyes perform in an average day. A musician who logs off the computer, drives to work, performs for an evening, then goes home to watch the “Late Show with David Letterman” on TV, before reading in bed, ideally might need different glasses for each task. Fortunately, opticians who are used to treating increasingly widespread computer-related eye disorders suggest their advice can also help working musicians.

A typical complaint of professional musicians is eyestrain. Its cause is similar to that which leads to the same diagnosis in computer users. The eyes just aren’t meant to repetitively scan the small text of a music score or computer screen at a distance of two or three feet for long periods of time. Close focusing and repetitive scanning can even lead to a condition called “spasms of accommodation.” This is when the eyes’ overworked muscles spasm and are no longer able to adjust when a musician looks at something far away. Everything distant becomes blurry because the muscles have lost the ability to focus. Another more serious consequence of eyestrain is ocular migraine, a condition believed to be caused by a spasm of blood vessels brought on by eyestrain and which leads to visual disturbances. Opticians consider eyestrain a form of repetitive stress injury, which takes time to develop and a long time to treat.

Two other eye problems that commonly affect musicians were identified in a study conducted by Dr. Paul Alan Harris and published in a 1988 edition of The Journal of the American Optometric Association. Harris studied orchestra members in situ and found that peculiar working conditions led to diagnoses of astigmatism (abnormal curvature of the lens) and anisometropia (a large difference between the refractive power of the two eyes). Specifically, different vision problems arose depending on which instrument was played and where a musician sat. For instance, Harris found that a bass clarinetist, who habitually tilted his head back to play and looked left to view sheet music and conductor, had a significantly astigmatic right eye.

Whether you wear corrective lenses or not, there are several actions that can be taken to reduce the risk of eye trouble:

  • Wear the correct lenses to play. A pianist’s glasses that are good for reading books might not be suitable for reading a score. She’ll have to have another pair to read the music; if not, she’ll probably find herself leaning forward in order to get the notes in focus. Modern lenses have been developed that can help musicians. Three of these are “progressive bifocal” lenses, “trifocal” lenses, and “variable focus lenses,” sometimes called “computer glasses.” The days when only grandpa wore bifocals might be over; opticians are prescribing these multi-task lenses even for young children these days.
  • Lubricate your eyes. One trick to avoid eye problems is also very simple: blink! Concentrating on a score during a recital might mean a musician forgets to blink, and when the cornea dries out, eyes can start to ache. Musicians who wear contact lenses are prone to dry eyes, especially if seated close to air conditioning ducts in an orchestra pit, so they should either make liberal use of artificial tears, or wear their glasses when performing in the pit.
  • Adjust the music stand correctly. The top of your sheet music should ideally be at or just below eye level to avoid straining. If the stand must be below eye level, it is better to lower the eyes than tilt the head. Avoid eye problems caused by neck rotation by placing the stand directly in front of you. Also, if you have a choice between wearing glasses or contact lenses, the latter might be preferable as they allow for better peripheral vision which in turn can reduce the need for neck movement.
  • Find an optician who understands. A musician’s eyes are arguably as important as his or her hands. If you think you have work-related eye trouble, find an optician who is sensitive to this issue or who works with other musicians. One professional musician suggests going as far as to bring your instrument, music stand, clip light, and sheet music (preferably a complex score with lots of minute instructions) to the clinic so the optician can get to know your working conditions and individual needs.

Huh? You May Already Have Hearing Loss

Following a recent live music event, I interviewed a longtime musician who joked that his years of gigging have made it more difficult to carry on a normal conversation. I patiently repeated my questions, trying to speak in an abnormally loud voice. When I asked if he’d ever considered using musicians’ earplugs the man laughed at the absurdity of such an idea. Unfortunately, hearing loss really is no laughing matter, especially for musicians.

The auditory system is one of the body’s most delicate sensory systems, and when you are frequently exposed to excessive sound levels, the system can be easily damaged. Though many people associate musician hearing loss with rockers (20% of whom have some hearing loss according to one Norwegian Institutt for Klinisk Medisin study), any type of musician is at risk. Often, only when noticeable hearing loss has already occurred, do musicians take the problem seriously.

The National Institute for Occupational Safety and Health (NIOSH) sets guidelines for the maximum time you can safely be exposed to various sound pressures measured in decibels (dB). Below is a table with approximate ranges of safe exposure for various instruments.

Hearing Loss chart

CLICK TO ENLARGE

As you can see from the table, the dangers are real and occur with a wide range of instruments and genres of music. Following are some tips to reduce the danger of hearing loss.

  •   Purchase and wear musicians’ earplugs. They are superior to traditional earplugs because they offer “flat” attenuation, while traditional earplugs tend to filter more sound from higher frequencies, resulting in a muffled sound.
  •   As you can see from the table, each instrument has a wide volume range. When possible, practice more softly, or play your electrified instrument “unplugged.”
  •   To reduce your overall exposure to sound, take precautions in your daily life. Avoid any environment where you need to raise your voice to be heard. Wear earplugs or earmuffs when mowing the lawn or operating other loud machinery, and turn down the volume on your television and iPod.
  •   During rehearsals take frequent, 15-minute silence breaks.
  •   When you have a break during your gig, take a moment to step outside and give your ears a rest.
  •   Spread out so you are not being blasted by the musician next to you. Also, move away from on-stage monitors and amplifiers.

For more information on musician hearing loss and additional tips visit House Research Institute at www.hei.org or Hearing Education and Awareness for Rockers (HEAR) at www.hearnet.com.

Prevent Voice Damage

Doctor Explains How to Prevent Voice Damage

Bob Dylan never had the most beautiful voice among musician, but listening to him today it’s easy to hear his voice has gotten even coarser over the years. With the release of his newest album, Shadows in the Night, Dylan is coverings songs made famous by singers like Frank Sinatra. Not exactly the easiest songs to sing with a voice like Dylan. Seeing how getting older can affect the voice of all musicians, we’re glad Vulture reached out to otolaryngologist Dr. Milan Amin, director of the NYU Voice Center, for an explanation and more importantly, if there is any way to fix it.

Amin listened to some of the new album Shadows in the Night and compared it with Dylan’s earlier hits from the ‘60s. “The top part of Dylan’s pitch range has dropped, so he can’t access that.  When he’s trying to go up in his pitch with certain words and phrases, the voice gets rough. The other thing is that his whole tone is lower.

Amin explains that vocal cords are basically muscles underneath layers of collagen and a watery substance called hyaluronic acid. “As you get older, you lose muscle bulk. The layer starts to lose both collagen and hyaluronic acid, so the entire vocal fold sags, just like skin would. How you produce voice is by having the vocal folds come in contact with each other and blowing air past them, so if the vocal folds can’t contact each other, then you can’t produce as strong a sound.”

Amin right away points out smoking can only hurt, and being in dirty bars for so long filled with smoke certainly didn’t help either. He points out that performing on a rigorous schedule for so long will wear down the vocals. He also attributes it to late night performances, lack of sleep to rest the vocals, and even eating before bed causes acid reflux which can inflame the voice-box region.

Amin makes a great analogy comparing it to a person’s joints. “You get a little ding and they don’t work like they used to. The surface lining of the vocal cords ends up getting little nicks, so they can’t vibrate like they should.”

Luckily, and very importantly, this isn’t irreparable. Unlike most other muscles in your body where you need to use them to build strength, the vocal cords can’t do that. As Amin points out, “singers would have these huge, fat vocal chords and wouldn’t be able to breathe.”

The most common solution is simple airflow exercises and behavioral modifications to make sure they aren’t damaging their voice. There are also surgical measures, as Amin explains, “You can inject materials that will essentially give the vocal folds more body. That can give you better contact between the cords and better volume. If you give the cords better volume, they can increase their pitch range.”

For all you musicians out there, take this as a warning. Listen to Dr. Amin on how to prevent voice damage. You need to protect your voice and be careful, or you will lose it. If you have an tips to share with how your keep your voice healthy, let us know in the comments below.

Don’t Let the Flu and Colds Get You Down

According to the Centers for Disease Control and Prevention, February is generally the peak month for flu activity. This season has been dominated by H3N2 viruses, which generally lead to more severe illness. The first defense against the flu is to get a flu shot and you should have done so last fall. However, because the circulating viruses have drifted from the original virus, the vaccine may end up being less effective than in previous years.

While colds can occur any time of year, they tend to be more prevalent and spread easier during the cold months, when people congregate indoors. There are steps you can take to lessen your chance of infection or reduce the length of the time you are ill.

Prevention

Most flu viruses are not spread directly
by airborne particles from coughs and sneezes, but by contact. Therefore, hand washing is a critical defense in illness prevention. When you are in a public place wash your hands often and avoid touching any part of your face. Carry hand sanitizer for those times when proper hand washing is not possible.

Bar soap is itself an effective breeding ground for all sorts of viruses and bacteria, so stick to liquids when washing up. Hand towels should be changed often for the same reason and, when in public restrooms, use disposable towels or air dryers.

Frequently clean surfaces such as stair rails, telephones, countertops, desks, music stands, and doorknobs. Likewise, clean your mouthpiece each time you handle it and avoid touching the part that will make contact with your lips.

Germs survive better in stagnant air, so whenever possible open the windows and air out your home or practice room. Also, avoid breathing smoke. Smoke is a respiratory irritant and can actually increase your susceptibility to viruses. If you have no choice but to play in a smoke-filled room, be sure to step out for some fresh air during breaks.

Treatment

Despite our best efforts the average American adult catches about two to four colds a year and 30 to 50 million Americans will come down with the flu. It is almost inevitable that you, or someone close to you, will become sick during the season. Here are some tips to help you get well sooner.

The first step is to determine whether you are dealing with a common cold or influenza. Flu is a contagious illness that can spread quickly from one person to another. It affects the nose, throat, lungs, and other parts of the body, causing mild to severe illness. More than 200,000 people are hospitalized from seasonal flu complications, which lead to more than 3,000 deaths each year. Most deaths are in persons 65 and older.

Cold symptoms usually include a runny nose, sneezing, and coughing. Influenza often includes a more severe form of these same symptoms with the addition of one or more of the following: fever, extreme tiredness, sore throat, headache, and muscle aches.

If you think you are coming down with the flu, there are prescription medications, such as Tamiflu, which may reduce the time you are sick, but they must be taken within the first 48 hours of the appearance of symptoms. Beyond that, you may take over-the-counter medications to relieve symptoms and make you more comfortable.

There are currently no medications that will cure either colds or flu, but there are other ways to help your body recover. First of all, stay home as much as possible. Not only does your body need plenty of rest, but you also don’t want to spread the illness to the rest of your group or other musicians. Drink plenty of liquids, avoiding alcoholic beverages, which are actually dehydrating.

There are many different types of cold and flu viruses and the length of illness varies. Generally, you should be feeling better in about one week. However, if you experience any of the following symptoms: high or prolonged fever; difficulty breathing or shortness of breath; pain or pressure in the chest; near-fainting or fainting; confusion; or severe persistent vomiting you should seek medical care immediately.

Aside from these tips, follow a healthy diet and get enough rest all year long to help build your resistance and shorten recovery time.

Less Is Best When Treating TMJ Disorder

EDITOR’S NOTE: This article uses research from several resources including the National Institute of Dental and Craniofacial Research at the National Institutes of Health (www.nidcr.nih.gov). The AFM urges musicians to seek professional medical advice when dealing with health issues.

If you are a musician suffering from temporomandibular joint (TMJ) pain and/or dysfunction you are not alone. One study showed that 75% of the population experiences one or more TMJ disorder symptom in their lifetime and those numbers are even higher among musicians.

The TMJ connects the lower jaw, called the mandible, to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth you will feel the joints. These joints are flexible, allowing the jaw to move smoothly up and down and side to side for speech, singing, chewing, and yawning.

When the mouth is open, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. They slide back to their original position when the mouth is closed. A soft disc lies between the condyle and the temporal bone to absorb shock. This combination of hinge and sliding motions makes the TMJ among the most complex joints in the body.

There are three basic types of TMJ disorders—myofacial pain (discomfort in the muscles that control jaw function), internal derangement of the joint (displaced disc, dislocated jaw, or condyle injury), and arthritis. You may suffer from more than one of these conditions at the same time.

Any musician could be affected by TMJ disorders, but violists, violinists, wind instrumentalists, and singers, seem to be more susceptible due to the stress they put on the TMJ. Other musicians may develop TMJ disorder because of poor posture or anxiety, especially if they tend to clench their jaw or grind their teeth at night. Other causes of TMJ disorder include arthritis, jaw injury, or muscle fatigue.

There is a wide range of TMJ disorder symptoms, which include radiating pain in the face, jaw, or neck; jaw stiffness; limited jaw movement or locking jaw; painful clicking or popping when opening and closing the jaw; or a change in the way the upper and lower teeth fit together. Some of these symptoms overlap with those of other conditions, such as sinus and ear infections or toothache, making TMJ difficult to diagnose. A health care provider may use X-rays or MRI images, in combination with medical and dental history, for proper diagnosis.

There is no certified medical TMJ specialty, so finding the right care can be difficult. Look for a health care provider who understands musculoskeletal disorders (affecting muscle, bone, and joints) and who is trained in treating pain conditions and able to understand your special needs and stresses as a performing musician. Performance Arts Clinics are often a good source of advice, particularly when pain continues over time and interferes with your career.

Complex cases, marked by prolonged, persistent, and severe pain; jaw dysfunction; coexisting conditions; and diminished ability to work, may require a team of experts from various fields, such as neurology, rheumatology, pain management, and others, for diagnosis and treatment.

For most people, TMJ problems will go away on their own. So, it is best to start with conservative treatments. Patients may be advised to make it a habit to take frequent breaks while rehearsing, relax facial and jaw muscles frequently during the day, avoid chewing hard foods and gum, apply ice packs, avoid extreme jaw movements (for example, yawning or loud singing), and learn relaxation techniques.

Even for persistent TMJ, most people do not require aggressive treatment. Short-term use of over-the-counter pain medicines or nonsteroidal anti-inflammatory drugs (NSAIDS), may provide temporary relief. When necessary, your physician can prescribe stronger medications to ease the symptoms.

Your doctor or dentist may recommend a stabilization splint or bite guard, especially if nighttime teeth grinding is suspected. These plastic guards fit over the upper or lower teeth and should only be used for a short period of time and should not cause pain.

Other irreversible treatments, such as orthodontics to change the bite, surgery, and implants are controversial and should be avoided. If your doctor recommends them, be sure to seek a second opinion.

For more information on TMJ disorders and support visit the TMJ Association website (www.tmj.org).

Vision Protection: More Than Meets the Eye

There are plenty of obvious injuries that can result from repetitive music practice and playing. Carpal tunnel, tinnitus, and neck pain are just a few injuries musicians should look out for. One commonly overlooked problem area is the tool used to read music—the eyes.

Factors that put musicians’ eyes at risk for injury and strain include focusing on small notes on a page for long periods of time, frequent reading with inadequate light, dry eyes, and playing loud and high pitched notes on wind instruments, which can double eye pressure.

The eyes weren’t meant to repeatedly scan small text such as musical notes for an extended length of time. Doing so overworks the muscles in the eyes to the point where they begin to spasm and cause vision to blur. This is called eye strain and it can sometimes lead to ocular migraines

Prevention is the best way to curb eye strain. One simple way to relieve stress on your eyes is to blink or carry eye drops. When the cornea becomes dry, the eye begins to ache. Blinking lubricates them. If you wear contact lenses, you are more susceptible to dry eyes. Consider wearing your glasses to gigs or when you rehearse. Also, be mindful of having proper light and taking appropriate resting breaks when your eyes begin to fatigue.

Janet Horvath of Local 30-73 (St. Paul Minneapolis, MN), author of Playing Less Hurt: An Injury Prevention Guide, and associate principal cellist for the Minnesota Orchestra, says a major cause of eye strain stems from the strenuous, uncomfortable positions musicians sit or stand in when playing in a group or with a music stand. Horvath suggests, when practicing at home or with a group or orchestra, make sure the room is brightly lit; that you aren’t too far away from the sheet music; and that you aren’t craning your neck to see the pages.

If you practice with a music stand, be sure to adjust it to eye level or slightly below and place it where you won’t have to turn your body or crane your neck to see the notes. Maintaining a neutral head and neck position is a key element to reducing the occurrence of eye strain. If you share a music stand with another musician and are used to craning your neck to one side, try switching places to create a better balance. “Studies show there is a higher rate of astigmatism in musicians,” says Horvath. “Some musicians often have to play in chronically asymmetrical positions and the amount of eye movement and head movement when tracking an object, like notes on a page, should be balanced.”

Those who wear corrective lenses should consult an optometrist or ophthalmologist on what types of product is most helpful for a particular performance situation. Horvath actually brought along her stand and a page of sheet music to her eye doctor appointment to illustrate the distance at which her eyes had to work when playing with the orchestra. “If you can take the instrument, that’s even better,” says Horvath. “The doctor wouldn’t know it’s quite a few feet away, it’s not book reading distance and not long driving distance.”

Horvath recommends progressive lenses for musicians in their 40s and 50s. These “allin- one” lenses pack every scenario, reading, driving, and watching TV, into one convenient pair and lack the lines that bifocals and trifocals have.

Since space issues are a common problem in orchestras, it’s important to make your conductor and orchestra aware of any discomfort or difficulty seeing the sheet music. Work with your stand partner to find the best placement of the music, where it is comfortable for both of you. Sometimes, simply turning a chair in a different angle is preferable and works better than twisting your pelvis, core, or neck to view the sheet music. “The most important thing is figuring out your head and neck angle and how you are tracking the music,” says Horvath. “This is essential to avoid injury to body, spine, and shoulders too.”