Wind instruments: good rules for hygienic maintenance
Flute, oboe, tuba, clarinet, saxophone, trumpet… with their mouth, the musicians of wind instruments produce wonderful melodies that enchant and marvel each of us. Often, however, we forget an important detail: the mandibular protrusion exercised to play the instrument and a lack of hygiene of the instruments themselves put the musicians at risk for diseases of dental interest.
Are musicians enough sensitized on the subject? Are they aware of the importance of a program of prophylaxis and maintenance of professional oral hygiene, to avoid any disturbance of teeth and soft tissues of the oral cavity?
This particular and unexplored area has attracted the attention of Eleonora Steffan, a student of Dental Hygiene at the Vita-Salute San Raffaele University, and a musician herself, who turned this subject into her Graduation thesis. Assisted by Prof. Raffaele Vinci, Associate of Odontostomatological Diseases and Coordinator of the Postgraduate School in Oral Surgery at UniSR, and by Dr. Anna Rita Ferreri, our graduate in Dental Hygiene in 2010 and Course teacher for several years, they decided to formulate a hygienic maintenance protocol for the mouthpieces of musical wind instruments. The aim is to underline the importance of guidelines, still absent, for the prevention of health also in the music sector.
They talked about it in this interesting and pleasant interview.
What are the main problems faced by wind instrument musicians?
Numerous scientific research has shown a prevalence of functional disorders of the musculoskeletal system in the dental field in wind instrument musicians. Very few, or almost zero, are the data available on the survival of bacteria on wind instruments.
In our study we have seen, in fact, that those who have been playing for years can have some problems concerning dental health and oral soft tissues, for example:
- Temporo-mandibular joint disorders
- Orthodontic problems: malposition and malocclusion
- Bruxism (teeth grinding)
- Prosthetic problems
- Traumas of soft tissues
- Focal dystonia
- Recurrent mouth herpes
- Xerostomia (dry mouth)
- Routine dental post-treatment injuries
- Dentinal hypersensitivity
- Chronic lung diseases
What is the study you conducted?
Biofilm is a thin film of microorganisms (especially bacteria) attached to a solid support. In our study we first wanted to visually evaluate, by means of photographic images acquired in two different moments (T0 and T1), the presence and extension of residual salivary biofilm on the mouthpieces of the main wind musical instruments (clarinet, flute, trumpet), i.e. instruments that are continuously in contact with the tissues and fluids of the oral cavity.
Then we compared the effectiveness of 3 different hygiene procedures, applied to the mouths of the instruments, which are based on the use of a mouthwash containing 0.2% chlorhexidine.
How was your survey structured?
For our survey we involved 27 musicians at music schools in Milan and Pordenone, with the aim of verifying the problems of these patients and formulating an effective hygienic maintenance protocol for the wind instrument mouthpieces. The survey was based on the photographic survey of a sample of 27 mouthpieces of wind musical instruments, divided into 9 clarinets, 9 trumpets, 9 flutes.
Each type of these instruments has been subjected to 3 different hygiene procedures, respectively:
- Only chemical action by immersion
- Chemical and mechanical action by rubbing
- Chemical and mechanical action by brushing
The musicians were also subjected to an anonymous questionnaire, which investigated the habits of oral hygiene, nutrition, lifestyles, cleaning procedures of the instrument, the relationship with the professional medical figures in the dental field (Odontologist and Dental Hygienist), the personal perception of what oral pathologies a wind instrument musician may run into, following the instrumental exercise.
What results did you obtain?
The mouthpieces submitted to a 1 minute rubbing with cloth and mouthwash containing chlorhexidine 0.2% show, at T0 and T1, more evident differences compared to the previous method. The mechanical rubbing action, associated with the use of mouthwash, allows a greater removal of residual biofilm. Also this procedure highlights the differences between the materials of the mouthpieces, as the clarinet and saxophone ebonite tends to retain a homogeneous film layer after cleaning, with respect to the metal of trumpets and flutes.
Finally, the mouthpieces subjected to a 1 minute brushing with a brush and mouthwash containing 0.2% chlorhexidine show, at T0 and T1, significant differences. It is evident that on all the types of materials the mechanical action of brushing, with a soft bristles that reaches the narrowest points of the mouthpiece, together with the chemical action of the mouthwash, favors the removal of almost all visible biofilm.
The questionnaires showed that these patients, while undergoing dental treatment and following periodic professional oral hygiene checks, do not seem to pay attention to the changes to which the teeth and soft tissues are inevitably exposed.
What hygienic maintenance protocol did you formulate following your study?
On the basis of our study, we proceeded to formulate a basic hygienic maintenance protocol for the mouthpieces of wind musical instruments, to guarantee them a long and healthy musical career:
- Whenever possible, every musician should have his own personal instrument
- If this is not possible, every musician should have at least his own mouthpiece
- The reeds must not be absolutely shared
- Instruments should be properly dismantled and cleaned at the end of each performance
- The mouthpieces should be sanitized with care, at least once a week
- For cleaning and disinfection, especially when sharing the instrument, it is recommended to brush the mouthpiece, for at least 1 minute, with a soft bristle brush and mouthwash containing 0.2% chlorhexidine
- Protect the cork parts of the instruments from moisture
- After 1-5 minutes of immersion, brush the surfaces, for at least 1 minute, with a soft bristle brush. This step may need to be repeated if the mouthpiece is excessively dirty. You can also use other smaller sized brushes to better reach the narrow areas of the mouthpiece
- Take care not to scratch the surfaces, pressing with the plastic parts of the devices used
- Rinse thoroughly (always protecting the cork parts)
- Place the parts of the instrument in a cloth or paper towel
- Dry them thoroughly (even inside)
- Always change the cloth you dry the instrument with. If this is not possible, store it in a separate case or at least take care not to store it when still damp
- The cleaning brushes, rags and drying cloths should be routinely passed in the microwave to speed up drying and to reduce contamination. The decontamination of the reeds with this method can be effective, but it can cause the premature deterioration of the natural reeds