Download MUYIA ROBERT MANDELA BWIRE

MALOCCLUSION
PATTERNS AMONG
SELECTED
WIND INSTRUMENT PLAYER GROUPS IN NAIROBI
-
MUYIA ROBERT MANOELA BWIRE
BOS LEVEL 3
V28j34711j2010
A community
dentistry
research proposal to be submitted
Nairobi School Of Dental Sciences in partial fulfillment
Bachelor of Dental Surgery Degree.
2013
to the University Of
for the award of the
DECLARATION
I, Muyia Robert Mandela
submitted
.
Signature
elsewhere
Bwire, declare that this is my original
work and h as not been
by any other person for research purpose or award of any degree.
~
~~r6f13
.
Date
ii
}--o ]-6
!J 3
.
SUPERVISORS' APPROVAL
We certify
INTERNAL
that this proposal
has been submitted
with our approval
as supervisors:
SUPERVISOR:
Dr Mua B.N. BDS [NbiL MPH [Nbi], PgD (STI) [NbiL MBA[Nbi]
Lecturer,
Department
of Periodontology/Preventive
and Community
Dentistry,
School of Dental Sciences,
University
of Nairobi.
Date
EXTERNAL
SUPERVISOR:
Dr Nicholas
Gichu BDS [NbiL
Consultant
Paediatric
Rift Valley Provincial
.
Signature
~
k})
MDS [Nbi]
Dental Specialist
General
Hospital
:..!-...............................
23/cG/QOI3
Date
iii
.
Table of Contents
Declaration
ii
Supervisors'
Approval
iii
Table of contents
_
iv
LIST OF FIGURES
vi
SUMMARY
CHAPTER 1
:,;
1
.
2
INTRODUCTION
2
LITERATURE REVIEW
5
CHAPTER 2
10
RESEARCH PROBLEM,
JUSTIFICATION,
HYPOTHESIS, OBJECTIVES AND VARIABLES
10
PROBLEM STATEMENT
10
JUSTIFICATION
11
OF STUDy
OBJECTIVES OF THE STUDY ...............•.....................................................................................................
11
~:.. 11
GENERAL OBJECTIVE
HyPOTHESiS
11
VARIABLES
12
CHAPTER 3
13
RESEARCH METHODS
13
AND INSTRUMENTS
STUDY AREA
13
STUDY POPULATION
14
STUDY DESIGN
14
SAMPLING
14
SAMPLE SIZE DETERMINATION
14
SAMPLING
16
INCLUSION
METHOD
AND EXCLUSION
DATA COLLECTION
VALIDITY
CONTROL
16
CRITERIA
INSTRUMENTS
AND TECHNIQUES
16
18
AND RELIABILITY
18
OF BIASES
iv
ETHICAL CONSIDERATIONS
18
DATA ANALYSIS AND PRESENTATION
19
PERCIEVED BENEFITS ..........................................................................................................•....................
19
BUDGET
_
20
REFERENCES
_
21
APPENDICES
APPENDIX
APPENDIX
23
1: DATA COLLECTION
FORM
23
2: INDICES
APPENDIX
27
3: CONSENT FORM
28
v
LIST OF FIGURES
Figure 1 Class A Instruments
with a cup shaped mouthpiece
-
6
Figure 2 Class B Instruments
with a single reed mouthpiece
_
7
Figure 3 Class C Instruments
with a double reed mouthpiece
_
8
Figure 4 Class D Instruments
with an aperture
9
vi
DEFINITION OF TERMS
Brass instrument-a
wind
instrument
causing the air within
the instrument
Embouchure-use
facial
of
muscles
in which
the player's
lips vibrate
onto
the mouthpiece,
to vibrate.
and
shaping
of the
lips to
the
mouthpiece
of wind
instruments.
Mouthpiece-
Musical
tube),
part of a wind instrument
wind
instrument-a
in which
mouthpiece
Woodwind
a column
that is placed partly in or against the player's
musical instrument
of air is set into
that contains
vibration
mouth.
some type of resonator
by the player
blowing
into
(usually a
(or over) a
set at the end of the resonator.
instrument-
A wind instrument
in which a player causes a reed to vibrate
against or over the edge of an open hole.
vii
or blows
ACRONYMS
BDS-Bachelor
of Dental Surgery
TMJ-Temporomandibular
SPSS-Statistical
Joint
Package for Social Sciences
viii
I
r
I
SUMMARY
Background
Malocclusion
is a common
players. Wind instruments
causing
malocclusion.
form
of dental
experienced
have been associated with exertion
Malocclusion
may
proficiency
amongst
the
relationship
between
wind instruments
instruments
may act as an adjunct
do cause malocclusion
anomalies
musicians.
whereas
locally on the relationship
Studies
in
have
report
of high pressure
diminished
been
and malocclusion.
to orthodontic
others
between
result
by musical wind
self
inconclusive
esteem
with
Some have noted
treatment.
no significant
on
the dqntition
- and
reg ards
that
musical
Others have conclud
findings.
instrument
However,
playing
to
the
wind
ed that they
no data exists
these two fields.
Objective
To investigate
malocclusion
patterns
on selected
musical
wind
instrument
player
groups
in
Nairobi.
Study Design
A cross-sectional
descriptive
Study Population
study.
and Study Area
Musical
Wind
Instrument
National
Youth Orchestra,
players
based in Nairobi
Kenya Conservatoire
including:
Nairobi
of Music Orchestra
School wind
band,
Kenya
and the Leidzen Brass Band.
Methodology
The study will comprise
ended questionnaire
collected
will
using a clinical
70 wind
and non-wind
players
used and an intraoral
examination
SPSS(12.1) and data will be presented
form.
examination
Descriptive
using frequency
1
from
the mentioned
grou ps. A closed
will
out.
statistical
diagrams,
be carried
Data will be
tests will be carried
tables and pie charts.
out using
CHAPTER 1
INTRODUCTION
AND LITERATURE REVIEW
INTRODUCTION
The term
'malocclusion'
teeth
of the two
may
be
refers to a misalignment
1
dental
arches.
I
I
bites and cross bites, overjets
r
Most
considered
malpositions
combination
r
specific
of
congenital
tooth
defects,
crowding,
are
(extrinsic)
habits
proposed
that
abnormal
pressure,
playing
a musical
the
contributes
wind
wind
relation
unsatisfactory.
to
factors.
predisposing
sucking,
between the
~
from the ideal occlusal relationship
This
and retroclination
attributed
includes
of anterior
a complex
factors
factors.
metabolic
tooth
teeth, scissor
climate
to abnormal
posture
the
in the
understood
malocclusion
factors
into
include:
to a
two
heredity,
and disease, diet, abnormal
posture
affects
poorly
could be attributed
of
General
instruments),
instrument
and
A small minority
etiological
and local (intrinsic)
(e.g. thumb
or incorrect
among others.
classified
environment,
pressure
proclination
and overbites
Graber
deviation
aesthetically
and environmental
cause.
General
and
malocclusion
of inherited
known
categories;
functionally
including:
incidences
An appreciable
of teeth
and trauma.
position
oral
It has been
of teeth
cavity
as it exerts
and trauma
to the
dentitlon.i
Musical
wind
instruments
Examples of woodwind
Brass instruments
instrument
pitch
include
include
trumpets,
The mouthpiece
of an embouchure
the mouthpiece
According
instruments
to permit
to Proffit,
balanced opposing
teeth
classified
clarinets,
trombones,
consists of a mouthpiece
produced.
Formation
are generally
woodwind
saxophones,
tubas, euphoniums
and a barrel which contains
is manipulated
involves
into
by a player's
use of the lips, tongue
and
flutes,
brass
instruments.
oboes and bassoons.
and horns. A musical wind
holes or valves that vary the
lips to form
and teeth
an embouchure."
to form
a seal around
passage of air and sound production.
are in a state
of equilibrium.
They are subjected
forces which ensure that they remain stable on the dental
2
to a variety
of
arch. The primary
factors in the maintenance
of this state of equilibrium
and lips and forces created
within
results in tooth
I
r
The orofacial
movement
during
membrane.
and the
the playing
dentition
are largely
of a musical wind
involved
instrument.
exert a high force (higher than thumb
result of this, individuals
who play brass instruments
predisposed
experience
to developing
a number
and proclination
lingual
of orofacial
of maxillary
bite and posterior
problems.
Other
with
cross bites."
Studies
of an
brass
on the dentition.
As a
large cup-shaped
mouthpieces
are
have be.en known
malocclusion
problems
formation
have shown that
sucking)
of mandibular
dental-facial
in the
Career musicians
This includes
incisors, retroclination
cross bites.
to
such as': retroclination
incisors, deep anterior
include:
focal
dystonia,
open
herpes
6
labialis, TMJ problems
and xerostomia.
It has been shown that the forces produced
higher than average
on the tongue
A change in any of these factors
musical wind instruments
more
pressures
and may cause malocclusion.'
musculature
embouchure
the periodontal
are the resting
muscle movements
during the playing of musical wind instruments
and may reach sufficient
levels to correct
are
or cause a
6
malocclusion.
Malocclusion
instrument
playing.
on the
Studies
malocclusion.
involving
maneuvers
embouchure
pointing
results.
out
the
manner
specific
between
musicians
and skeletal
In addition,
the
holding
wind
have dental
are forced
constituents
musical
instrument
and facial
experienced
planning.
3
by the
playing
to achieve
factor
features
in
that
that
the required
musical
wind
treatment."
should ensure that he/she fully
is manipulated.
player
may
to adapt compensatory
during fixed orthodontic
instrument
of the
and wind instrument
it has been demonstrated
difficulties
position
or may be an etiological
is very crucial and the dentist
in which
the
orthodontics
that
treatment;
Those with deformities
embouchure
problem
to influence
have proposed
some
musculature
stage of treatment
the
that
formation.
players experience
The diagnostic
fields
effect on orthodontic
orofacial
for optimum
shown
There is an interface
It has been shown
involving
understands
has been
these two
or negative
easy embouchure
instrument
hand
and embouchure."
have a positive
permit
other
and
also
This is useful
aids in treatment
in
Patients
who play these
practitioners
structures.
instruments
who understand
Individuals
with
including
lack of self esteem
therefore
lead to improved
of wind instrument
require
preventive
the relationship
between
malocclusion
as a result
dental
and supportive
musical
have been found
of their
aesthetics,
players.
4
instruments
to have certain
appearance."
masticatory
wind
treatment
Addressing
function
from
dental
and orofacial
psychosocial
effects
this
would
problem
and psychological
well being
Patients who play these instruments require preventive and supportive treatment
from dental
practitioners who understand the relationship between musical wind instruments and orofacial
structures. Individuals with malocclusion have been found to have certain psychosocial effects
including lack of self esteem as a result of their appearance." Addressing this problem
would
therefore lead to improved dental aesthetics, masticatory function and psychologic al well being
of wind instrument players.
4
LITERATURE
REVIEW
It is a common
etiological
belief
factor
are often
amongst
in the development
discouraged
at an early
age.
mouthpiece
musicians
that
playing
of malocclusion.
by music teachers
Brass instruments
a musical
As a result,
from allowing
are
wind
parents
their children
especially
instrument
discouraged
with young children
to play these instruments
due
and the higher pressure they exert on the dentofacial
may be an
to
complex
the
nature
of the
in comparison
with
5
other wind instruments.
Brattsrom
et al. studied
morphology
height
in children
and wider
orofacial
the effects
of playing
at the ages of 6,9,
dental
in the
wind
study
participants.
a cross sectional
study in Switzerland
among adult professional
The latter
that
in the control
reed instrument
Herman
of junior
instruments
however,
found
mouthpiece
exerted
difference
that
to have a certain
adult musicians
in occlusion
brass instrument
by brass instruments.
of lingual
In comparison,
players and confirmed
in file
,-
molars
to
et al.
musicians
was smaller
in
tooth
that
that
among
a
to Pang et al who found that
on the anterior
on a group
instrument
whose
movements
teeth
on
basis a class of wind
12
teeth.
et al. found that there was no
players
instruments
and a control
group.
It
had a large cup shaped
crossbites.i' He alluded this to the high pressure
Fuhrimann
et al. studied
the presence of higher pressures
tissues during the playing of a wind instrument.
bite morphology
anterior
effect on the anterior
players
by Rindisbacher
was smaller
' This is in contrast
wind
to increased
group."
in the UK, Grammatopoulos
between
facial
This was in-contrast
musicians
and mandibular
significant
it wa-s suggested
had a high prevalence
wind instrument
10
the effect of playing a musical instrument
basis. However,
can be theorized
a reduced anterior
factor.
arch width
at the maxillary
et al. demonstrated
to predict
Among professional
significant
The width
dental
high school instrurnentalists.f
it was impossible
an individual
group.
and upper
and flute players than in the control
In New York,
majority
the overbite
on the dentofacial
This was attributed
pressure as a contributing
found
instruments
12 and 15 years. It revealed
and intraoral
than
muscle activity
arches
musical
They however
of the players.
5
natural
lip function
in
on the teeth from soft
did not detect
any effect on the
Strayer
classified
He also
wind
provided
instruments
indications
classification
and theorized
embouchures
as follows:
Class A instruments-with
indicated
instruments
result
for
Class
in retroclination
and
distribution
a cup
shaped
I and
a horizontal
of these
to the embouchure
contraindications.i"
the
II Division
can exert
according
mouthpiece
class
force
teeth
of forces
I cases
overbite."
Figure 1 Class A Instruments
Grammatopoulos
around
with a cup shaped mouthpiece
6
the
with
protruding
tuba,
upper
and mandibular
in reduction
applied
dentition
(e.g. trumpets,
on the maxillary
and result
used and the muscle groups.
in overjet
Strayer's
by observing
the
trombones)
are
14
These
that
might
incisors.
incisors
and an increase
in
I
I
I
Class B instruments
for
with
Class III cases and
protruding
maxillary
incisor
upper
in overjet
contraindicated
incisors.t"
and mandibular
retroclination,
a single reed mouthpiece
incisors
intrusion
and a reduction
These
(e.g. clarinets
in Class II Divisions
instruments
that might
of maxillary
result
in overbite."
Figure 2 Class B Instruments with a single reed mouthpiece
7
I and
can exert
incisor
incisors,
are indicated
II; and class I cases with
horizontal
in maxillary
and mandibular
and saxophones)
and
vertical
proclination,
and therefore
forces
in
mandibular
an increase
Class C instrumentswith
cases presenting
can exert
result
a double
hypotonicity
horizontal
reduction
in overjet
and contraindicated
and vertical
in retroclination
and
reed mouthpiece
forces
intrusion
(e.g. oboes,
bassoons)
14
in complicated
on the maxillary
of maxillary
and
are indicated
Class 1.
and mandibular
mandibular
in all
These instruments
incisors
incisors
that
might
and therefore
a
and overbite."
Figure 3Class C Instruments with a double reed mouthpiece
Class D instrumentscontain
an aperture
class I and III with
upper
shorter
class II and complicated
mandibular
.
overjet.
incisors
class I
that might
through
lips and unruly
which
air is blown
mentalis
cases.i" These instruments
result
in retroclination
5
8
action.
(e.g. flutes)
They are contraindicated
can exert
of mandibular
are indicated
a horizontal
incisors
force
in
in
on the
and an increase
in
Figure 4 Class D Instruments
15
Studies by Porter
with an aperture
and Parker16 seem to arrive at a similar
propose the use of musical wind instruments
this requires
careful
selection
Herman
correction
of overjet
recommended
that
and overbite
the use of wind
they could aid in management
From the mentioned
studies,
musical wind instruments
designated
treatme
for a particular
nt. However,
malo cclusion
and
music teachers.
al, also proposed
et
to Straye r. They both
as an adjunct to orthodontic
of the instrument
proper guidance from qualified
conclusion
dentists
should
as an adjunct
instruments
of orofacial
to orthodontic
in orthodontic
instruments
treatrnent.t
treatment;
that
aid in the
' Strayer
not only
but also th eorized that
muscular defects.
it is clear that there
in dentistry,
recommend
especially
is a lack of consensus
in orthodontics.
regarding
Some implicate
the role of
musical
wind
instruments
in the causation
of malocclusion
while others show little association
between
these
two factors.
It has also been recommended
that they could act as an adjunct
to orthodontic
-e-
treatment
and in the management
a local based study using a different
of facial muscle defects. It is therefore
study method
9
to add knowledge
necessary to conduct
to this growing
field.
CHAPTER 2
RESEARCH PROBLEM,
JUSTIFICATION,
HYPOTHESIS,
OBJECTIVES AND VARIABLES
PROBLEM STATEMENT
\
In recent years in Nairobi, there has been an increase in the number
musical wind instruments
professional
musicians
increase of musical wind
as part of a school program.
or regular
instrument
their chosen career.
In addition,
them from achieving
optimum
With this increasing
number,
the knowledge
Dentists
occlusion
performers.
it is important
to equip dentists
instrument-orthodontic
orofacial
there
has been an
problems
as a result of
deformities
that do not permit
studies
of malocclusion.
and wind
interface
effects
instrumentalists
of preventive
in the past on whether
It is important
our local setting.
10
therefore
with
based on local studies.
of wind
instruments
effects, if any, of exposing their
at an early age and the need for initiation
part on the etiology
regard,
results in their musical endeavors.
need to be aware on the possible
There have been conflicting
In this
players who experience
so that they are aware of potential
instruments
Most of these players end up becoming
others already have orofacial
on the musical wind
and parents
amateur
of young people taking up
on the
children to these
measures.
musical wind
establish
instruments
whether
playa
this is true in
JUSTIFICATION
OF STUDY
No such study on wind instrument
As more individuals
encountered.
instruments
take up musical instruments,
This study
will
in malocclusion
oral healthcare
players has been conducted
they need advice on possible de ntal problems
serve to investigate
so that preventive
in Kenya before.
the possible
measures
involvement
of
musical
wind
are taken by the music ians and their
providers.
OBJECTIVES OF THE STUDY
GENERAL OBJECTIVE
To investigate
malocclusion
patterns
on selected musical wind instrument
players.
SPECIFIC OBJECTIVES
1. To determine the types of wind instruments used in the study population.
2.
To determine
the
prevalence
of malocclusion
among musical wind
instrument
players in
selected groups in Nairobi.
3.
To describe the malocclusion
4.
To compare
instrument
malocclusion
patterns
patterns
observed
between
in the different
wind
instrument
instrument
players
categories.
and
non wind
players.
HYPOTHESIS
There is no difference
wind instrument
in occlusion
patterns
between
players.
11
musical wind instrument
players and non-
VARIABLES
--------------------------~--r_------------.---.-----SOCIODEMOGRAPHIC
..
-~--.'
..
.....
_--.
-----_.
__
.
MEASUREMENT
VARIABLES
-------------------------f---.--.------
Gender
---.--_.-
._.
Male/Fem~I~
..
.
INDEPENDENT VARIABLES
MEASUREMENT
1--------------------+----------.----.-------1
Type of instrument
Woodwind, Brass .
.
Age
__.
._._._.
.
Yea~
I-""---------------------f----·-----------·-----·---·--------.
_
__
Instrument class
-_._--------------_._.
__ __
A,B,C,D
__ ._---- ------------------_._--_._
...
.... _. - _._--- ..
..
._-----Duration of play
Years
f------'--~-.--------.----..
---.--.-----.----.-.---------.---..
--..
-- -..
- ----.-.----Frequency of play
hours/day
f-.------.-------1---.:...----'----.-------- -.-----.-.-...
----.---DEPENDENT VARIABLES
MEASUREMENT
1------_·_------------------------------_·
__
·--.------... --.. -..--....
-------.Maxillary Overjet
Mm
Overbite
---------"_
.._---
Anterior open bite
_._-_
crossbite
_ ..'.Posterior
__ ...
%
------------_
.. -
_._ .. -.------_
..
Absent/Present
__
_
.. -.--.----.-
-.---.--.
Absent/Present
'----------_
-
Scissor Bite
Absent/Present
-j!!molar re~-tio;ship·-··----··--·-------··-··---·--·---- Angle's Class I, II, 111- .--...
------------'---------------._ .._---._-_._Crowding
-.1.-Absent/Present
__
....:-.
..
_
L-.
---"''--
.__
.
12
CHAPTER 3
RESEARCH METHODS AND INSTRUMENTS
STUDY AREA
The study will be carried
out at the Nairobi School, The Kenya Conservatoire
The Leidzen brass band and the Kenya National
Nairobi
School
approximately
program
is a boys' national
1200
consisting
students
The Kenya Conservatoire
instrument
located
the
along Waiyaki
8-4-4
curriculum.
way in Nairobi,
The school
Kenya. It has
has a wind
band
15 to 18 years. It has one of the
in Nairobi.
of Music is a music teaching
next to the Kenya National
all over Nairobi
studying
Youth Orchestra.
of about 40 players whose age ranges from
most active wind band programs
from
school
of music orchestra,
Theatre.
It has a resident
of the conservatoire.
institution
amateur
The orchestra
located
consisting
of students
has 60 players of which
20 are wind
players, 30 string players and 10 percussionists.
orchestra
on Harry Thuku road
The players'
age range is from 16 to
30 years.
The leidzen
comprises
Brass
of young
Band
players
players, some of whom
and performs
in churches
The Kenya National
is a regularly
aged between
are professional
Youth Orchestra
It is based at the Art of Music
Nairobi
brass
band
18 and 30 years.
players. It conducts
based
in Nairobi,
It consists
rehearsals
Kenya. It
of approximately
at Alliance
40
High School
in Nairobi.
is an amateur
players of which 40 are wind instrument
players are from
performing
based in Nairobi,
co.nsisting of 80
players, 35 are string players and 5 are percussionists.
foundation
and its environs
orchestra
in Hurlingham
along Argwings
Kodhek
and their age ranges from 16 to 25 years.
13
road. The
STUDY POPULATION
The study population
shall consist of wind instrument
who are non wind instrument
players.
School,
of Music
Kenya
Conservatoire
players and a control
They shall be drawn from the four study
Orchestra,
the
Leidzen
National Youth Orchestra.
STUDY DESIGN
The study shall be a Cross sectional
descriptive
study.
SAMPLING
SAMPLE SIZE DETERMINATION
The sample size will be calculated
Where
using the following
Z=Z value corresponding
C=l-confidence
P=Prevalence
grou p of musicians
formula
to 95% confidence
interval.
interval
of the problem
under investigation
14
Brass Band
areas: Nairobi
and
the
Kenya
The sample size will be calculated based on a study by Grammatopoulos
et al. in 2009 which
reported the prevalence of Class 11(2)incisor relationship to be 8.1%:
N=
1.962xO.081(1-0.081)
(1-0.95)2
=114 persons
However, the population of this study will be less than 10,000 therefore the following
to be used:
n
nf=
n
1+-
N
Where nf= desired sample size for a population<10,OOO
n=sample size derived for a population>10,OOO
N=estimated
size of the population with the characteristic of interest under investigation.
n=114
nf=180(total number of players in the three groups)
nf
=
114
114
1+ 180
=69.9 (70 persons)
The study shall comprise 70 wind instrument players and 70 non-wind instrument
15
players.
formula
SAMPLING
METHOD
Convenience
sampling will be used to obtain the study population.
INCLUSION AND EXCLUSION CRITERIA
INCLUSION
CRITERIA
1. Those that play musical wind instruments
and non-wind
instruments.
2. Study participants
who have consented
to the study
3. Study participants
below 18 years who have assented and whose guardians
have consented
to the study.
EXCLUSION
CRITERIA
1. Those who are musicians
but do not play an instrument
2. Study participants
who have not consented
3. Study participants
undergoing
4. Study participants
who have undergone
5. Study participants
who have had extractions
orthodontic
DATA COLLECTION INSTRUMENTS
A closed ended questionnaire
the basic demographic
of play. The type of wind
treatment.
orthodontic
of permanent
brass) and according to a modification
previously.
teeth.
1.) will be administered
the type of instrument
instrument
treatment
AND TECHNIQUES
(Appendix
variables,
to the study
played, the frequency
played will be recorded
of Strayer's classification.
16
by the investigator
according
outlining
and the duration
to type (woodwind
or
Modification
of Strayer's classification of musical wind instruments
Class A(I)-Instruments
(1939)
with a large cup shaped mouthpiece e.g. tubas ,trombones,
eupholJium.
ClassA(II)- Instruments with a small cup shaped mouthpiece e.g. trumpets, French horns
Class B-Instruments with a single reed mouthpiece e.g. clarinets and saxophones.
Class C-Instruments with a single reed mouthpiece e.g. oboes, bassoons.
Class D-Instruments with an aperture through which air is blown e.g. flutes
An intraoral exam will be conducted by the investigator
collection form that is a modification
under natural light and entered
into a data
of the Dental Aesthetic Index(DAI). Variables will be recorded as
follows:
Maxillary
overjet
will be measured, using a graduated
edge of the most
prominent
parallel to the occlusal
Overbite
upper
will be estimated
incisor to the corresponding
as the maximum
overlap
four upper incisors do not overlap
crossbite
will be recorded
maximum
height of a buccal cusp of an opposing
will be recorded
crowding.
or absence.
incisor
It will be recorded
labia-incisal
central
incisor
in relation
to
Crowding
only
when
all
in the occlusal plane.
tooth
lies lingual
to the
lower tooth.
when a lingual cusp of an upper tooth
will be assessed for presence
for
the
lower
upper central
when the buccal cusp of an upper
height of a buccal cusp of an opposing
be examined
of either
any lower incisor when viewed
Posterior
Crowding
from
as a percentage.
open bite will be assessed for presence
Scissor-bite
probe
plane.
the lower incisor and recorded
Anterior
central
periodontal
lies buccal to the maximum
lower tooth.
or absence.
in the
incisal
17
Both upper and lower
segment
is the
incisal segments
condition
in which
will
the
available space between the right and left canine teeth is insufficient
to accommodate
all four
incisors in sufficient alignment.
Molar relationship
will be recorded according to Angle's classification as follows:
Class I-Mesiobuccal cusp of the upper first molar occludes in the buccal groove of the lower first
molar.
Class II-Mesiobuccal
cusp of the upper first molar occludes mesial to the buccal groove of the
lower first molar.
Class III-Mesiobuccal
cusp of the upper first molar occludes distal to the buccal groove of the
lower first molar.
VALIDITY
AND RELIABILITY
The questionnaires
will be pre-tested on a sample of the study population.
form shall be a modification
calibrated
The data collection
of the Dental Aesthetic Index. The principal investigator
by the supervisors
to calculate
inter-examiner
reliability.
A repeat
shall be
examination
procedure shall be done on every tenth subject. Cohen's Kappa will be used to calculate inter
and intra-examiner
CONTROL
reliability.
80% Kappa score will be acceptable
OF BIASES
Only the respondents
who meet the inclusion criteria will be enrolled into the study. All data
collection tools will be pre-tested. All instruments
used will be calibrated.
ETHICAL CONSIDERATIONS
1. The research proposal will be submitted to I<NHethics committee
2. Permission will be sought from the Nairobi school administration,
for approval.
The Kenya Conservatoire
of Music Director, The Leidzen Brass Band Director and The Kenya National Youth Orchestra
Director to conduct the research.
3. Participants and guardians of minors will be required to consent to the study.
18
4. All information
collected
will be treated
with
confidentiality
and used for research
purposes
only.
DATA ANALYSIS AND PRESENTATION
The data collected
will be coded.
used for data analysis.
various
variables.
Descriptive
The Chi square
be used for the continuous
The Statistical
statistical
Package for Social Sciences
tests will be carried
will be used for the categorical
variables.
Data will be presented
(SPSS) 12.1. will be
out to explain
the frequency
data and a standard
using frequency
of
T test will
diagrams,
tables
and pie charts.
PERCIEVED BENEFITS
The study will offer
to development
an insight
onto whether
a musical
wind
instrument
may contribute
of malocclusion.
It will also serve as a benchmark
systemic
playing
diseases that musicians
It will also serve in the partial
for further
research
may be predisposed
fulfillment
towards
19
regarding
other
orofacial
to due to the nature
the BDS degree.
of their
problems
occupation.
and
BUDGET
__ _-----------------
.
..
.-..- .----- ..
Activity
- .--,--------.---------~------------ -- - - ----_ ... - - _._-_. ----- -- ._--Total
Unit Cost
Unit
-_.---------_.--------.--
--------.---------f------.--
...
-...
------.-------.---..
-----.-----
Printing and photocopying:
a)
Consent forms
150 copies
10
1,500
b)
Questionnaires
150 copies
10
1,500
c)
Clinical forms
150 copies
10
1,500 '
----.------.-------.-.-.--.Stationery:
..
- ..--
.--
._-
..
-.-
------ .. -..-.---
-_.__
.
__
-.. -.
..
..
-
_.
...
-
_
a)
Rulers
3
30
90
b)
Pens
6
30
180
.-...
.._._._------
r----------------------~--------------_4--------------I-----------------~
Typing
and
printing
the
5 copies
400
5 copies
- ..-.--------+
1000 minutes
400
a)proposal
b)report
1---------------_·_-Internet costs
--..
---..
-.-----.--.-.-.---.--Sh 2 per minute
500
50
Binding costs
10 copies
r----------------------+----------------j----------------+--------.-----2,000
Transport to study areas
4
500
-----------------------I-----------------!-----------------'-----·--·---·--300
Disposable
tongue
1 packet
300
depressors
-----------------+-----------------4----------Latex examination gloves
3
200
}---.
.-_
....
_--------_
..
_--------+-----.Face masks
1 packet
450
..
---.---.---.--.--------------.---
600
..... _.
}----------.--------.---I---.--.-----------I---------------.--
...
---
--..
---.-.--------.--
14,620
TOTAL
'--
--_._.-----
450
L-.
-L...
20
.
.
.
_
REFERENCES
l)Gruenboum
Tamor.
Famous figures
2) Premkumar.(2009).Graber's
in dentistry.
textbook
JASDA 2010;30(1):18.
of orthodontics:
Basic Principles
and
Practice-t" ed.(JP)
Elsevier.
3)Proffit
W.R. Equilibrium
Orthod.
1977; 48:175-186.
theory
4) Baines A.(1961).Musical
5)Grammatopoulos
occlusion.
instruments
E, White
American
revisited:
Journal
the factors
through
A.P, Dhopatkar
influencing
of the teeth.
a wind
instrument
Am J
the ages.(Pelican)
A. Effects
of Orthodontics
position
of playing
and Dentofacial
Orthopedics.
2012;
on the
141(2):138-
145.
6)Yeo
D.I<.L, Pharm
musicians.
7)Ou
Australian
Daigaku
morphology.1990
8)Neil
J, Porter
Dental Journal.
Shigakushi.
S.A.T. Specific
orofacial
problems
experienced
by
2002;47:1:2-11.
Influence
of
playing
the
clarinet
on
the
dentomaxillofacial
Jul; 17(2):131-154.
Raney. Effects
Orthodontics2006;
T,P, Baker
of Orthodontic
appliances
on wind
instrument
players
Journal
of Clinical
40:384-387.
9) Khan M, et al. Assessment
of psychosocial
impact
of dental
aesthetics.
J Coli Physicians
in children
playing
Surg
Pak. 2008 Sep; 18(9):559-564.
10) Brattstrbm
V, Odenrick
instruments:
a longitudinal
11) Herman
E. Influence
L, Kvarn
E. Dentofacial
study.European
of musical
Journal
instruments
80(2):145-155.
21
morphology
of Orthodontics.
on tooth
musical
wind
1989 May; 11 (2):179-185.
positions.Am
J Orthod.
1981 Aug;
12) Pang A. Relation
of wind
instruments
to
malocclusion
J Am
Dent
Assoc.
1976
Mar;
92(3):565-570.
13) Rindisbacher
T, Hirschi
playing a wind instrument.
14) Strayer E.R. Musical
Perversions.
the 'embouchure.'
Angle Orthod.
Instruments
Angle Orthod.
15) Porter M.M.
U, Ingervall
B, Geering
A. Little
influence
on tooth
from
1990; 60(3):223-228.
as an aid in the treatment
of Muscle Defects and
1939; 9:18-27.
Dental aspects of orchestral
wind instrument
playing with special reference
Br Dent J. 1952; 93:66-73.
16) Parker J. The Alameda
position
Instrumentalist
Study. Am J Orthod.
22
1957; 43:399-415.
to
APPENDICES
APPENDIX 1: DATA COLLECTION FORM
PART I
1.
Age
2.
Gender
D
LJ
Male
3.
Female
c=J
Location
Nairobi School
Kenya
Conservatoire
Kenya National
of Music Orchestra
c=J
Youth Orchestra
LJ
c=J
Leidzen Brass Band
4.
Are you a wind instrument
(If 'Yes' answer Question
player?
4, If 'No' skip Question 4 and answer question
Yes
5.
No
Type of wind instrument
Woodwind
6.
c=J
Type of non wind instrument
String
7.
Brass
Duration
CJ
Percussion
c=J
CJ
1 to 3 years
LJ
Other
of play
Less than a year
23
more than 3 years
c=J
5)
8. Frequency of play
Ihour/day
9.
Yes
[:=J
2 to 3 hours/ day
Do you think playing a musical wind instrument
[::=J
NoD
24
,
c=J
more than 3 hours/ day
affects the position
I don't know
[:=J
[:=J
of your teeth?
PART II
1. Maxillary overjet (mm)
Edge to edge<3mm
3mm to <6mm
6mm to <9mm
9mm and>
c=J
c=J
c=J
c=J
Overbite
2.
Edge to edge to<one thirds overlap
U
One thirds to< two thirds overlap
U
Two thirds to<three
U
thirds overlap
Three thirds overlap and over
Anterior openbite
3.
Present
4.
5.
c-J
Posterior
Absent
c=J
Absent
CJ
crossbite
L
Present
c=J
R
Present
CJ
Absent
CJ
Absent
CJ
Scissor Bite
L
R
Present
Present
CJ
CJ
Absent
25
CJ
6.
lower
anterior
Present
7.
c:::J
Upper anterior
Present
crowding
Absent
crowding
CJ
Absent
8. 1st molar relationship
Angle's Class I
c:::J
Angle's Class II
Angle's Class III
9.
Instrument
Class A(/)
Class A(II)
Class B
Class C
Class D
class
Cl
CJ
c:::J
c:::J
CJ
26
D
APPENDIX 2: INDICES
Modified Strayer's classification of musical wind instruments (1939)
Class A{I)-Instruments
with a large cup shaped mouthpiece
Class A{II)-Instruments
with a small cup shaped mouthpiece
e.g. Tubas, trombones.
e.g. trumpets,
French Horns
Class B-Instruments
with a single reed mouthpiece
e.g. clarinets and saxophones.
Class C-Instruments
with a single reed mouthpiece
e.g. oboes, bassoons.
Class D-Instruments
with an aperture
Angle's
classification
Class I-Mesiobuccal
of molar
through which air is blown e.g. flutes
relationship
(1899)
cusp of the upper first molar occludes
in the buccal groove
of the
lower first
molar.
Class II-Mesiobuccal
cusp of the upper first
molar occludes
mesial to the buccal groove
of the
distal to the buccal groove
of the
lower first molar.
Class III-Mesiobuccal
cusp of the upper first molar occludes
lower first molar.
27
APPENDIX
rd
I am a 3
3: CONSENT FORM
year undergraduate
student
Dental Surgery degree. I am currently
musical wind instrument
I wish to request
involved
conducting
answering
some questions
will be assessed and recorded
be carried out maintaining
and an intraoral
in a data collection
will be performed
and orthodontics.
problems
and you are free to withdraw
kept confidential.
form
am ong selected
part of
exam in which
form.
my degree
the type of
There wi II be no risks
and the entire
exa mination
by musicians
the relationship
of musical
will
in our local setting.
research
Participation
wind
regarding
is voluntary
from the study at any stage. The study entails no costs on the
The participant's
However,
regarding
It will also open up avenues for further
experienced
part of the participants.
a Bachelor of
absolute hygienic measures.
The study will serve to provide more information
orofacial
pursuing
research on malocclusion
in this study that would
because no invasive procedures
instruments
of Nairobi
player groups in Nairobi.
for your participation
course. It involves
malocclusion
at the University
identity
appropriate
and the results of the investigation
advice shall be given for
any urgent
will be
treatment
required.
I would therefore
I, Muyia
Robert
appreciate
Mandela
your consent by signing here below.
Bwire,
confirm
that
I have explained
the relevant
parts
of the
study to the participant.
Signed:
I, the participant,
Date
confirm
that
_
I have understood
the relevant
hereby give consent to participate.
Signed:
Date
28
_
parts of the study
and do