Please God, Let me Floss

Dental Part 9

I never imagined bartering with God over dental floss but here we are. The stitches are still in and until the gums are healed, there will be no flossing or proxabrush. Over the years my teeth have all crowded at the front to see what is going on in the world leaving the introverted back teeth roomy and comfortable. To prevent meals from moving in between my back teeth, flossing is essential. The only solution during recovery is rinsing vigorously (still love this word). Plus I wonder if I need to stand a few feet away from people???

Stitches come out somewhere between 2 and 5 wks. At 3 weeks hopefully the stitches will be removed. Not sure how to describe my relationship to the stitches. Mostly I was unaware of them except the ones in the lower front which will not let up on the inside of my lip. But even that has not been too much of a problem.  Warm saltwater rinses are a staple of my new life.

A Bad Thing Happens

Dental Part 8

Nine days after surgery and all is going well. Feeling confident, popping the trays in and out, eating solid food although nothing too crunchy or hard to chew. In hindsight it reminds me of a ski lesson many years ago. I was learning fast, feeling good, ready to get to the next level. At the bottom of the slope, preening in all my glory, I noticed another student skiing out of control straight for me. Maybe I wasn’t so great after all. Worse, she crouched down just before impact. I yelled don’t bend down but it was too late, she came in fast and low. I was propelled into the air, landed flat out leaving my skis exactly where they were.  What a great photo that would have been.

Back to teeth. The orthodontist office is one big open area with 4 dental chairs. Doctors and nurses tend to patients in soft, calm voices creating a serene ambiance. On this day all the chairs were occupied by young kids with mothers perched nearby and of course me, not a kid. We are ready to put in my second set of trays. As you may have guessed there was substantial difficulty even for the doc. So I am attempting to force the tray on my lower teeth and my finger slips and digs into my tender, Frankenstein gums. Yes, the F bomb came out of my mouth, vigorously you might say.  It was not my finest moment. Of course I stood in the no longer serene room and apologized to all the young moms.

Which led me to another observation. Am I the oldest patient they have fitted with invisalign? There was a long pause before answering the question in the negative.

 

Zombies

Dental Part 7

Soooo, let’s get to the question you have been dying to ask. How do you look after surgery? Not bad at first but the swelling kicked in on Wednesday and peaked Friday. Fair warning, these photos do not grasp the extent of the swelling but perhaps this story will paint an accurate picture. Earl was away for the weekend and when he returned on Sunday the swelling was almost gone. He duly noted that and then told me that I had looked like an old lady who lost her teeth. Hot.

I thought I had escaped any real bruising but no I was sadly mistaken. On Friday, two bruises popped and started draining down my face. Peak blackness was Sunday but those babies lingered through the following weekend. Come up with a good story. People either stare or ask. I like the “askers”. What I needed was some black lipstick to complete the look but alas my black lipstick was in Key West where such things are needed.

To sum up, swelling gone in a week and bruising gone in two.  Not a bad tradeoff to reduce the time in braces/invisalign by more than half.  The first selfie above was the day after surgery, the second was 3 days after and the selfie with the zombie base makeup was at 6 days.  And for comparison, the nonselfie photo was taken just before all this started.  My vanity demanded inclusion of a normal photo.

A Girls Gotta Eat

Dental Part 6

Sleep is your friend. Do a lot of it. Also, before surgery, set up a nest in the living room so you can comfortably lounge and binge watch a series your significant other has no interest in.  Rest, be kind to yourself and keep the talking to a minimum.  For some of us that is a challenge.

Advance planning on the food front is essential especially for those who clock in multiple hours a day snacking and dining. The periodontist will recommend soft food. Pull the long ignored vitamix out of the closet unless you find days of yogurt and protein shakes satisfying. I started with foods like soups; blended vegetables with almond milk and protein powder; yogurt with hemp, peanut butter, fruit and walnuts. But before long I got really hungry. Drastic measures were called for and I did something that just feels wrong.  I added meat to the blender. Cook a sweet potato, sauté shiitake mushrooms with a bit of ginger and put all this in the blender with flavored bone broth, a good source of protein.  Add chicken, hit blend and do not look at the mess that is created.
By the fifth day, I was ready to sauté veges with eggs, lots of eggs. It was wonderful. And yes, there was also ice cream.

During this initial period, the invisalign trays are only removed for cleaning once per day. On Thursday (surgery Tuesday) I went back in to have an area restitched and  could not to remove the trays at all plus rinsing vigorously (great word) was verboten. Could only gently swish the hydrogen peroxide. Friday I went back since another stitch pulled at which point he  removed the trays for cleaning.  Yuck.

Btw if a stitch comes loose, it is typically in the lower front gum. It is not uncommon and other than the novocain shot, restitching does not hurt. Therefore, as much as you may not want to do it, have a look see in your mouth after surgery and call the doc if anything concerns you. Truly, looking at blended meat is far worse.

 

Don’t Believe Everything You Read Online

Dental Part 5

I appreciate the irony of that statement. But really, do not go online and start reading what others say the day before your surgery. That is a sure fire way to ramp up anxiety to previously undiscovered heights. Plus my imagination went a little crazy with the idea that I would not be completely under during the surgery. The periodontist said I would be able to hear, respond and talk but would not remember anything. That sounds a little like being conscious, a totally unacceptable state when having bone grafts.

They provide a happy pill the night before surgery to aid in sleep and something similar to take an hour before your appointment time. Not a fan of painkillers and all their friends but I slept and was a bit looped by the time I arrived that morning, a good thing. And it was true, the last thing I remember is the novocain shots and the next thing I remember is an angelic voice quietly saying open more, turn your head, open a bit more. This was at the end of the 2 ½ hr surgery. As I started to come to, they put ice packs on my face. Note to self, when on anesthesia do not attempt to discuss the relative merits or lack thereof of putting ice on swelling. I think all I could manage was, “no ice, no ice”.

Earl picked me up and I honestly have limited recall of the drive home. Of course I wanted a photo immediately after the surgery for this article and to Earl’s amazement, I was sitting in the car taking a selfie. I have no memory of this. As you can see I was not dripping in blood or any other horrible state your imagination might conjure when considering dental surgery. I do have to work on selfie skills however. Why did selfies ever get popular? They are horrible.

And I needed food. Luckily Earl helped with that too. It was a bit of a challenge getting that soup actually in my mouth and staying there.

Here is the amazing thing. While uncomfortable, I experienced no pain. I was giddy with relief. Consider this statement on another periodontist’s website: “The pain after Wilckodontics can be rather pronounced, but everyone’s pain threshold and experience is different. With that in mind, patients who undergo Wilckodontics may notice major issues with pain even if they bite or chew soft food items. It’s for this reason that patients should take all pain relievers as recommended in the early days and weeks after surgery and that they follow their post-surgical instructions to the letter.” Does she moonlight for the drug companies I wonder? At my first follow-up, I told the periodontist that I had no pain and he said all his patients say the same thing, discomfort yes, pain no. Two questions and an observation come to mind. Who would you hire? Why don’t more people do this? And I have been spelling Wilckodontics wrong.

 

The Invisalign Survival Kit

Dental Part 4

One week before the Wilcko surgery, it was time to start Invisalign. I walk into the orthodontist office with no small measure of trepidation and the patient coordinator said you must be so excited. No, not that. Many other adjectives came to mind and some preceded by an odd expletive or two. But it truly gave me some comfort because to even consider a state of excitement she must clearly see a positive end game. I know it is there.

Step one is placing the fasteners on your teeth. These are bits of composite that are temporarily attached to your teeth and aid the trays in moving the teeth accurately. I have a lot of them. This is an easy procedure, no sweat. Then it is time to put the first set of trays on. This was not an easy procedure and there was a lot of sweat. I couldn’t get them on and I couldn’t get them off. Plus the attachments were shearing off as I tried. When it was time for my flustered self to go, I said I would put the trays in before bed. Very bad decision. I soon discovered that my teeth had been weaponized. The attachments on the lower front teeth ate holes in the inside of my lip while I was engaged in some much needed retail therapy. As soon as I got home, I rushed to put the trays in but the damage had been done and now the edge of the tray was having its way in the same area. I should have called the orthodontist for suggestions but instead made the first of many trips to the dental and first aid aisle trying one thing after the other to alleviate the pain. I ended up tearing off a bit of napkin and shoving it in there at dinner and it was blessed relief.  I didn’t even care that I looked like I had a chew in.  

Save yourself time, money and aggravation and get the invisalign survival kit and avoid repeated trips to this aisle and go straight to the ice cream instead. Buy dental wax, emery boards, hydrogen peroxide and salt for warm salt-water rinses. That’s all you need. The orthodontist loaded me up with wax and I threw all the useless items away and bought large quantities of hydrogen peroxide and kosher salt

It would be a lie to say the first few days were easy. They were unpleasant at best but everything turned around by day 4 and I struck an uneasy alliance with the trays. By the day before surgery, the inside of my lip was healed and the trays were easy to put in and out. Good thing too because no dental wax was allowed after surgery…

 

My Love Hate Relationship with Invisalign Begins

Dental Part 3

When I asked the orthodontist what Invisalign was, no doubt he wondered what hidey-hole I have been in. Here is the short answer. Once the periodontist evaluates the bone/gum situation, the orthodontist will recommend braces or Invisalign based on what you have going on in there. Some folks can do either and some will have a better outcome with one or the other. In my case, Invisalign was recommended by my excellent orthodontic team. Plus also note that everyone in the office is dedicated to making the experience positive. Since you will spend a great deal of time there, this is important.

To begin, the orthodontist completed a 3D scan of my teeth. Invisalign uses this scan to produce clear plastic aligners or trays which when worn sequentially will shift the teeth into the proper position. For me, 41 trays were produced. Consider this process a real life flipbook.  

My primary concern with Invisalign was a requirement that the trays be worn a minimum of 22 hours a day and removed when eating or drinking anything besides water. The math simply doesn’t work. Imagine a relaxing Saturday. Start the day leisurely drinking coffee followed by breakfast (1 ½ hrs), lunch (1/2 hr), dinner on the town starting with a cocktail (1/2 hr), followed by appetizer (1/2 hr), main course (1/2 hr) and if I have no self control, ice cream (1/2 hr). If we are kicking over the traces, we may go out after dinner and that could be any amount of time. But let’s say 1 hr. This totals 5 hrs and does not include the endless snacking I do all day so let’s throw in another hour for good measure. Even on a weekday, total eating/coffee time is definitely over 2 hrs a day. It was a question of lifestyle vs. snaggle teeth. Time to run???

Did not run, discussed further and the solution is simple, don’t take them out when you eat and clean trays and your teeth afterwards. Great. I got the answer I wanted and stopped stressing.

Your approach will depend on whether doing Wilcko surgery or not. Without Wilcko, each set of trays is worn for two weeks or so. They will stain badly and suddenly Invisalign is disturbingly visible. One small serving of curry chicken salad will tinge them yellow. A blended vegetable drink turns the trays a lovely shade of light green. Plus great gobs of food get stuck in them. Really attractive. And let’s not forget cavities.

On the other hand, with Wilcko surgery, each tray is only worn for a couple days since the teeth are moving so fast. Therefore staining is much less of an issue. I still have a little fear since no doubt even keeping them in will require adjustments to my daily feeding frenzy.

Up next, the first day of wearing the trays…

Searching for the Answer I Want

Dental Part 2

Earl calls it “the press”.  It is a relentless cascade of questions designed to skillfully penetrate or as the case may be, ruthlessly jackhammer through the chaff to uncover the truth or essence of a thing.  Once found, the big picture and the way forward magically appear.  Like all magic however, it can be used for ill-advised purposes such as searching for the answer I want. After initial research on the pros and cons of orthodontics at my age, I figured my dentist was an idiot. Hmmm.

A friend from the gym is the root canal guy of Annapolis and when I suggested I needed a new dentist, he recommended another local with a great reputation.  The sign on the door said she was a Prosthodontist.  I had absolutely no idea what that meant but visions of excruciating pain and suffering bubbled up.

Contrary to expectations I found complete competence, one of my favorite things.  Now the press could proceed in earnest.  Of course as you already know, regardless of how many times I asked the questions or in what form, I didn’t get the answer I wanted, ie. an easy way out. I was told plain and simple, you need braces.  Ok, my dentist is not an idiot.

 Luckily birds of the feather flock together and she recommended other competent and knowledgeable people, one of which was a periodontist who introduced me to Wilkodonics.  I asked a LOT of informed questions.  He was good with that (for over an hour).  Many doctors are not.  I learned a great deal and after mulling things over, was struck by the thought that much of this should be part of the conversation with the regular dentist and it is not. With knowledge, one can make an informed decision either to keep your head in the sand, roll the dice that your teeth will hang in there or take action.

If you want to proactively increase the odds of keeping your teeth into old age, now is a good time to focus.  When your bite is off, teeth can become unstable. This subtle loosening allows the bacteria that exist in all our mouths to get busy causing bone loss around the teeth.  Bone loss results in additional instability and more bacteria.  Plus that oh so attractive gum recession will occur.  Eventually a tooth will fall out which accelerates the bone loss, etc. You get the idea, it’s a negative spiral. And guess what, it is impossible to have a good bite with snaggle teeth.  I don’t care how many times the dentist has me smash that blue paper between my teeth and he grinds away some offensive spot, the bite is wrong.  For me, the term is subclinical periodontal disease.  Everything looks fine on the surface but when you open the closet door, things start tumbling out.

So priority one, fix the bite.  How?  Orthodontics is the answer but first the periodontist has to determine if there is enough bone around the roots to accommodate movement of the tooth.  In other words, if there is not enough bone, the root could pop out of the bone during orthodontics.  This is bad.  I do not have enough bone so orthodontics on its own is out.  Enter Wilkodonics.  The following article will make you’re your head spin so I will sum up in as few words as I can.  Wilkodonics is a bone graft that increases the volume of the bone around the root.  Therefore for those of us who have already had bone loss, orthodontics is now an option to correct bite issues while turning back the clock on periodontal disease.  But the giant cherry on top is that as the new bone assimilates into the old bone, it all becomes much softer.  Therefore with applied pressure, teeth move very fast thus dramatically reducing the time in braces from years to months. Further, combining Wilkodonics with orthodontics results in less relapse down the road, ie. the tendency back towards snaggle teeth.  There are other benefits and one in particular that I will save for another post.  Of course there are possible downsides that must be understood but the potential risk was far less than the definite benefits.  http://www.orthotown.com/orthotown/article.aspx?aid=3384

Happily the path forward has been revealed.  I am taking it. Invisalign and Wilkodonics may not have been the answer I wanted but they are the comprehensive solution I needed.  The money has been paid, appointments confirmed and frankly, anxiety sky high.  Next step is kicking off the Invisalign process…

My Travels Through the Scary World of Dentistry

Dental Part 1

The tooth fairy was clearly in a bad mood when visiting me.  This along with my parents’ decision to forgo braces has led to adult snaggle teeth.  A dentist would refer to this as significant overcrowding.  My teeth are not straight when viewed from any plane.  They jog up and down and back and forth with a bit of caving in to make it really interesting.  And when my permanent teeth arrived, the dentist decided to grind down the extra long canines to avoid that unpleasant vampire look. I am not making this up. Plus my teeth were very cavity prone.  Not sure it had anything to do the bandaid box of sweetarts I brought to school everyday but lots of cavities meant lots of dreaded dental visits often without novocain.  To make it worse our family doctor supplemented our diets with constant antibiotics.  That does amazing things to the color of your teeth.

Fast forward to 58 years old.  I figured by keeping my teeth tidy and gums healthy, the really scary dental work magnified by an active imagination could be avoided.  To this end I had my teeth cleaned 4 times a year, flossed, proxabrushed and replaced amalgam fillings with composite.  But the snaggle teeth would not be ignored and I started to experience pain.  My dentist said I needed braces.  Whoaaa, I am 58, is that even possible?  He said to see an orthodontist.  This was the beginning of a learning curve that culminated in a decision to fix my teeth with Invisalign and Accelerated Osteogenic Orthodontics (AOO) also known as Wilkodonics. Unfortunately there is an incredible lack of awareness about Wilkodonics, even among the dental community. So in an effort to change that, I will chronicle the process from beginning to end. Hopefully it helps someone else out there.