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Letter to the Editor |
22 Blenheim Road, Bristol BS6 7JP, UK.
Dear Sir,
In the recent edition of `The Horn', a journal for French horn players, a
senior teacher, in an article titled `Brace Yourselves' describes his increasing
despondency about the rising prevalence of fixed braces on the teeth of young horn players and
the resultant limitations on their musical progress (de Souza, 1998
). He
sets out some sound advice for parents and teachers, and in the subsequent edition of the
magazine this is followed up by a helpful article `The Horn/Orthodontic Interface'
by Richard and David Williams who are experienced as patient or orthodontist and as horn
players. Clearly this needs to be supported with more awareness by orthodontists in general.
The stability of the incisors is important to all who blow an instrument but the contribution of aligned incisors and a Class 1 arch relationship is probably only as relevant to them as to any other person. On the other hand, the continuity of musical progress through the very years when orthodontics may be indicated is essential for those with serious musical ambitions. Sustaining a child through this period with the additional difficulties presented by a multibanded appliance may become very difficult.
Ideally, a full pretreatment debate, including the parent child, and teacher, about the pros and cons of orthodontic intervention should be initiated by the GDP, but it is evident that this may not occur. Wherever the orthodontics is to be delivered, a debate between all concerned should at least confirm that the prospect has been discussed with the instrument teacher. The need for orthodontics and whether intervention is, indeed, essential or desirable and how then this could be minimized and simplified is what the parents ultimately want to know as they try to bring a perspective to their childs needs.
Good simple orthodontics as delivered by many of my generation to the majority of their patients, including their own children and those of colleagues, supported by sound treatment planning and skills with removable appliances is possible and what a significant number of such patients with their special needs require. This will not be adequate for all but two issues are worthy of comment in the light of the current debate on appliance therapies in the journal. First, it is not surprising that reputation of removable appliances is not being sustained when the skills required are being neglected in current training. Secondly, that aspirations of arbitrary perfection pursued by many today are unlikely to ever figure in any statement of medical ethics. Acceptable negotiated compromise is the noblest and most professional outcome to most difficult situations and is what most choose given the facts.
The specialty has a responsibility to be sensitive to those with special needs and offer care acceptable to the patient. In particular, this is to urge all practitioners to make themselves aware of all patients who are wind instrument players, to take their special needs into account and to feel good about acceptable compromise!
Yours sincerely,
References
de Souza, S. (1988) Brace Yourselves,The Horn Magazine 6 p28–29.
Williams, D. and Richard (1988) The Horn/Orthodontic Interface,The Horn Magazine , 6 p. 30 –32.
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