Does playing awind instrument influence tooth position and facial morphology? : Systematic review and meta-analysis.

F N Van Der Weijden,C Valkenburg,D E Slot,R B Kuitert,G A Van Der Weijden,F Lobbezoo

doi:10.1007/s00056-020-00223-9

Abstract

PurposeTo systematically search the scientific literature concerning the influence of playing a wind instrument on tooth position and/or facial morphology.MethodsThe PubMed, EMBASE and Cochrane databases were searched up to September 2019. Orthodontic journals were hand searched and grey literature was sought via Google Scholar. Observational studies and (randomized) controlled clinical trials that assessed tooth position and/or facial morphology by profile cephalograms, dental casts or clinical examination were included. The potential risk of bias was assessed. Data from wind instrument players and controls were extracted. Descriptive analysis and meta-analysis were performed.ResultsIn total, 10 eligible studies with a cross-sectional (n = 7) or longitudinal design (n = 3) and an estimated low to serious risk of bias were included. Sample sizes ranged from 36 to 170 participants, varying from children to professional musicians. Descriptive analysis indicated that adults playing a single-reed instrument may have a larger overjet than controls. Playing a brass instrument might be associated with an increase in maxillary and mandibular intermolar width among children. Longitudinal data showed less increase in anterior facial height among brass and single-reed players between the age of 6 and 15. Children playing a wind instrument showed thicker lips than controls. Meta-analysis revealed that after a follow-up of 6 months to 3 years, children playing brass instruments had a significant reduction in overjet as compared to controls. The magnitude of the effect was of questionable clinical relevance and the generalizability was limited.ConclusionsPlaying a wind instrument can influence tooth position and facial morphology in both children and adults. Aspects that stand out are overjet, arch width, facial divergence/convergence and lip thickness. However, evidence was sparse and the strength of the premise emerging from this review was graded to be “very low”.Electronic supplementary materialThe online version of this article (10.1007/s00056-020-00223-9) contains supplementary material, which is available to authorized users.

Highlights

The proposition that wind instruments have an influence on orofacial aspects and may enhance treatment of malocclusions and stimulate development towards a normal condition of the facial musculature was first described by Strayer [34]
The question to be answered was the following: What is the difference in tooth position and/or facial morphology between people who play a wind instrument and those who do not, as found in observational studies and controlled clinical trials?
The following criteria were imposed for inclusion in the systematic review: Observational studies and controlled clinical trials describing the effect of playing a wind instrument on tooth position and facial morphology

Summary

Introduction

The proposition that wind instruments have an influence on orofacial aspects and may enhance treatment of malocclusions and stimulate development towards a normal condition of the facial musculature was first described by Strayer [34] He was an orthodontist and professional bassoonist and classified wind instruments according to the types of mouthpieces (Fig. 1). Brass instruments (e.g., trumpet, trombone, horn, tuba) are placed outside the mouth by pressing the bowl-like mouthpiece against the upper and lower lip. Both upper and lower anterior teeth provide support for the lips. This is done by a rotation movement of the flute in the plica mentalis in combination with alternating protrusion and retrusion of the mandible ([3, 39]; Fig. 1d)

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Conclusion