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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