Music to My Mouth
Dentists Discuss the Art, Challenges, and Rewards of Treating Brass and Woodwind Players
BY ERIC K. CURTIS, DDS, MAGD
World-cIass jazz trumpet player Jon Faddis, leader of both the Chicago Jazz Ensemble and the Jon Faddis Jazz Orchestra of New York, grew up with a gap in his smile, the result of a rotated right maxillary central incisor with.a severely fractured mesial-incisal angle. As Faddis achieved professional success—and he became famous for his ability to play really, really high notes—he decided to get the tooth fixed. So he had his dentist place a big composite restoration. He took out his horn to play that night and immediately lost three octaves off his range. As the story goes, Faddis was back on the dentist’s doorstep the next morning, waiting for him to open the office. “[Joni wanted to undo the repair,” a colleague explained, because he had lost his range and was limited to very low notes. The dentist removed Faddis’ composite, and the high notes came back.
Among dentists who treat musicians, stories like Faddis’s are common. “I retreated a trombone player who got veneers and then couldn’t play,” says Peter J. Silver, DDS, of New York City. Dr. Silver, many of whose patients are professional musicians, runs his musically-oriented Greenwich Village practice with a very hands-on approach. One of Dr. Silver’s famous patients is jazz musician Wynton Marsalis, who once gave Dr. Silver a lesson at Marsalis’ apartment. As a trumpet player and longtime member of Musicians Union Local 802, Dr. Silver has led a brass quintet for more than 25 years and 17-piece big band for a decade. He also plays in a Latin jazz ensemble and a small, straight-ahead jazz band.
In a recent interview on National Public Radio’s (NPRJ “Marketplace,” Dr. Silver said, “If a trumpet player chipped a tooth and the dentist restored it in a way that made it look nicer than it looked before, it would be great from a cosmetic point of view but it could completely ruin [the trumpet player’s] career.” NPR host Kai Ryssdal noted at the beginning of the segment that “Greatness takes many things: talent, drive, training. For a horn player, it also takes a healthy set of teeth.”
Although health is important, it fulfills only one part of a musician’s unique oral needs. Maintaining comfort, which specifically includes preserving the dimensions of teeth and soft tissue to which musicians are accustomed, also is critical. A change in tooth length, width, or thickness means a change in embouchure, which also means a change in the delicate interplay of structures that forms the musician’s unique sound.”
DENTISTS ON STAGE—AND TO THE RESCUE
To Many Dentists, the Pursuit of Music Means Much More Than Turning Up the Muzak®
Steve Raymond, the hero of Eric B. Olsen’s mystery novel Death in the Dentist’s Chair, is a crime-solving dentist and jazz saxophonist. While presumably few real-life dentists trade chair time for detective work, many actively embrace music.
Some dentists prominently support the music of others. For example, Chet Moore, DOS, is credited with founding the Shasta Jazz Festival in Redding, Calif. Philip Terman, DOS, whose patients have included Stan Getz, Sonny Rollins, and Dizzy Gillespie, mentored alto saxophonist Phil Woods and later produced a CD-ROM sax tutorial by Woods. Ahmet Ertegun, founder of Atlantic Records, started his record label in 1947 with $10,000 he borrowed from his family dentist.
For a number of prominent musicians, patronage started at home. Trumpet great Miles Davis, jazz pianist Billy Taylo and jazz
saxophonist Barney When (an associate of both Miles Davis and Thelonius Monk) all had fathers who worked as dentists. Additionally, “Tonight Show” bandleader Carl Severinsen was nicknamed “Doc” because his father was a dentist.
Many serious musicians, including jazz clarinet virtuoso Sidney Bechet, have been dentists. Jazz woodwind player and bandleader Clarence (Chip) Shelton, Jr., DDS, is an orthodontist. Jeffory M. Eaton, DDS, of San Mateo, Calif., recently released a CD entitled Romanticas, featuring vocalist Angela Bofill and musicians from Tower of Power, Santana, and Huey Lewis & The News, Dr. Silver has a CD in the works.
While Dr. Eaton loves the excitement and travel of trumpet playing (“I’m not anybody’s first call, but I
keep my tuxedo by the door”), he confesses to an occasional disconnect in his double life as dentist and trumpeter. “I don’t look bohemian enough,” he says. “I imagine people look onstage and say, ‘Oh, look! Six musicians and a dentist.” Dr. Eaton remembers a time when he sat in on a session with Gregg Allman. At one point, Allman turned to him and said, “Take it.’ I wanted to say, ‘I’m only a dentist.”
For Norman Becker, DDS, of Revere, Mass., the rewards of treating musicians lies in hearing them play beautifully. Dr. Becker describes music as a source of comfort. “You need to have a balance in your life, including activities that bring peace, satisfaction, and fulfillment to the soul,” he says. “Otherwise, when you retire, you’ll end up lost and lonely.”
For his part, Peter J. Silvet DOS, of New York City—.the son of a music teacher whose dentist uncle inspired him to the profession—is content to let dentistry play the leading role in his life. “I love music,” he says, “but it’s a tough way to make a living. Dentistry emphasizes constant improvement. It’s the best profession.” At the same time, Dr. Silver donates a portion of his resources to help musicians improve their oral health—both by offering discounted care to musicians and supporting philanthropy organizations such as the Jazz Foundation of America. Some talented people make the best of both worlds.
Dr. Silver invites dentists with questions about treating musicians to contact him at care@jazzdentist.com.
“Musicians who make their living
with their mouths are extremely sensitive to any kind of alteration to the oral environment,” Dr. Silver says. “If you do a composite repair on an anterior tooth, you should realize that a half-millimeter change to the incisal edge could affect a musician’s playing ability.”
Understanding embouchure
Embouchure (pronounced ahm-boo-shure) is a French word meaning roughly ‘to put into the mouth.” It is the term wind musicians use when they refer to the way their mouths rest against the instrument they play. More precisely, embouchure embodies the use of the lips, tongue, mouth, and facial muscles applied to a mouthpiece to produce good tone, range, and endurance while playing a brass or wind instrument. Developing one’s embouchure involves a complex interaction of orofacial components, including teeth aperture and jaw movement, lip contraction, tongue placement, and air pressure through the lungs and throat. Embouchure requirements vary by instrument. Brass players, for example, make their lips vibrate into ,, a mouthpiece, while woodwind players typically use lip muscles to form a seal around the mouthpiece that allows reeds to properly vibrate.
Developing and retaining a strong embouchure is at the heart of a wind player’s ability. “It’s a constant struggle to keep your lip up,” says Jeffory M. Eaton, DDS, of San Mateo, Calif. Dr. Eaton is a trumpet player who has toured with the Nelson Riddle Orchestra and backed up Lou Rawis, Jorge
Santana, and the Righteous Brothers; he also treats many professional musicians. “Brass players in particular are very sensitive and highly attuned to little changes that can be detrimental to their performance,” he says. “They also can be neurotic about maintaining their ability to play. If dental treatment makes their mouth feel different, they panic.”
Anterior dentistry, such as bonding and veneers, is especially scary for brass and woodwind players, Dr. Eaton says. All kinds of stories about dental mishaps make the rounds of musician water-cooler talk. A recent tale involves a well-known San Francisco Bay-area saxophone player who suffered a sinus exposure during a tooth extraction that put him out of work for eight months.
Musicians’ dental concerns—as well as dentists’ potential confusion about how to address those concerns—are graphically illustrated in the 2002 movie “The Secret Lives of Dentists,” in which a patient with a bad attitude faces off with his new dentist. “I’m a trumpet player,” he snarls, “and I don’t want you messing around with my front teeth, because it could screw up my embouchure.” The quiet, introspective dentist frowns but doesn’t reply.
Dr. Eaton, who was an associate clinical professor of restorative dentistry at University of California, San Francisco, and an artist-in-residence at San Francisco School of the Arts (where he taught the brass ensemble), understands the tension on both sides of the chair.
Dr. Silver agrees. “Most dentists don’t understand the concept of embouchure, and many don’t pick up on musicians’ concerns enough to learn about it. Preserving embouchure is crucial. Dentists generally don’t get that, and some musicians don’t know enough about dentistry to explain their needs.”
Playing for the school of hard knocks
From lungs to lips, blowing a wind instrument involves a very active engagement of physical forces, and musicians take a variety of risks along the way—both real and theoretical. For instance, dentists have long worried that a child’s choice of instrument might affect his or her occlusion. To compensate, they traditionally have prescribed brass instruments for Class II malocclusions and woodwinds for Class Ills. “I played a saxophone for a number of years,” says Dennis Mihalka, DDS, of Redding, Calif. “As a dentist, I am aware of the pressures that the teeth are subjected to by the mouthpiece. It’s kind of like a crowbar between the maxillary and mandibular anteriors.”
Yet Dr. Mihalka says his experience leads him to believe that oral risks are minimal for most young musicians. Research seems to bear him out: While a 1989 study showed that musicians had a decreased facial height and wider dental arches than non-musicians, another study found that playing a wind instrument had little influence on tooth position. Still another study found that the effect on anterior teeth from playing musical instruments is unpredictable. Several studies of musicians and periodontal bone height concluded that playing wind instruments regularly does not seem to be associated with increased risk of periodontal deterioration.
On the other hand, some dentists believe that playing a wind instrument may exacerbate tongue thrust situations and lead to bruxism. Other common problems identifiedamong serious musicians include a laundry list of oral ailments—from soft tissue trauma, dry mouth, herpes labialis, and lack of denture retention to malocclusion, TMJ disorders, endodontic pathoses, and even focal dystonia (a neurological condition that causes involuntary muscle contractions).
Add to those situations a musician’s more pedestrian but potentially biggest threats: dental caries, periodontal disease, and trauma to teeth. “Heaven forbid that an accident damage a horn player’s teeth,” Dr. Silver says. “It could be devastating.”
SONGS WITH TEETH
Dentistry as the Musician’s Muse
At one time the only body part musicians would sing about was their—or their true love’s—heart. Then came Donald Yetter Gardner’s “All IWant for Christmas Is MyTwo Front Teeth,” innocuous enough in 1946, but a clear harbinger of edgier times to come.
Elvis brought not only wild gyrations to music but also an emphasis on nice teeth and big hair. “Hair and teeth,” James Brown said. “If a man got those two things, he got it all.” It was only a matter of time until bands started taking dental names. There was the 1970s American rock band Spooky Tooth and a Swiss punk band in the 1 980s called The Dentists. You can still tap your toes to Broken Teeth, Jon the Dentist, and Wet Dentists. Even on the silver screen, the movie “Richie Rich’s Christmas Wish” features a rock group known as Root Canal.
Music with a dental theme emerged. The Rolling Stones once recorded (pre-meth mouth era)
a number called “Cocaine on a Dentist’s Chair.” More responsibly, the Swedish group ABBA sang something translated as “Brush the Teeth Goblins Away.” Steely Dan recorded not one but two enigmatic songs about Type Ill crowns, “Your Gold Teeth” and “Your Gold Teeth II.”
“No, we are not a rock band,” screamed rock group Iron Maiden. “We are dental floss salesmen from Montana.” Frank Zappa sang, “I wrote a song about dental floss, but did anyone’s teeth get cleaner?” The most famous song in “Little Shop of Horrors” is the dental number: “Here he is, folks, the leader of the plaque.”
These days, dentally-inspired tracks are everywhere. Alternative band Wilco cut a 1999 CD called Summerteeth. Ani DiFranco named her 1999 CD To The Teeth.The band Carlos recorded Bigger Teeth in 2000. The band Saliva made a single called, perceptively, “Your Disease,” while Green Day recorded the song “Pulling Teeth.” Jazz and big band composer Frank Mantooth
released a 1994 CD entitled Suite Tooth,” and blues guitarist Willie Lomax recorded Give Me Back My Teeth in 1996. More recently, guitarist Dom Minasi recorded a song named “Who’s Your Dentist?”
Music invoking anesthetic is practically a genre in itself. A host of rock bands answer to the name Novocaine, including current groups based in Atlanta and eastern Tennessee, as well as in Italy, Wales, and Norway. A punk record label from Chicago is called Novocaine Records, Inc. Novocaine also figures prominently in music titles and lyrics. Southern rock band Kings of Leon’s debut album is called Holy Roller Novocaine and Kurt Bordian’s new CD is called Novocaine. Even veteran shock rocker Alice Cooper left the golf course long enough to record a 2003 CD, The Eyes of A lice Cooper, on which track five is entitled “Novocaine.”
Dentist-musicians also can’t resist feeding the dental music fire. Jeffory M. Eaton, DDS, of San Mateo, Calif., who named his dental practice “Dentistry and All That Jazz,” had a band in dental school—made up of fellow dental student-musicians—called Plaque Sabbath. Dr. Peter J. Silver’s New York City-based big band Blue Nitrous lists a number of dental titles among its music charts, including “A Great Big Grin,”“Blues and the Abscessed Tooth,”“Blues
for the Cap,”“I’ll Never Smile Again,”“Make
Me Smile,”“Open Wide,”“Root Canal,”“Sugar Blues,” and “Toothless Grin.” Dentistry is not only an art, it seems; among musicians, it’s practically a muse
Treating the wind musician
Experienced dentists suggest four rules for treating horn
players. The first is to make models of the musicians’ oral environment and encourage patients to store them safely and update them often. “One of the most important aspects of treating a player is preserving the initial dental situation by performing precision impressions,” says Jochen Dornbusch, DDS, an avid trombone player from Barsinghausen, Germany. “That way, you provide the player—and yourself—with a reliable lifeboat in case of unforeseen changes.”
“It’s a good idea for musicians to keep models of their teeth,” Dr. Silver says. “Then if something happens, they can tell the dentist, ‘Rebuild me this way.”
Dr. Dornbusch advises new impressions annually. “Musicians shouldn’t leave their models at the dentist’s office,” he says. “You never know when you will have to see a new dentist.”
The second rule for treating wind players is to make changes gradually and make them reversible—especially in anterior teeth. Dr. Silver advises dentists to “make changes with composite first.” He says, “I would hesitate to place veneers on the professional trumpet and trombone players.” When doing major reconstructive cases, Dr. Silver advises giving musicians temporary crowns, letting them play their instruments on the temporaries long enough to get used to them and taking impressions of the temporaries as a guide to fabricating durable restorations. “I’m not going to go right to the finish first,” he says. “The most important rule is to make small changes and only reversible ones!”
Small changes can reap big rewards. “Recently, I opened up a trumpet player’s incisal embrasure between eight and nine over three visits, a little at a time,” Dr. Silver says. “Those adjustments increased his range and made it easy for him to play in the upper register.”
The third rule: Be patient. What works for one musician may not work for another. “It is vital to listen to the patient who will often tell you all of the information you need in order to make a slight adjustment to help him or her,” says Dr. Silver.
Norman Becker, DDS, of Revere, Mass., treated many members of Louis Armstrong’s band. He recounts the story of Buck Clayton, a trumpet player and composer who was involved in an automobile accident that avulsed some anterior teeth. A bridge seemed to fix the damage. “From a dental point of view,” Dr. Becker says, “the replacement teeth were fine. They looked good and fit well. But when Buck tried to play, the new teeth hurt his lips.” Clayton stopped performing. Hearing about Clayton’s impairment, Dr. Becker and a colleague, Anthony Minichiello, DDS, invited the trumpeter to Boston, where over the course of several months they gradually adjusted the shape of Clayton’s bridge to help him regain his embouchure. Within a year, Clayton resumed his performances.
“Many times musicians really can’t tell you what’s wrong,” Dr. Becker says. “You have to play detective to figure out their problem.” Some of Dr. Becker’s most challenging patients were horn players who wore dentures. He learned that when an edentulous trumpeter complained of difficulty “screeching” (playing fluid high notes) to first try thinning the palate, often by replacing a resin palate
with a cast metal version. “In some instances, I made both an eating denture and a playing denture,” he says. “1 designed the maxillary playing denture with a plastic platform in the place of posterior upper teeth to act as a stop against the lower teeth, so that the air pressure that would normally dislodge the denture would now reseat it automatically.”
Dr. Becker encouraged his musician patients to play in the office. “My musician patients always brought in their horns,” he says, “or at least their mouthpiece. I’d have them play on it, and then they could tell me, ‘I’d like a little more pressure here, or less pressure there,’ or, ‘It’s getting in the way of my tongue.” Dr. Eaton follows the same practice:
“1 will have patients come into the office with their instrument and play for me while I’m making adjustments.”
The fourth rule is to be realistic about results. Dr. Silver recalls treating a musician whose previous dentist refused to adjust an anterior tooth restoration on esthetic grounds. “For musicians,” he says, “esthetics have to be held in balance with function.”
Dentists who treat musicians also should take lifestyle considerations into account. “Professional musicians tend to have inadequate oral hygiene while on the road, and most musicians can’t afford major dental procedures,” Dr. Silver says. “1 try to get wind players to understand how important it is to take care of their mouths. I remind them that they need to clean their horns every day. I say, ‘Look, the horn is just an extension of you. Take care of yourself as well as you take care of your instrument.”
Dr. Silver also tries to help musicians make the best of unavoidable changes. “1 counsel wind players that a change in their teeth can be an opportunity for advancement. [It allows them] to learn to use air better and reduce pressure on their lips.”
The recipe for satisfaction in treating musicians looks a lot like the elements of greatness in musicians themselves:
Start with talent and passion, add experience and patience, and then don’t just look for results, listen for them.
Eric K. Curtis, DDS, MAGD, practices in Safford, Ariz., and is an adjunct associate professor in the Department of Dental Practice at the Arthur A. Dugoni School of Dentistry, University of the Pacific. Dr. Curtis was first trumpet in the Safford High School (Arizona) jazz ensemble, but in college he traded his embouchure for braces. To comment on this article, send an e-mail to impact@agd.org.
“Dentists often don’t know what to do about the anxiety that brass and woodwind players have about changing their embouchure,” says Dr. Eaton. “In fact, many dentists may not know what to do with musicians at all.”
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