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about lip swelling, lip pain, and other debilitating embouchure problems.
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Lip Swelling
While every brass player experiences lip swelling from time to time, for the chronic sufferer, swelling almost always appears very shortly after he begins to play and prevents him from feeling his lips or mouthpiece normally. Understandably, someone plagued by this sort of relentless, inexplicable swelling looks for a physical explanation, such as an allergy to the metal of his mouthpiece rim. Tissue swelling can result from either physical trauma or a physical disorder. Obviously, a severe trauma like a blow to the lips would cause them to swell. Any physical disorder which causes edema
(fluid in the tissues) can cause the extremities, including the lips, to swell. Certain medications can cause fluid retention and general swelling. Allergic reactions to ingested substances like foods, herbs, or vitamins, or to environmental or chemical exposure can also cause the extremities, and not just the lips, to swell. Although allergies to metal do exist, such as in the form of contact dermatitis, the reaction usually presents itself as a crusty, painful rash or irritation on the skin and not as localized swelling.
Any player suffering from chronic lip swelling should consult a dermatologist to be checked for possible allergies.
In general, swelling in areas of the body besides the lips (ankles, hands, wrists, face, eyelids,
etc.) would indicate the presence of a physical disorder. If swelling is only noticeable in the lips and occurs only during
playing, more than likely, it is the result of embouchure
overuse syndrome. Peripheral Neuropathy
in the Embouchure Itchy--Tingly, Pin-prick pain
This is a unique kind of lip discomfort which is described by sufferers as a sharp pin-prick pain, usually on the upper lip under the mouthpiece rim, and noticeable when playing.
The cause is an entrapment neuropathy that often results from a front incisor pressing the lip against the rim of the mouthpiece.
Certainly, any kind of chronic lip discomfort can eventually have a negative impact on a player’s
ability to play and lead him into developing embouchure
overuse syndrome. Filing down the offending tooth may correct the problem. Speak with your doctor or dentist.
Acid Reflux Disease (GERD), Excessive (hyper)Salivation (water brash), and Mouth Discomfort
One of many factors contributing to hypersalivation and a burning sensation in
the mouth (not Burning Mouth Syndrome) is acid reflux disease, also known as Gastroesophageal Reflux Disease [GERD]. When the lower esophageal sphincter [LES] is functioning correctly, it prevents stomach digestive acids from moving up the esophagus. If the LES has become weak or ineffective, the result is GERD. Reflux of gastric contents irritates the lining of the esophagus and causes heartburn or discomfort in the middle of the chest. Once reflux occurs, esophageal peristalsis, which is the wavelike muscular contractions of the alimentary canal, may not be adequate to clear the gastric acid quickly. This has the effect of stimulating esophagosalivary reflex (ESR) and leads to episodic sialorrhea (hypersalivation,
also known as water brash). Saliva has a natural therapeutic quality to it. Swallowing therefore neutralizes the residual gastric acids, albeit temporarily so. Excessive salivation can also be caused by certain medications, such as those for seizure and affective disorders.
Embouchure problems are bad enough, but when a player has to deal with mouth discomfort and too much saliva excreted in the mouth or under the upper lip, playing can become a real challenge. The remedy for this problem begins with a visit to
a specialist in gastric disorders. The American prescription drugs Prilosec and Previcid are quite effective in treating acid reflux and reducing water brash. If none of the medications for GERD improves your hypersalivation, you might consider speaking with your doctor about taking an antihistamine allergy medication or an antidepressant drug, such as amitryptiline, both of which
will reduce salivation.
Dry Mouth
Since saliva lubricates the mouth, tongue, and lips, it is an essential component of playing. If the inner lining of the lips is not moist enough, the lip surface becomes sticky and cannot vibrate easily. On-the-job performance anxiety is probably the most common cause of dry mouth in brass players. A beta blocker may be helpful in relieving performance anxiety. Speak with your doctor for more information. However,
if you have a chronic version of dry mouth, you should see an ear, throat, and nose
specialist and/or an oral surgeon. You may have have an underlying disease
that requires treatment. Saliva is necessary component of good oral and
dental health, so it is important to speak with your doctor about any kind of
ongoing dry mouth. There are prescription drugs, such as Salagen and Evoxac, which can help promote the production of saliva.
Embouchure Dystonia (Focal Dystonia)
All voluntary movement results from a complex sequence of neural and neuromuscular events which originate in the brain. Any kind of abnormality or disruption in this sequence can affect motor function. Dystonia is a disorder of motor control and produces sustained, involuntary contraction of a muscle. There are different kinds of dystonia: primary dystonia is genetic, while focal dystonia is occupational. The area which bears the most responsibility in playing, such as a brass player’s lip, is affected.
A dystonia is initially perceived or felt as a loss of playing control–or that the affected lip is weak. A player may find himself having to use more effort to play the most routine passages and, therefore, interpret the early onset symptoms as an embouchure problem. As the disorder progresses, a player loses the ability to perform, although all aspects of range and technique are not compromised. An embouchure dystonia may be triggered by range (perhaps occurring only in four or five notes), articulation, a slur between notes, in a few notes of the low range, in fast staccato, or slow legato tonguing.
An interesting and unusual thing about focal dystonia is something called the geste antagoniste. In most focal dystonias, like
writer’s cramp, when a light touch (geste antagoniste) is applied to the affected area, the muscle contraction stops. This is not always the case with musicians’ dystonias, however.
Since dystonias are classified as movement disorders (along with Parkinson’s disease, alien hand syndrome, tics, tremors, and choreas), a musician experiencing symptoms or suspecting the presence of a dystonia should seek treatment from a neurologist with expertise in such problems. There is no cure for dystonia, although there are some treatments for its symptoms. There are a few drugs which may be mildly effective. Injections of botulinum toxin
(Botox), which weakens the overactive muscle, can help improve the condition but not necessarily restore a player’s ability to play.
Focal dystonia usually remains isolated to the same affected area. In only the rarest of cases does the dystonia spread to another activity. Dr. Steven Frucht,
sf216@columbia.edu, who has conducted a study on brass players’ embouchure dystonias at New York’s Columbia Presbyterian Hospital, says that it is unknown what triggers a dystonia in musicians, but any musician can develop one. Musicians who do will usually begin to experience symptoms in their late 20s to early 40s,
although younger and older players have also developed dystonias.
Dr. Frucht’s original study included approximately 20 brass players from all over the United States. He has been working and consulting with neurologists Michael Charness of Harvard and Chris Browning in Colorado Springs, who have also treated brass players with dystonia. Another aim of his project has been to assist
musicians by making documentation and information available to musicians who are attempting to claim workers’ compensation or disability benefits for dystonia. He has also created a foundation to assist musicians suffering with dystonia and especially those who can’t afford treatment. For more information on where to seek help and treatment for dystonia, please visit
www.dystonia-foundation.org and
www.care4dystonia.org.
Although they are not life threatening, dystonias are largely career ending. At present, no cure or therapy exists which will overcome its effects on playing.
If you would like to locate a physician who treats musicians, please contact
artsmed@comcast.net. If you need medical assistance and cannot afford it, please visit
www.actorsfund.org/ahirc. Actorsfund.org has compiled a list of free clinics and medical services available for performing artists. It also has information on low-cost health insurance.
See more medical links by clicking the links icon in the left column.
Dental Bonding, Porcelain Veneers, and Caps
Dental bonding, veneers,
and caps are used to cover teeth. Bonding
is semi-permanent. Veneers and caps
are fixed permanently to the teeth. Caps
are generally used to cover a tooth after root canal or to cover a tooth which
is cracked. Bonding is often used
for cosmetic dentistry to close small gaps or chips in teeth.
Veneers are also used for cosmetic dentistry and to repair cracks.
Bonding,
veneers, or caps may have no negative effect on playing, depending on their
location. Players who try to make
their dental surfaces more comfortable with bonding usually find that the change
in the feel of the bonded surface makes playing different and more difficult.
Overlays and caps can have the same effect.
Gum
Disease (periodontal
disease)
Periodontal
diseases, ranging from simple gingivitis to pericoronitis, is caused by an
accumulation of bacteria and can erode the gums, bone, and the roots of teeth.
Teeth
are as important to a brass player as his musical equipment.
A strong dental surface, upon which to rest a mouthpiece, is essential
for comfortable and secure playing. If
a player’s gums are inflamed and his teeth have become loose in the sockets
from periodontal disease, his dental surface will change, and he will gradually
lose control of his playing. Good
oral hygiene and regular dental screening is the only way to prevent periodontal
disease. Preventive dentistry in
general will increase your playing life.
More
extensive information on medical and dental problems which affect brass players can be
found in Broken Embouchures. |
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