Category: Dental

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The Dentists are Coming

By Sue Seboda, Dental Part 19

During my own dental saga, I began to notice a good number of women in my age group considering Invisalign.  Let’s call us the over 50 gals.  A friend of mine, who had just started Invisalign, wondered aloud if they were coming after us. Yup, I reckon they are. 

It’s not just us.  Align, the company who owns the Invisalign system, is on the hunt for market share wherever they can find it and doing a brilliant job.  They are a billion dollar a year public company with approximately 80% of the clear aligner market.  They have a big bottom line to feed and shareholders to keep happy.  Absolutely nothing wrong with that.  But there can be unintended consequences if a company’s emphasis is weighted more heavily on the bottom line and less on the ultimate end user, the patient.  And if that is the case with Align, the patient must be vigilant.

Align markets directly to the end user (patients) and the providers (dentists and orthodontists).  Very smart.  Build demand from the bottom up especially in a dental industry that is probably slow to change.  They market to teens and their moms.  Good idea.  They have simplified orthodontics so dentists with minimal training can handle patient cases. Also very smart.  This increases the number of providers which will ultimately increase the number of end users, fattening up that bottom line nicely.  Therein lies the rub.  And why patients in general and the over 50 gals in particular need to be careful. Let’s dig in.

On https://www.invisalign.com, plug-in your own zip to find a doctor.  I did this using a 5 mile radius and came up with 29 providers, 22 of which were dentists and 7 orthodontists.  Interesting…  Note there is a rating system from VIP down to bronze based on the number of Invisalign cases each provider has handled. The more cases, the higher and more visible the provider.  Great information for the public, right?  Yeesss, but…  Also providers pay Align a lab fee for each Invisalign patient.  The more patients, the lower the fee.  Sounds logical?  Yeesss, but…  Also Align has attempted to set quotas for providers but so far has failed I believe.  Hmmm…  Because we humans are incentive driven to the max, these incentives do wonders for Align’s bottom line.

You know what is coming.  The potential downside for patients:

  • Incentives may encourage general dentists with only a superficial understanding of orthodontics to manage Invisalign cases that should be referred to an orthodontist.
  • To get numbers up, providers will tap into undersold markets such as us over 50 gals. This is fine with a provider who understands the complexities of orthodontics at this age.  It could be disastrous otherwise.
  • Incentives may also result in a provider recommending Invisalign when another orthodontic appliance may be more appropriate.
  • Providers with little experience may be unable to properly navigate the side effects of Invisalign.

Stay with me a bit more, especially the over 50 gals.  I am all in favor of orthodontics and Invisalign at any age.  And, yes, there are general dentists who have an in-depth knowledge of orthodontics.  But as compartmentalized as the dental field is, I seriously question whether the typical general dentist falls into this category.  So what’s my problem with hiring any ole dentist to manage your orthodontics?  It’s simple, SHIT HAPPENS.  As we discovered, moving teeth can be an unpredictable business.  I want a top notch orthodontist and periodontist who know a lot about tooth movement, bone loss and a healthy bite to AVOID shit happening and who know what to do when it does (it will).

 

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Yea or Nay?

By Sue Seboda, Dental Part 18

Start down the long road or not? The Phoenician Steps

Sooooo, you might wonder after hearing this dental saga, am I happy with the choice to do Wilckondontics and orthodontics?  Without question, the answer is yes.  The outcome is nothing short of amazing.  And correcting my bite will result in good dental health well into the future whereas pulling an overcrowded tooth to resolve pain would have created nightmares both functionally and aesthetically.  Is doing surgery and orthodontics a challenge and expensive?  Yes, but it would have been far worse  if I had done nothing.

Combining Wilckodontics with orthodontics was a winner, especially at my age.  First of all, I needed the bone graft to even move the teeth and second, Wilckodontics reduced the overall time in orthodontics dramatically.

So what’s next?  In a couple months after my back teeth settle, the periodontist will install a permanent retainer on the lower teeth and pull out the blue paper and grinder to make final adjustments to the bite.  Remember the wear pattern on the teeth is based on the original location before the teeth were moved.  It makes sense that the wear pattern may need to be adjusted before the bite is correct.  This is done with subtle adjustments to the tooth’s surface.  Unfortunately, I also have to replace some crowns for the same reason.  Sigh.

After the bite is adjusted, my dentist with her artistic flare will do some bonding to fix the chips and minimize the appearance of the vertically challenged teeth.  I have no interest in veneers or other invasive procedures that are strictly aesthetic.  And that will be a wrap (I hope).  Before and after pictures will be forthcoming.  Plus I will do a complete summary of the pros and cons of the experience.   If you need the list before it’s posted, please send a message.

The choice to do Wilckodontics and orthodontics should be made with open eyes, fully understanding your goals, the total cost, benefits, potential side effects and consequences of doing nothing.  It is a long process requiring patience and perseverance.  For me it was worth it.  On the other hand, if the goal had been purely aesthetic, not sure my opinion would be the same.  Pick the right team and feel free to ask for recommendations.  My team is excellent.  Which leads me to discuss an interesting trend….

 

PS.  Thanks Lori for the perfect description of this experience, a saga.  

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What Fresh Hell is This?

By Sue Seboda, Dental Part 17

When I decided enough was enough, the world was a sunny place.  I only had to wear my trays at night.  Happiness.  All was good until I had the first major meal without the trays.  My incisor on the right side scraped against the lower tooth creating a most unpleasant fingernails on blackboard sensation.  Plus my back teeth did not come together properly.  Eating was very uncomfortable.  I gave it a few days and then called both the orthodontist and periodontist and said that my bite may look good, but it is not good.  Back to the drawing board we went.

The orthodontist had explained before that my back teeth may need to settle after completing Invisalign.  Didn’t pay a lot of attention to that.  I got it now.  Here is the deal in very simplified terms. The jaw is essentially a hinge.  When biting, the top and bottom teeth come together.  Now insert a piece of plastic over your teeth (Invisalign).  With the additional thickness near the hinge, the front teeth do not come together as before.  This was subtle and unnoticeable to me.  The teeth (having supernatural powers imho) then adjust naturally so all the teeth come together again when chewing.  In other words, the back teeth recede a bit.  

When the plastic is removed, sometimes the incisors have too much contact and the back teeth have none.  This is called a posterior open bite as shown above (wish my gums looked like this).  For minor situations, the rear teeth will correct on their own.  For dramatic cases, further action such as rubber bands pulling the back teeth together may be required.  If still in Invisalign some orthos will cut off the back portion of the tray.  There are different opinions as to what causes a posterior open bite during Invisalign but the above appears to be the prevalent one. 

To encourage the teeth to settle, rather than wearing a plastic retainer at night covering all the teeth, a Hawley retainer was recommended.  The dental term for these retainers is “vertically permissive”.  Hmmm.  What else do they allow?? The orthodontist filled my mouth with that nasty stuff to create an impression of the teeth and roof of my mouth.  A couple of weeks later, I put the retainers in and looked at my very good and intuitive orthodontist with eyes that emphatically said, “no f*&$king way I can do these”.  With no other verbal communication, she said I can trim them.  Yes PLEASE.  She cut away the plastic covering the roof of my mouth.  After wearing them a day or two, I prefer the Hawley retainer over the plastic.  Since a retainer must be worn at night indefinitely, finding what works best for you is important.  Ultimately, I will have a permanent retainer on the bottom teeth plus a bite adjustment.  More on that to come…

Takeaways:

  • Invisalign sometimes results in a posterior open bite. In many cases this will correct on its own over time.  The chance for a posterior open bite increases when eating while wearing the trays as is done with Wilckodontics (another reason braces might be preferable when doing Wilcko).
  • When completing orthodontic work, wearing a retainer at night is necessary. There are options.  One may work better for you than another.  Ask questions.
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Holding Patterns and Other Unpleasantries

Dental Part 16

Holding patterns are not my favorite thing.  I am a moving forward kind of gal. So I was disturbed to learn that the second set of trays would take almost a month to arrive.  I offered any amount of money to expedite the trays.  Nope, not possible.  The orthodontist made hard plastic retainers to hold my teeth in place and I wore them night and day. 

Aside from adding a month to the overall time in orthodontics, this month is critical if having Wilckodontics.  Recall that a tremendous benefit of the Wilcko bone graft is that for 4-5 months teeth move very quickly when orthodontic forces are applied.  For example, instead of spending two years in braces, one would be finished in 6 months.  Since I completed the first 38 trays in 3 ½ months, I wasted the final month of fast moving time waiting for the second set of trays.  This is a huge downside of Invisalign when doing Wilckodontics.

The refinement included 16 trays and lasted 3 months, almost as long as the first 38 trays.  The photos below are trays 1 and 16 for the bottom and top .  Unfortunately, my teeth once again did not follow directions.  While there was notable progress, I did not achieve all of the expected movement and a third set of trays was recommended.  

What to do???  The primary goal was to fix my bite which would curtail bone loss and give a chance to hang on to my own teeth.  The periodontist was confident he could perfect my bite without additional Invisalign.  Therefore the third set of trays would be a purely aesthetic effort.  I ultimately decided against it.  Why?  Instincts.  For the second time, my teeth started to firm up and my instincts were screaming that loosening them for a third time could have unknown and unpleasant consequences.  Not sure science supports this fear, but it was too strong to ignore. 

For those considering Wilckodontics, this paragraph is for you.  I strongly suggest discussing the pros and cons of braces vs Invisalign.  As horrible as they are, braces may be preferable since they provide a more constant force on the teeth and a higher level of control.  If a tooth goes walkabout, the braces can be adjusted immediately rather than waiting a month for a new set of trays.  This is a highly individual decision and there are many factors that influence the choice including things that have nothing to do with your teeth like your travel schedule.  For example, if you have braces and your teeth don’t follow directions, the braces need to be adjusted immediately.  Things go real bad if not, so its best to be consistently near the ortho office.  Find a good orthodontist who will dig into this with you.  And if your orthodontist is unfamiliar with Wilckodontics, find another.

Takeaways:

  • Several rounds of Invisalign may be required to achieve goals. Understand the worst-case scenario before starting.
  • The gap between scanning for and receiving the next set of trays could be as long as a month. Add this into the overall time calculation.
  • Review the type of movement required, ie. lateral, vertical, rotational and ask which appliance is better suited for that type of movement, braces or Invisalign.
  • Do a thorough comparison between braces and Invisalign if considering Wilckodontics. In this one instance, vanity may have to take a back seat. The driving factor should be which appliance will manage the required orthodontic movement in the shortest time period.

 

 

 

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The Back Foot Comes Forward

Dental Part 15

Remember dating?  The early days were all smiles and perfection with the well-turned, best foot forward.  But as always, that back foot inches into view and we are reminded that nobody is perfect.  Bummer.  Turns out Invisalign is not perfect either.  So let’s have a look at the “back foot” so well informed decisions can be made. 

The orthodontist will explain prior to starting Invisalign that a “refinement” period may be required.  A refinement is more appropriately described as another set of trays because your teeth did not follow instructions during the first set.  Requiring a refinement is reasonably common and becomes more so when the desired orthodontic movement is complex.  Since I had tremendous success for the first few months, it appeared that I would have only a minor refinement period.

Unfortunately, the wheels came off in the last few weeks when my front tooth dropped down.  In addition other teeth did not move vertically or rotationally as expected. On the positive side, the lateral movement was excellent.  Without lateral movement, there would have been no room to sort out overcrowding, the main problem with my bite. 

Because the trays still fit very well on the back teeth, it was agreed that the best course of action was to finish the set, complete the lateral movement and then tidy up the vertical and rotational issues in a second set of trays.  Would post the photo of my teeth but it is simply too unattractive in that selfie, horse teeth sort of way.  This photo with the retainer on gives an idea of what happened to the front tooth.

Here is Invisalign’s “back foot” #1 and #2:

  • Moving teeth can be an unpredictable business. It does not matter if you have the best orthodontist (I do), once your teeth loosen up and start moving, they may move the wrong way or get stubborn and stop moving.  Everyone’s teeth loosen during Invisalign.  They loosen exponentially when doing Wilckodontics so I suspect that the possibility of teeth going walk about is higher.
  • Invisalign may have trouble “finishing” when notable rotational and vertical movement is necessary and it could take several sets of trays to achieve the desired result.

So let’s look at how the second set of trays went…

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You’re So Vain

Dental Part 14

Early in this journey before I had established a happy truce with Invisalign, I left a v/m for one of my brothers asking him to remind me why I did this. His chuckling return v/m suggested I had done it because my vanity is completely out of control. Ouch! While the primary goal is to fix my bite and avoid unthinkable dental work, as my brother correctly surmised, one does not have to scratch the surface too deeply to discover aesthetic motives.

First, straight teeth look better than snaggle teeth and let’s be honest snaggle teeth don’t age well. They just continue their march toward yellowed chaos. Of course when my teeth are straight, they will still be unattractive due to the chips, black triangles and varied lengths. But once overcrowding has been eliminated and the bite corrected, this opens the door for my talented dentist to work her magic. I can’t imagine what she will recommend but it does seem a bit silly to do all this and skip the pretty part.

It was pain in the crowded area that landed me in the periodontist’s chair initially. I asked the periodontist what happens if the pain converts from intermittent to constant. I was horrified to learn that the offending tooth would have to be extracted. In addition to a million other questions, how do you make that look good??? My substantial vanity could not possibly tolerate that.

Before proceeding, I did not fully grasp a significant aesthetic benefit.  I was concerned that expanding the arch to make room for straightening the teeth would impact my appearance negatively. The periodontist assured me that the impact would be subtle and positive. I accepted this and moved on to the next question. For this article however I delved more thoroughly into this question and discovered that dental bone loss wreaks havoc both functionally and aesthetically. If function has declined, form has already been compromised. Rather than making your head spin with the details, will sum it up as simply as possible:

  • Your outer facial appearance is a function of the underlying bone structure.
  •  If your bones change, so does your appearance.
  • Healthy stable bone is maintained by the activity of healthy stable teeth.
  • A bad bite and/or poor dental hygiene results in gum disease, unstable teeth and bone loss.
  • Unmitigated bone loss results in tooth loss.
  • Tooth loss without immediate implants results in a truly alarming rate of bone loss. Btw, just say no to dentures.
  • Bone loss causes the lips and cheeks to recede, ie skinny Irish lips disappear and one gets a Wicked Witch of the West chin.

I had 360 degree bone loss as a result of years of a bad bite and early gum disease. I was delighted to discover that by addressing my bite and bone loss I also stopped sunken old lady mouth in its tracks. Yes indeedy I am very good with that.

And an important side note to consider. When looking up at a 10,000’ mountain it looks much larger when standing at sea level than it does at 5,000’. So it goes with your nose. If your lips recede, guess what is going to appear bigger? For those of us with prominent noses, this is totally unacceptable.

The moral of the story is to go to an accomplished periodontist in your 30s and periodically thereafter to monitor the status of bone health and gum disease. Chances are the dentist who is cleaning your teeth will fail to explain the details.  Even if you follow all the dentist’s instructions about dental hygiene as I did, bone loss can still occur. And if vanity is of no concern, healthy teeth and a good bite have long term positive impacts on general health.

For the Curious and/or Vain

In my research, I read many articles on aesthetics and bone loss. The following article, while specifically addressing facial bone loss after tooth extraction, explains general consequences of bone loss quite well. Below is an excerpt. Now I know why I instinctively want to hang on to my own body parts.   https://drkhazian.com/dentures-facial-bone-loss-premature-aging

“A well-shaped, symmetrical face with healthy looking facial skin needs an intact and healthy underlying bone structure. This is demonstrated well in young adults with intact boney structures. The same is observed in middle aged or even old individuals who have been able to maintain their facial structure. It might be called graceful aging but it is not an accidental phenomenon or due to luck. It is directly related to the state of their oral and dental health. A 65-year-old individual who has been able to maintain all his or her teeth looks much younger than the same age individual who has lost teeth and wears dentures.”

To understand how poor dental hygiene can cause periodontal disease and bone loss, read the following.

https://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm#canPeriodontal

Even with excellent dental hygiene, bone loss can occur as evidenced by my situation. Finding a succinct, non-technical article explaining why has proved difficult. Will continue the search and include upon discovery.

 

 

 

 

 

 

 

 

 

 

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But Grandmother, What Straight Teeth You Have

Dental Part 13

Only this is not a fairytale, its Wilckodontics. Wilcko surgery was May 16, today is August 9 and I am on tray 31 of 38. Below are scans of my original snaggle teeth and approximate progress to date. Remarkable isn’t it?

After tray 38, another scan will be done and new trays prepared to bring a couple of slowpokes into line. My bite (which is key to future dental health) should be corrected sometime in October.

As a reminder Wilcko creates more bone around the root so teeth have room to move. Plus during the 4-5 month period when new bone grafts to old, everything softens up and teeth move very quickly.

Notice the lateral movement in the images below. Lateral movement provides the space needed to straighten crowded teeth thereby avoiding the need to yank a tooth out. That alone is a great reason to do Wilcko.

Plus the collapsed arch is almost fixed. This is important.  Did you know they have discovered that a collapsed arch has a direct impact on the quality of your breathing and can cause sleep apnea?  It does not take a rocket scientist to realize proper breathing is integral to good health.

Lower Teeth
Upper Teeth

OK let’s ask this again, how come most people, including many in the dental profession, are unaware of Wilckodontics?

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My Teeth Love Italy

Dental Part 12

Usually guests bring presents for the bride and groom but Susan and Chris were the ultimate gift givers when they chose Italy for their nuptials. Nothing quite like the exchange of vows within the embrace of magical Italy.

The traditional Hotel Terme Rosapepe, located near Contursi, has been in Susan Rosapepe’s family for decades. This area is famous for natural mineral pools and the Hotel Terme Rosapepe is the crown jewel. I love mineral baths and was delighted to discover this journey would include hours of soaking time. The hotel is pleasing, in a gorgeous setting, comfortable and well off the American tourist route so prices are quite moderate.

After a long day of travel, I arrived Wednesday evening (without green teeth I might add). It was clear immediately there would be no time for jet lag. After a quick refresh, we were all firmly ensconced in lovely Italian wine and conversation followed by a leisurely meal. Italian wine is good, inexpensive and continuously present but even better one can drink a lot of it, remain coherent and have no hangover. How is this possible? We can send people to the moon but we can’t figure that out here?

It is a good thing the wine has a lower alcohol content because happy hour starts at the normal time but dinner is very late, typically already in bed late. The second day I joined a couple of Susan’s friends and Susan for a hair appointment in the nearby small town of Oliveto. We had lunch in a lovely spot and because I was starving and had no idea when my next meal would be, ordered the carne mista without any consideration of how it would actually get into my stomach. Unfortunately much of the meat was too tough to handle due to my current dental state. The rose, however, was lovely.

 Predictably dinner was delayed until after 10:00 and the first two courses where pasta. Normally I don’t eat gluten free pasta but I wolfed it down. The main course was veal stuffed with spinach. You got it, too tough to manage. Spinach was good.  

Friday the bride and groom took the group to a gorgeous winery. I loved every second of this trip including the bus ride with wheels a foot from the cliff. We wine tasted to our hearts content while enjoying stunning views and noshing on cured meats and cheeses. I desperately wanted to load my plate but good manners dictated otherwise . We returned to the hotel late afternoon and met on the gorgeous patio for yes more wine and yet another superb sunset. New friends invited me to join them at a nearby seafood restaurant and we arrived at 9:30. The restaurant was empty so I assumed perhaps not everyone eats late but to our amazement the place was full by 10:30.

My hunger is now something to be reckoned with. At this point, even the wine is not helping. But to my delight copious quantities of food start to flow, sardines, grilled octopus, calamari followed by mussels and pasta. It was fantastic and I ate with abandon. My friends spoke Italian and their friends only Italian. Some quick conversation passed back and forth with fingers pointing between me and my constantly full plate. Our hosts were curious how I could be thin considering the amount of food I was stuffing in my mouth.  The burning question was if I had a thyroid problem. I laughed and kept eating. Impossible to explain.

The wedding was the following day and as one could predict, many of us were moving slow. Luckily the magic pools awaited. Susan explained how to create a mask from the pockets of mud and viola, no more tired faces. After a relaxing day we gathered for an early evening ceremony conducted by the mayor of Contursi. Absolutely beautiful. And in due course, a full Italian meal began to unfold. It was truly a wonderful night. Thank you Susan and Chris.    

 

 

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Crossing Oceans

Dental Part 11

Crossing oceans is like flossing. It has to be done regularly.  It can be via air, boat or magic carpet, doesn’t matter, as long as it happens. Four weeks after Wilckodontics gum surgery and 5 weeks after my initial encounter with Invisalign, I took to the skies. Because airplane water does not inspire confidence, my sole concern was cleaning gums, teeth and trays on the plane. Decided there was an easy solution, don’t do it and go with gross teeth.

After eating I went to the restroom and unfortunately looked in the mirror (don’t do that). There was a wonderful selection of green bits of lettuce in my trays. As you might guess this was completely unacceptable. So here is what you need for travel in general and crossing oceans in particular. Bring a small bowl, retainer brite, bottled water, travel bottle of hydrogen peroxide and toothbrush. Retainer brite is a tablet for cleaning trays not unlike the “plop, plop fizz, fizz what a relief it is” equivalent of Alka-Seltzer. Put tablet and bottled water in bowl, add trays, use bottled water to brush and rinse trays. Trays back in. For good measure rinse with hydrogen peroxide and water. Yes there will be a line out the door when you are finished. Oh well.

When doing Wilcko, tray changes happen every two to three days and since there are always many excellent and delightful distractions on the road, a reminder system for tray change days is essential. I chose to label trays with the change date. Worked well and decided this was a habit to continue since there are always countless distractions and venue changes.  

Why was I in Italy you might ask? A wedding near the small town of Contursi, Italy at the Hotel Terme Rosapepe…

 

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Flapping in the Breeze

Dental Part 10

Two weeks after Wilcko surgery, I went back to the orthodontist to switch to the third set of trays.  I entered the office repeating 50 times, no loud outbursts, no loud outbursts. We changed the trays with some difficulty but without incident and was provided trays for the next 10 days. I felt like a reluctant bird being pushed out of the nest. My first solo tray change came two days later and yes my finger slipped again into my gum, yes there was inappropriate language as if that would help get the trays in. Then deep breaths and the aahaa moment when I understood the purpose of the “chewy”, a small cylindrical rubberish thing one bites to ensure the trays are seated fully. Add this to the invisalign survival kit.

Fast forward to 4 weeks after surgery and the world has brightened considerably. Transitions have improved and will continue to do so as the teeth become less jumbled. Teeth are moving at warp speed and the last stitches came out today.  Fair warning, a few weeks after Wilcko surgery some of the teeth feel like they are flapping in the breeze. Teeth are not actually as loose as they seem but the support of the trays is much appreciated. I laugh when considering the extensive debate regarding daily tray time. Don’t waste a minute on this since the very last thing you will want to do is remove the trays. And, at least for now, eating without the trays is unthinkable. I guess that steak will have to wait. But as inducement, the longer the delay, the better the wine.  It will be worth the wait.  

So tomorrow is a big day. Taking this show on the road. Are you ready Italy???

PS.  Talk to your doc about when to use the chewy. If the tray is not aligned correctly it could cause problems to use the chewy to help install the tray. Also my sister took the photo of the baby bird. Excellent photographer.