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?

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.    

 

 

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…

 

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.

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.

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…