Invisalign

My relationship with my teeth has always been complicated. As a kid, my mouth experienced a whole lot of hardware: the stainless steel palate expander with the medieval key crank, braces, a rainbow of rubber bands coaxing my jaw into place, and, sexiest of all, the nighttime headgear that buckled around my face. Around 1998, I looked like Wednesday Addams fell face-first into a tackle box.

I fell head over heels for trumpet playing around the same time, but the revolving door of orthodontic appliances made those formative years rough. There was a lot of self consciousness and drooling. 

When my wisdom teeth made their grand entrance, they came in on a 45º angle and shoved everything out of alignment again. I was told they would have cracked my adjacent molars if they hadn’t been removed. In the decade following that surgery, the crowding worsened and my bite became more misaligned than ever. Jaw pain was setting in and my shrinking hard palate was making trumpet articulation difficult. So, with some optimism and a little apprehension, I began Invisalign treatment.

Artist’s rendering, yours truly at the turn of the millennium

In terms of my playing, I expected this to be a breeze.

It hasn’t been.

Before I discuss the trumpeting setbacks of this adventure, however, I want to underscore how amazing Invisalign is. Rather than biting down on a tray filled with purple impression goo and waiting for it to set and be filled with plaster, a handheld intraoral scanner creates a digital model of your teeth in real time. You can see what to expect in a year by watching that model shift in a simulator. The aligners are 3D printed and barely noticeable when worn. It’s all very, very cool.

That said, there has been a grueling adjustment period. The first few weeks were full of headaches, jaw aches, and mouth sores. I had some gum irritation and bleeding after having the enamel shaved down in two spaces between my teeth (“interproximal reduction” or “slenderizing”) to create enough space for movement. My treatment plan also requires a greater-than-average number of attachments (also called “buttons”) bonded to the front of my teeth: five on the top row, nine on the bottom row. They provide the leverage needed to push and turn teeth in the right direction. 

While most of these growing pains wreaked havoc on my trumpet playing, especially during the first two weeks, there has been noticeable improvement. I don’t regret beginning treatment and I don’t mean to deter anyone from doing so, but knowledge is power and I wish that information about Invisalign re: trumpet playing had been more readily available on the internet. 

Here are some of my observations. Your mileage may vary.

Trial and error has been my weapon of choice. Week one was mostly rest, but I did some gentle mouthpiece buzzing and long tones for about 5 minutes each day. Beginning in week two, I played for 2-3 hours per day in 20-minute blocks to test strategies and build endurance. Some of my issues were solved with patience and physical adjustment to the aligners, but raking myself over the coals in the privacy of my own home brought some peace of mind.

Playing with the aligners in reduces my flexibility and range. It eases lip irritation and friction from the attachments on the front of the teeth, but the back edge of the tray does not sit perfectly flush with the hard palate. The air stream is split by the edge of the aligner, especially in the upper range when the air’s path through the oral cavity is narrow. Clean lip slurs, which are normally a strength of mine, are nearly impossible. Intonation is fine in and below the staff, but it gets squirrely at G and above. If I need to play something low without much flexibility demand (i.e. demonstrating tunes for my elementary school students), I choose to keep them in. Otherwise, it isn’t practical.

Playing with the aligners removed restores the flexibility and range I had pre-treatment, but with attachments on the front of every tooth behind the mouthpiece rim, it feels like playing with a mouth full of broken glass. The edges are sharper than I anticipated. Fortunately, they have smoothed out a bit with regular wear over the past month. 

Orthodontic wax has been my go-to for playing comfortably, though it doesn’t stick to smooth surfaces as well as it sticks to traditional metal brackets, so you run the risk of it coming loose and ending up in your mouthpiece as you play. 

Topical anesthetic was a life-saver during the first weeks. It might be helpful on a long gig, but I worry that masking pain too often might lead to unintended damage.

Dry mouth is an issue. With the aligners in, saliva can’t circulate as it normally does. I try to have a full water bottle with me at all times. If taking a bathroom break every 20 minutes is impractical, sugar free mints are very helpful. I keep a tin of Altoids smalls in my trumpet case now.

Fluctuation is normal for every player: we all have great days and days we want to throw the trumpet out the window, and we try to minimize it with our routine. Invisalign just magnifies the ups and downs. Mostly the downs. 

Timing can be used to one’s advantage. Switching to a new set of aligners causes aches and pains, but doing this right before bed and chasing it with ibuprofen minimizes discomfort. Each new set seems to be less painful than the last. I don’t recommend starting Invisalign from scratch two weeks before your first three gigs after a year-long pandemic hiatus. Ask me how I know. 

So, is it worth it? I’ll let you know in a year. For now, let’s talk about it! What’s your experience with Invisalign and brass playing? Did it go as you expected? Are there any strategies that you’d like to share? Leave it in the comments!