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Embouchure problems and treatment

Oral health

Good oral health is required by musicians to provide a successful embouchure. During the 1950s and 60s, the oral health of the adult population was generally poor. Gum disease and poor oral hygiene often led to loss of teeth. In the Adult Dental Health Survey of 1968, 37% of the population was edentulous with a further 22% wearing partial dentures. High levels of gum disease and limited oral hygiene had a detrimental effect on a musician’s ability to play. Playing a musical instrument with an unstable occlusion caused by dentures or loose teeth was highly unsatisfactory. 

Dental problems

In addition to general poor oral health, Porter recognised dental conditions which commonly hampered musician. Frequent problems included sharp or loose incisors causing lip damage and disrupting the embouchure, inflammatory gum conditions, dislodged dentures and orthodontic appliances impinging on the lips or tongue and causing discomfort. All could lead to players stopping playing due to discomfort.

clarinet player lip damage
Restoring the embouchure

Maurice Porter recognised that wind and brass players required specialist treatment for their embouchure problems.  He encouraged musicians to play their instruments during stages of their treatment to test the embouchure.  Through his research he understood the importance of the air pressure, volume and direction of air entering the instrument, the role of the lips, the control of the jaw and the mouthpiece position and embouchure comfort. He developed pioneering temporary devices to help musicians play again. He treated many famous musicians at his London practice. 

Lip Shield

Porter noticed how musicians altered the playing position of the mouthpiece to accommodate irregular and painful teeth. This was a common problem in both wind and brass instrument player. Sharp edges from broken or crooked teeth often caused trauma to the lips whilst playing.  Porter devised different temporary devices to protect the lips to regain a comfortable mouthpiece position.

From his experience Porter suggested metal lip shields had many disadvantages but that gutta percha was ideal for temporary purposes. However, for longer lasting lip shields he recommended acrylic resin lip shields. Porter preferred to make these lip shields himself in the surgery directly with the patient so that the musician could hold the embouchure position whilst the shield was being made. He made the shield by placing a thin sheet of foil over the incisors and before the acrylic resin set, the musician played the instrument and the foil and resin removed.  Any alterations could be made then and there in the surgery. He preferred this direct approach rather than sending an impression of the teeth to a technician working in a laboratory on a model. 

Lip shield on a plaster cast model
Performance denture

Unstable full and partial dentures were of particular concern to the performing musician. Porter devised the ‘embouchure denture’ for musicians with few or no teeth.  These were designed to stop dislodgment by the pressure of the mouthpiece against the lips particularly for brass instrument players where the pressure of blowing is strong.

A set of performance dentures
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