It has always been a cause of incomprehension and amusement to me that woodwind players are more worried and paranoid about injuring their hands than their mouth or teeth.
In my professional capacity as a dentist, the oral hygiene and dental state of such players is also similar to the way they look after the cleaning of their instruments. Given that this mouth will be in constant intimate contact with the reed, mouthpiece, and saxophone, it is quite sensible to be proactive in preventing contamination of these separate components.
I was prompted to address this following an article I read in Huffington Post regarding something called “Saxophone Lung” – a euphemistic term for a specific allergic based chest infection called hypersensitivity pneumonitis.
A man in Atlanta had confounded doctors and specialists for over a year with a condition which did not respond to antibiotics, steroids or any other therapies.
It was only after he mentioned that he played clarinet in a Dixieland jazz band several nights a week that researchers examined his clarinet and reed.
A growth of Exophiala fungus was discovered inside his mouthpiece. Normally associated with decaying wood and soil, the growth meant he was essentially inhaling spores and fungus every time he played the clarinet.
He also had an allergic reaction to two other fungi that were present: ”Alternaria”, and “Curvularia”, a soil fungus from the tropics.
The warm moist environment of a wind instrument, it seems, is an ideal breeding ground for such things to colonise and set up home.
In his case for over 30 years!
Following a thorough disinfection of this musical compost heap it was no surprise that his condition improved. The resources wasted on chest X-rays, medications, prescriptions, and a year’s clinical time could have been spent better somewhere and on someone else if he had just cleaned his instrument or given up playing Dixieland!
“He was essentially inhaling spores and fungus every time he played the clarinet.”
Other cases reported included a bagpiper, who was hospitalised for weeks with a near fatal infection from molds that had been accumulating undetected inside his instrument, a trombonist who had suffered from a cough for 15 years which ironically always stopped when he had to stop playing, and a saxophone player who had now begun to cough up blood.
What to do?
This threat of infection has existed for as long as we have been playing wind instruments. Just imagine where we were before antibiotics!
However the cause is quite simply poor, or a total lack of, instrument hygiene.
At this point I know the “I-Reckon” brigade reading this will be saying “I never bother to clean my instrument or mouthpiece and I am fine – so what”.
Well to them I say, you would not be impressed or happy if I gave you a check up, filling or an extraction using the last patient’s dental instruments.
“If your pitch or intonation is changing have a good look down the neck first – it just might surprise you.”
Even if you do clean your saxophone, are you doing enough to avoid similar issues? How often do you really clean it and have you ever used a chlorine based solution or isopropyl alcohol as well?
Assuming you have cleaned the saxophone thoroughly enough, the crook especially on a tenor or baritone is where most of the moisture will be concentrated, being the narrowest part of the conical tube.
The body and bell are ventilated to dry out more easily and unlikely to have such an effect when inhaling.
So if your pitch or intonation is changing have a good look down the neck first – it just might surprise you.
Also please be aware of Nickel Allergy. It is a common contact dermatitis leaving an allergic redness and soreness on the lips and tongue. It can also be seen on hands and fingers from saxophone keys (and from handling money).
Cleaning up your act
Right: let us get started cleaning up our act. I am assuming you do not knowingly have any of the following: HIV, AIDS,Hep B, Hep C,Herpes Simplex (oral and genital), Herpes Zoster (Cold Sores), Syphilis, Gonorrhoea, Oral Candidiasis (Thrush) or Tuberculosis. All of the above are around and I am sorry to say, from the statistics, on the up so to speak!
I have given this matter some serious thought as you may now realise and after careful consideration decided to adapt some of the very protocols expected and demanded in a modern dental clinic to mouthpieces.
These are best cleaned with a very dilute hypochlorite solution, which is swimming pool water to you and me. The most popular and safest would be Miltons, commonly used on baby’s bottles.
Alternatively, you could switch to a synthetic reed which can be washed with soap and water and wiped with alcohol instead.
Most of us would neglect cleaning our pull through however they can also be a breeding ground for diseases. Most pull throughs can be microwaved quite safely according to one study in 2011. Just be sure yours doesn’t have a metal weight stitched into it.
You may have one, a hundred and one, or in my case, usually the wrong one, but it will be most likely made of plastic, ebonite or metal.
We can use a similar approach for cleaning mouthpieces as that used to clean my dental equipment because they both have to go in your mouth, and should be non allergenic and sterilisable.
Sterilising vs Disinfecting – what’s the difference?
Sterilisation is defined as “the complete elimination or destruction of all living organisms” and is unnecessary unless you have one of the above illnesses and are selling your sax mouthpieces etc.
Sterilisation is what you expect and receive when you see the dental instruments in those blue pouches during treatment. It protects each patient from transmission and cross-infection.
Disinfection is defined as “the killing of pathogenic disease causing organisms or rendering them inert”. This is what we are aiming for on a regular basis for our mouthpieces.
You will be glad to know to achieve this it is not only simple but cheap as well.
Stage 1 – Reducing the biologic load
Start with soap and water.
Be sure to fill your bowl first, then add your mouthpiece so you don’t risk dropping and damaging it. Use a new clean toothbrush to scrub your mouthpiece. A cheap battery powered one is even more effective for removing sticky bacterial colonies known as Biofilms.
![A biofilm is a group of micro-organisms that stick together on surfaces](Biofilms stick to surfaces.jpg)
Stage 2- Disinfection
I suggest using Milton Sterilising Fluid. This is a weak solution of Sodium Hypochlorite. It should be diluted to 0.6%. Around 15 minutes soaking should be sufficient for all plastic, metal and ebonite mouthpieces. Be sure to rinse well with cold water afterwards. Any smell of chlorine will evaporate quickly.
Dentural is a denture cleaner which is also hypochlorite and designed for acrylic as well as Chrome Cobalt Metal Dentures but you must limit the contact time to 10 minutes otherwise metal tarnishing may occur or bleaching of coloured acrylics.
Do not under any circumstances use household bleach. It’s also best to avoid Steradent or any other fizzing tablet type of denture cleaner. They do not work.
You may also find a white buildup on the mouthpiece. This is a calcium deposit from your saliva. Use white clear vinegar, (ethanoic or acetic acid) in a 50:50 dilution with water to dissolve and soften the build up.
You could also use an ultrasonic cleaner to remove these deposits. A cheap denture or jewellery cleaner from the internet will work efficiently but make sure to check it is large enough to take your mouthpiece. Immerse the mouthpiece fully, ideally in a ziplock bag to prevent it rattling around and damaging the tip or facing.
During any of these cleaning stages be careful to not damage the tip, baffle or side rails by scraping.This regime should prevent most things from growing in sufficient numbers to cause a problem, if done as an initial protocol and ideally on a weekly basis.
I understand that this is not practical for daily gigging use so at a minimum I would suggest a rinse and gentle scrub with soap and water. Finish with a surface disinfectant wipe that contains isopropyl alcohol, or alternatively use a non alcohol wipe that is safe for personal use.
About the author:
Dr Duncan Grant B.Ch.D is a dentist at the Behrens Clinic in London (opposite the Natural History Museum!) where he treats some of the top saxophonists and musicians in the world. As a saxophonist himself he is a busy performer with his own sextet and playing alongside many other leading players on the London circuit.