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One of the most common queries that finds its way into my email inbox concerns the issue of mouthpiece hygiene.
In most cases the query relates to the purchase of a secondhand mouthpiece and asks for advice regarding a suitable method for cleaning and sterilising it. My general advice is that a wash and brush out with lukewarm water to which a few drops of detergent have been added, followed up with a sloosh of disinfectant, is usually quite sufficient - though rather more heavily encrusted pieces might benefit from treating with vinegar.

Most people seem quite satisfied with this advice, but one or two write back to say "Are you sure that's enough?" - and in some cases I've seen the same person subsequently post the same query to one of the various internet forums in the hope of finding some advice that perhaps better fits their expectations.
And their expectations are often met - with various responses that recommend all manner of products and techniques.
The thing is though, just how much of a risk is there - and what are the possible consequences if you choose not to adopt any form of mouthpiece hygiene?

The biology:

In order to assess any risk you must first find out precisely what it is you're up against.
It's common sense, surely, that a woodwind mouthpiece is a good place for bacteria to live and thrive - it's a protected environment, often warm and wet with a ready supply of nutrients, and there are any number of nooks and crannies in which substantial colonies of bacteria can hide.
This sounds appalling already, but that description could easily apply to your mouth - and to some degree, other parts of the human body...such as the fingernails.
This is the first principle that must be accepted; bacteria are everywhere, and the fact that you've lived long enough to learn how to read this article indicates that we can quite happily co-exist with a significant number of wee bugs floating around the general environment.

But people do fall prey to disease and infection, and on the whole this is due to a number of factors such as a type of bug that our bodies are not too adept at dealing with, an immune system that's compromised ( perhaps due to a recent illness ), or a concentration of bugs so large that it overwhelms the body's natural defences.
In the first instance the chances of coming across a rare and virulent bacteria on a secondhand mouthpiece are extremely slim. It would need to be able to survive in that period between the last time the piece was played, put up for sale, bought and played again - and assumes that no cleaning process of any sort had taken place. It also assumes that the previous owner was exposed to the bug...and thus must have survived long enough to sell the piece...
In the second instance the risk is greater - but it would be a universal risk in that ordinary day-to-day life would be quite hazardous, and you probably wouldn't be feeling much like playing a saxophone or a clarinet.
In the last instance you'd have to rely on ingesting a very significant amount of contaminated material - and if your secondhand mouthpiece turned up with that much crud in and around it you'd probably have to take a chisel to it before you were able to get a note out of the thing.

The tests:

It already looks as though the chances of contracting something from a dirty mouthpiece are quite slim - but let's have a look at it from a more scientific perspective.
It was originally my intention, with the assistance of a microbiologist colleague of mine, to test a number of mouthpieces and analyse the bacteria present - until I happened upon an article by Christopher King ( University of Newcastle-upon-Tyne ) detailing this very experiment in far greater depth and detail than I could have achieved. Similar articles were found by Arthur H. Bryan ( Florida Air Academy ) and W.G. Walter & Dorothy Chaffey ( Montana State College ).
The articles make for fascinating, if heavy, reading - though on the face of it they could be quite worrying...unless you put the findings into context.

All the studies start with the assumption that the mouth plays host to various assorted bugs. These are known as 'commensals' - they're just part of the natural microbial flora of the human body. Indeed, we actually need them for a variety of reasons, one of which being that they compete with each other for resources which makes it harder for any one bug to gain the upper hand. This is the principle behind 'probiotic' foods such as 'live yoghurts', and it also explains why a dose of antibiotics can sometimes lead to some inconvenient side-effects, such as diarrhoea.
The next stage in each study was to identify whether any of these bugs could survive and prosper in various woodwind and brass mouthpieces. This is where it all gets a bit technical, and hard-to-pronounce names are thrown about all over the place, but the essential facts are that some bugs that exist quite peaceably within your mouth can colonise a mouthpiece - and that colony can prosper to such an extent that there's a risk of being exposed to potentially massive doses of assorted nasties or their resultant toxins.
A few of the more impressive bugs include Staphylococcus aureus - a variant of which is responsible for MRSA; Staphylococcus saprophyticus - responsible for urinary tract infections; and various haemolytic streptococci - which are implicated in sore throats, ear infections and respiratory problems. Nasty, eh?

Further testing on mouthpieces that had not been used for some considerable period of time ( several months ) showed that reduced but viable colonies of certain bugs remained present - and that concentrations of microbes on mouthpieces in regular use increased for many hours after the musician had ceased playing.

It all looks pretty bleak and foul, and yet our streets aren't littered with the decaying corpses of dead musicians.
This is because of our natural immunities - though both studies clearly indicate that there are times when this isn't enough to protect us, such as in the case of glandular fever and, possibly, syphilis!

If you're already reaching for the antiseptic you should pause a while and consider the efficacy of the various potions and solutions you might be tempted to sloosh your mouthpiece out with. Both studies show that it isn't often all that easy to fully eradicate the various bugs found and that true 'sterility' is largely impractical.
It's also unnecessary.

The levels of risk:

But what exactly is necessary, or at least advisable?
It depends largely on your level of paranoia. If you wish to adopt a no-tolerance approach to bugs then you're going to have to invest in some pretty serious chemicals and kit. You're also going to have to consider your own role in the contamination process, and this could lead to a pretty harsh personal hygiene habit. Frankly if you're this concerned about the issue then you'd be well advised to bone up about how many bugs exist on and around us in every day life...and then go hide under a ( sterilised ) blanket until the grim reaper comes round for tea and a quiet but earnest chat.
There are, however, products and services you can avail yourself of that cater to this level of hygienic need.
For example, I've heard of a product that consists of, essentially, a gas-filled bag that claims to completely sterilise your instrument.
It may well do, but what's the point? An instrument so treated is only sterile so long as it remains in that environment - as soon as it's removed it becomes infected, and you're back to square one ( minus, of course, a suitable sum of money ).
Granted, it's possible for an instrument to harbour some pretty nasty organisms - but there simply isn't the need to kill all and any bugs, just to bring the population size down to an acceptable and normal level.
To a large extent the media is responsible for the current level of paranoia regarding bacteria - time and again you'll see the message that your house is dirty unless you zap everything with the microbial equivalent of a neutron bomb...though perhaps the tide is turning as people start to wonder whether such levels of cleanliness are actually all that good for us. There might indeed be a great deal more to the old phrase "You'll eat a peck of dirt before you die" ( a variant of which is the phrase "A child needs a peck of dirt a year to grow" ).

For the genuinely concerned but philosophically circumspect the prospects are very much brighter indeed.
It's been shown that the bugs that live on the mouthpiece are more than likely already present in your mouth ( unless you've been doing something very strange with your mouthpiece ), and that contamination is something that's going to happen whether you like it or not - so the object is to maintain a sensible and safe level of that contamination.
From a professional standpoint my advice would have to be that you clean and disinfect your mouthpiece after playing - the studies indicate that there's significant growth in the levels of contamination in the period immediately after you've finished playing.
From a musician's standpoint, and perhaps a more practical one, I suggest that at least a weekly cleaning regime is in order.

And if you don't bother?
Well, I have to admit that up 'til now my mouthpiece cleaning regime has been less than exemplary, but consider this:
I stated that we don't see dead musicians lying about in the streets - but I wonder how many of us have woken up on the day following a gig feeling a bit under par? I know I have, and I've always put this down to a combination of a late night and perhaps a pint too many...but there's evidence here to suggest that my body might have spent half the night beating back a potential infection courtesy of my cruddy mouthpiece.
Implausible? I don't believe so - we all know that when we're exposed to a bug of some kind ( typically when a partner goes down with something ), we might not perhaps succumb to it fully ourselves but we often feel a bit off for a day or so. This is just the body doing its thing, fighting the bugs.
Consider too the nature of the work a musician might do; lots of travel, late nights and early mornings, inconsistent diet, a tad too much of the old booze every now and again ( or worse! ) - not to mention the stress and the physical strain. At the end of a working day that musician could be quite exhausted, and the very last thing the body needs to deal with at that point is a huge intake of bacteria.
I've always maintained that the human body is quite robust, and that there's no reason to become paranoid about the cleanliness of the mouthpiece - but through reading the various articles in the course of my research I'm convinced that I need to pay a bit more attention to the hygiene factor. I might double my cleaning routine and wash my mouthpiece twice a year ( only jokin'! ).

After that you're down to the common-sense approach.
Both studies made mention of quite nasty diseases that could, potentially, be passed on via mouthpieces. In most cases this referred to the practice of sharing mouthpieces.
This is an obvious risk - your body is quite able, generally, to cope with the bugs you already have, but it might get caught out by bugs that it doesn't have. Borrowing a mouthpiece off someone who's clearly pox-ridden and covered in suppurating sores is simply asking for trouble - but a great many minor but nonetheless annoying and sometimes painful infections aren't always easy to spot in the unfortunate victim...especially if they're in the early stages.
That's a risk factor that only you can ascertain, but consider the following:
On what basis do you decide whether or not to kiss a person? How many times has a friend handed you a glass of beer and said "'Ere, does this taste funny to you?" How many times have you shaken hands with your fellow musicians as they arrive at the gig, and then set about putting your reed on your mouthpiece...without washing your hands first?
That last point bears some closer examination because our hands are a good environment for bugs to thrive on, particularly fecal coliforms ( no prizes for guessing where THEY come from! ).
In a fascinating experiment conducted on the TV show Mythbusters, it was shown that - in their words - 'poo is everywhere'.
It'll be on your hands, your toothbrush, your lunchbox...and your saxophone. Were you worried about it? I doubt it. Are you worried about it now? I would hope not...
In other words we live in a world that positively heaves with quite literally countless numbers of bugs, the majority of which do us no harm in ordinary circumstances.
In a practical sense I'd say that children should avoid sharing mouthpieces with each other. Any parent knows that it only takes one child at school to go down with a bug, and before you know it half the school is off sick. Adults are going to be more robust.

One issue touched upon in the studies that might lead you to changing your cleaning regime is that of re-infection.
I mentioned earlier that the body is at greater risk of infection if it's in a weakened state, and this is perhaps a factor that few of us consider after having spent a few days in bed with a 'touch of the lurgy' before picking up a horn again to do a spot of practice or play on a gig. Whatever it was that knocked you for six might still be present in your mouthpiece, and the chances of it infecting you again could be quite high. Similarly, to play someone else's mouthpiece while you're in this condition is going to be quite a risky proposition - and not just for you.

At this point it's worth extending consideration to associated accessories. For example, the various pull-throughs and swabs that are used to clear water out of the bore of the instrument. These are just as prone to picking up bugs and detritus, and are ideal candidates for re-infecting your instrument every time you use them.
Let's take a typical scenario of a player swabbing out the bore of a mouthpiece after playing. If that player then cleans and disinfects the mouthpiece and then plays it again later it will become contaminated with whatever's in the player's mouth. If the piece is then swabbed again it will also become contaminated with whatever was left on the swab from last time.
It has been shown that some bugs can remain viable for a lengthy period of time after playing and that they can survive quite adequately in the matrix of your swabs and pull-throughs. Spores survive readily in such conditions too, and these can trigger an allergic response in those so affected. It would be wise, therefore, to periodically clean such items as best you can...which is only common sense anyway.

In particular I would draw attention to the variants of the 'pad saver' device which are used on crooks and mouthpieces and are generally left inserted. I have never considered these products to be a good idea, and the studies surveyed for this article indicate that my doubts are entirely justified. It's akin to keeping your cutlery in the bin.
In a similar vein attention should be paid to the mouthpiece cap and the ligature - especially if it's of the flexible variety, which often have cervices that can fill up with goo.
Players of solid or silver plated mouthpieces may have a slight advantage inasmuch as studies suggest that silver has some antibacterial properties...though I wouldn't be inclined to wholly rely on them. Solid silver crooks will also have such an advantage, but not silver plated.

As regards the issue of contamination further down the bore of an instrument, I don't believe it's a significant factor. I certainly wouldn't suggest that it's particularly healthy practice to lick the bore - but then I don't know many people who would ( just a few, perhaps ). It appears to be sufficient to concentrate one's hygiene regime on the mouthpiece and the crook - or that portion of the instrument to which the reed or mouthpiece is attached. In the case of flutes etc. I would consider the entire head joint to require cleaning - though the nature of blowing means that the risk of cross-contamination is lessened.

The solutions:

The suggestions for suitable means of disinfecting a mouthpiece and crook ( and the reeds etc. ) are varied and quite complex, with solutions such as dilute hypochlorous acid being put forward as effective agents.
However, it's it clear that nothing more complicated than hot water, detergent and scrubbing ( with a suitable mouthpiece brush ) will have a significant and measurable effect on the multitude of bugs, and that proprietary domestic disinfectants ( such as Dettox etc. ) are as effective as is necessary. Dental disinfectants are also sufficient.
Every once in a while, and perhaps certainly following an illness, it would be worth soaking the mouthpiece in neat disinfectant for half an hour - this will practically completely sterilise it.

Alcohol is also suggested, which gives merit to the practice that some reed players indulge in in keeping their reeds in a glass of whisky or vodka. It also appears that taking a slug of whisky yourself prior to playing will help. If you feel it's necessary to treat your reeds, some studies showed that soaking the reeds in a neat disinfectant solution followed by rinsing and air-drying effectively decontaminated the reeds without affecting their performance.
Crooks in particular may be treated with vinegar - it's surprisingly effective as a bug-killer and has the added bonus of removing any calcium carbonate build-up in the bore. It can also be used, with care, to clean mouthpieces.
When it comes to swabs and pull-throughs you're rather limited in what you can do to clean them. Personally I just wash them in hot water and detergent with a generous sloosh of disinfectant added.

Of all the fascinating information I uncovered during the course of my research I particularly enjoyed the findings of W.G. Walter & Dorothy Chaffey, in which they found that simply wiping a trumpet mouthpiece with the tail of a shirt made a significant impact to the number of bugs. That's the kind of real-world science we can all take home!

Acknowledgements and thanks:

Christopher King - "A microbiological survey into the presence of clinically significant bacteria in the mouthpieces and internal surfaces of woodwind and brass instruments": University of Newcastle-upon-Tyne - 1994-1995

Arthur H. Bryan - "Band wind instrument mouthpieces may harbor countless disease viruses and bacterial flora": Head of Science Department, Florida Air Academy, Melbourne, Florida - 1969

W.G. Walter & Dorothy Chaffey (.pdf file ) - "Bacteriological and cleaning studies on the mouthpieces of musical instruments": Dept. of Botany and Bacteriology, Montana State College, Bozeman, Montana - 1958

Jo Ransom - Biomedical scientist specialising in microbiology: Portsmouth, UK

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