Foxface's frankenbite

Change we don't believe in

2010-06-17T11:11:00.001+01:00

Guess who's back and still in braces? Yeah. Never thought I'd still be here, 8 months after BSSO.

On the one hand, the worst of the BSSO aftermath is over and done with - after a five month marathon of meetings with the acupuncturist, the dentist, the surgeon, the tooth cleaning fairy, two sets of physiotherapists who took turns massaging my aching jaw muscles from the inside, and last and least, my orthodontist.

The swelling in my face has gradually subsided from red balloon to drooling hamster to lumpy goblin to the point where I hardly notice it anymore. (Which was helpful, since noone takes your anger seriously if you look like a pouting blowup doll)

On the other hand, I'm still waiting for a debanding date - with increasing frustration, since I'm still planning to find a new job and move to another city when I'm done. I need a date to have an idea how much longer I should expect to be here and press cherry kernels to the roof of my mouth with my tongue (the speech witches' newest addition to my ever increasing list of wacky tooth strengthening exercises).

Yesterday was a writeoff: my supervisor told me in passing that I won't get a chance to do a project in India after all, and then, to my complete lack of surprise, the ortho took a long look at my teeth and said 'Why are these molars still not touching?'

Beats me! If the three months they spent in punitively tight rubber bands couldn't convince them, maybe they're just not that into each other?

The ortho's not giving up, though. Not him. He cemented some extra braces on my molars, took the upper wire out altogether and put a new tight rubber band around the new construction. I'm supposed to wear it 24 / 7 for the next 4 weeks. At first I thought it had no effect whatsoever, but I was wrong: A couple minutes later, the molars hurt like buggery.

I asked him whether he had any idea why the molars won't move. And who's he gonna blame? The surgeon: 'We should have taken that transpalatal arch out months ago.' Maybe so.... AND maybe he should have discussed it with the surgeon if he thought putting it in was the wrong decision.

As always, I turned to the gym and this blog for solace.

We shall overcome! Stay tuned for an impossibly lengthy recount of my surgery. I wrote it down for a local forum for the toof-challenged, but would like to put it on the
blog as well, along with some more bracefaced pictures.

The way of the ninja

2009-10-15T12:34:00.001+01:00

I found a speech therapist! And she's a gem.

It took me three days of playing phone tag to get an appointment with her, and by then I was fearing the worst. She has a second job as a yoga instructor. I can feel my neck muscles spasm and my breathing get shallow when people talk to me about energy bodywork and breathing exercises. I can just about get through my Sunday yoga class without developing irrational resentment against my serenely smiling teacher' as I contort myself into uncomfortable positions and focus on my breath(yuck!).
Her message on my voice mail also told me that she speaks in slow motion, overpronouncing every single word just slightly.

So I was happy to see that she's different in person - friendly, but resolute. She listened to the tale of my adventures in orthodontia and did a series of quick tests on my tongue and mouth. It took her all of three minutes to find out that the muscles in my lips and tongue are too weak, which is causing the mouth breathing, tongue thrusting, and frequent throat infections. She asked me to call my mother to do some research on when I developed the habit of breathing through my mouth. She also said (and this was new) that a lot of patients with the same problems have a history of mild dispraxia and weak connective tissue. I still have no idea how these two things can be related, but she was right.

I went home with a brand new tongue depressor and a series of pictures of a boy doing lip and tongue strengthening exercises that I'm to practice. (My favourite one has to be speaking with my lipf ofer my teef. I can use that one while practising my Russian vocabulary)

And I'm supposed to keep the tongue depressor between my lips in the evenings to remind me to keep my lips closed whenever possible. Such is the way of the tongue ninja.

Lopsided

2009-10-11T22:02:00.003+01:00

Last week I was back at the hospital for my first pre-op appointment with the surgeon. It was a fairly exciting morning.

The receptionist sent me straight to the radiologist to have more x-rays taken. The lady at the radiology department was not having a good day. 'Not another extraoral x-ray - we're getting a technician to fix the machine later this morning. Good luck.'

She was right - I spent a fun 15 minutes standing very still with my forehead pressed against a piece of plastic, my tongue pressed to the roof of my mouth and my teeth as closely together as they get while the resigned looking black radiologist and his new intern tried to get the machine to work. It kept making promising noises and then dozing back off with a weary sigh. It finally sprang to life on the fifth attempt, when they were about to
send me home without a new inside view of my skull.

The next suprise came during my appointment with the Chainsaw. The man in the white labcoat looked nearly like the doctor I had expected to see, but not quite. It was as if someone had glued a moustache onto his face by way of a primitive disguise. He also looked 15 years older.

The chainsaw's evil twin tried to head off lengthy explanations at first, but this time I was ready.

ET: 'So, I suppose Dr. Z has explained the procedure to you during your last..'
me: 'No, he did not.'
ET: 'but he sent a letter to your orthodontist...'
me: Yes, to my orthodontist. My orthodontist told me you were supposed to explain the surgery to me.'
ET: 'We have a patient info day coming up in November..'
me: 'my surgery date is on the 29th'
ET: '...I admit your surgery is scheduled pretty soon after that....'
me: '...the twenty-ninth of OCTOBER...'

At that point he gave up deflecting and started to explain:

Apparently I won't have my upper or lower jaw shifted forwards or backwards after all. NO! It's just that both the lower and upper jaw are a bit asymmetrical. Which is fancy doctor speak for wonky and lopsided. (He gave me a mirror and put a tongue depressor between my teeth to demonstrate HOW lopsided. My tongue was not quite as depressed at the result as the rest of me.)

Since my palate is still too narrow and I'm showing too much teeth, they'll cut a slice out of my upper jaw to move it upwards. Then they'll buzzsaw it into three pieces to broaden my palate and slightly rotate both sides to make my teeth fit together.
The lower jaw will just be rotated slightly. Then they'll staple the pieces back together with plates and screws and wire a splint onto my teeth for 5 weeks. Wheeeee!

More Q&A: It is hospital policy to take the plates out after one year. He admitted some hospitals don't do that, but Evil Twin tells me that is mainly done to keep costs down for patients. Leaving the plates in can cause infections and temperature sensitivity among other things, and after a year the plates are still easier to remove than later on.

I am not supposed to donate blood prior to the surgery for a potential autologous blood transfusion. 'Only six percent of patients need a transfusion. And if they really do need one, just the two units that you would donate would not be enough' he said cheerfully.

Will I get by on my own without anyone at home to cool my fevered brow when they kick me out? Evil twin had no doubt that I would (and that my stay would be closer to 6 days than 2 weeks), but I intend to turn back to my fellow jaw surgery bloggers for more advice. I doubt that he has ever tried that at home.

Will my face change a lot, I asked? Not a lot, but it will - the middle bit will be a bit broader, and and the lower part around my chin a little less elongated and more symmetrical. 'And your nose may become a bit broader and maybe slightly turned up at the tip. But that's an improvement
because you have a hump on your nose.' Nice and honest, ET.

The doctor also measured my face and bite, took pictures and asked me a long list of questions.

ET: How about your jaw joints. Any clicking or popping?
me: No.
ET: Are you sure? (puts his fingers on my joints). Open - close - open...

Deafening CLICK.

me: Oh...

The worst moment of the day came when the surgeon asked me WHY I haven't had an appointment with a speech therapist so far into the process.
Apparently my swallowing technique leaves much to be desired. What a serve! I was about to reply 'I haven't had any complaints yet'. Then I spent a happy moment fantasizing about creative ways to kill my orthodontist instead. Both the orthodontist and the surgeon know, and have known since the beginning, my open bite will come back if I don't retrain my tongue into not pushing against my teeth. Preferrably before the surgery will turn my facial bones into jelly. If Boris had sent me to the speech therapist back in April, when I had my expander removed, I might already know how to avoid that.

The surgeon told me people with open bites should not even undergo surgery if the speech therapist advises against it. In some cases it's not possible to retrain the tongue, or the patient is unable to breathe through his nose.

Then I was ushered me out with more info material on my surgery and its potential side effects, to study thoroughly before I get to ask him anymore questions. He made me promise to go and make a first appointment with a speech therapist before surgery day. Which I did! My ortho is SO DEAD.

I learned an important lesson today....

2009-09-23T12:28:00.003+01:00

If your toothpaste tube is all gummed up and you feel like squeezing it harder, point it somewhere else than your right eye.

I am very ready to get to the point where I DONT have to take a toothbrush with me no matter where I go. 5 and a half weeks to go until surgery day!

I am very excited, but also a little scared. Reading up on other people's jaw surgery experiences may not have been the smartest move. I'm a little uneasy about the fact that they won't just move both jaws, but also split and broaden the upper one. (or so my ortho said) The other BSSO people seem to get in and out of hospital in about 4 days. My letter from the hospital said they'd keep me there for two weeks. Also, there's no one else here to pick me up from the hospital and feed me soup or anything, so I need to be able to get by on my own by then.

But I faced my fears like any good hypochondriac would. I made all necessary pre-op appointments with the ortho and the hospital and marked them on my wall calendar. I made a plan to reduce my coffein and sugar intake gradually during the weeks leading up to the surgery. I'm taking food supplements, which may not be the worst idea since I'm a vegetarian. I'm going to the gym 3-4 times a week. I even started taking cold showers.

I may be trembling in my boots, but I will be prepared as a boy scout come October.

It's the final countdown!

2009-09-06T01:46:00.004+01:00

Hi! I'm back among the living. With. A. Surgery. Date.

The chainsaw and I are going to meet for the second time on October 29th.

7 and half weeks to go! I'm psyched. This is how psyched:

While I've not always been thrilled with my ortho, Dr. S, during the last months of minor jaw pain and teeth grinding, I'm really happy he got me surgery ready on schedule. He said it'd be a year after I had SARPE, and it is - I had SARPE surgery on October the 30th last year. Guess I won't need a costume this Halloween, either.

Now reading Kate's, Susan's and Chris' stories to be prepared for the second round of face sawing and the aftermath. I'm slightly dismayed that I will need another round of surgery next year to get the plates from this round removed (one and a half year of orthodontia seems plenty... ), but I will make it my mission to use the remaining weeks to get in shape and cut down on caffeine and sugar. Madness? This is not madness.

This! IS! SPARTAAAAAAAAA!

(Cut to training montage )

Braces: A mental health hazard

2009-09-06T01:10:00.011+01:00

I'm posting this separately because it concerns the last months rather than how I feel right now.
Stephanie, Kate, Jeff and Michelle: thank you for your kind words.

The aftermath of SARPE was a bit of a mess to sort out in my case, this is partly why I temporarily dropped off the radar. It was not so much that my bite was getting worse. Rather, I was not sure if things were moving in the right direction, if I was still more or less on schedule, and whether my bite could even be sorted out by another surgery with just the amount of palate expansion I achieved with the expander.

Take this period of orthodontic frustration, and add a less-than-satisfactory-job situation,a new town, little contact to old friends and a boyfriend in a war zone, and you've got a recipe for a very depressed braceface.

------------------------------------------
This is a short time line of the orthodontic developments. Feel free to skip this bit if you're only interested in the current status:

January: Dr. S confirms Junior's decision not to put a second expander in, but to expand my bite a little further with braces and fix the rest during my second surgery. Front teeth start moving back together, but since the magic plastic of teeth broadening is still in place, I still look like a pouting gerbil.

February: Ortho & witch in his employment assure me we're doing great, jaw-wise. Then, the witch takes a chisel to my front teeth to get part of the plastic off. It feels more like she's solving my gerbil problem the other obvious way. Also February: First post-op teef cleaning and checkup with my dentist. My dentist, Dr. L, is loud and optimistic and has more folksy charm than Sarah Palin. When I first met him, he offered this comment on my brace dilemma: 'Opinions are like assholes - everyone has them, but you don't need to see them all'. The dental hygienist was not happy with me because I was bleeding all over the shop. I left the scene of the carnage with three extra toothbrushes, a checkup date and many good intentions for my future cleaning habits. Flossing is much easier sans braces.

November '08-April '09: Working full time on hopelessly underfunded and overstaffed software project from hell.This requires me to attempt speaking English with the Japanese, sometimes over the phone, with the expander still in place. With mixed results. By the end of these months, I have learned to work around the expander and can speak quite clearly, but at the end of the workday, I sound like something off the muppet show. I spend a lot of time doodling on whiteboards ("A house! a motorcycle! A plane! Oh, it's just a list widget.") and use chat clients as my primary mode of communication whenever I can.

March: During a routine checkup with the ortho, I complain about the expander and ask when I can get it out.

Dr. S: "Does it bother you, then?"
me: "I think I've had more fun."

After some haggling (I got quite nervous he'd take a spanner to my teeth right away, my yuppie ortho is not much of a one for nuance), we agree on a removal date in April

April: Expander is taken out and replaced, where necessary, by additional braces. Ow, ow, OWWW. Since SARPE surgery, my eating habits have slowly reverted back to regular soft foods, and getting enough food down was never a serious problem. But chewing puts nowhere near as much pressure on individual teeth and upper jaw as having the expander taken out. I spend an hour lying in the orthodontist's chair with my head way below my feet - ideal waterboarding conditions - while a team of assistants tortures my upper jaw. [It was pretty embarrassing, but my front teeth were still so sensitive after the surgery I literally had tears streaming down my face and had to stop myself whimpering when they put the new wires and ligatures on.]

Back on my feet, I am so pale even my none-too-observant ortho notices I'm not feeling so hot. Still, the result is worth it - no more RPE!

I also overhear an interesting conversation between my ortho and the new lady doctor who is working with him (the witch seems to have taken her tarot wagon to another town).

Junior Witch: "and you think you can fix this until November?"
Dr. S: "Ahh, we had better buckle down and get on with it then."

May: The braces go to Egypt to meet the boyfriend (flying in from Sudan). I get to brush my teeth in some more interesting places.

June: After some prodding, Dr S remembers he still needs to take the remaining plastic off my front teeth so the gap can close fully.I leave his surgery with newly powerchain'd front teeth and his permission to get another appointment with the surgeon. This visit pretty much sums up everything that is wrong with my orthodontist. He is a wizard with a diamond drill, but you basically have to weld him to the floor to get any information about the status of your treatment out of him. I trust his judgement, but I have to remind him of every little thing and basically handle the whole information flow between him and the hospital because he has too many patients to remember anything about individual ones between visits.

July: I'm back at the hospital for an appointment with the surgeon, hoping for some info on how long it will take to get me surgery ready. It's quite a memorable appointment. The hospital is very busy that day and the phone in the treatment room is ringing off the hook. Something seems to be wrong with the call forwarding system. The chainsaw is his usual friendly self, but flat out refuses to give me an estimate of the remaining treatment time at first. [I'm ashamed to say I got a bit upset at this point. I told the chainsaw in one long whine I was really worried my treatment would drag on for some more months without anybody telling me how things were going, that I felt hospital and orthodontist should be exchanging information on my treatment plan directly instead of asking me, and that I feared the expansion that was achieved>with the RPE was so insufficient it could not be fixed during the second surgery. It would actually have been funny if I hadn't been so upset, since everybody in the room was looking very flustered and the phone never stopped ringing. The chainsaw finally interrupted his reply to tell the nurse 'I don't care what you do, but make the damn thing stop ringing.' She ended up taking out the batteries, with shaking hands.] Then, Dr Z sends me off to have molds and x-rays taken again. Back in the treatment room with the x-rays, the chainsaw wins my heart by apologizing for the confusing updates I got. He says I should be ready for surgery sometime within the next 6 months, and that he will send my ortho a letter detailing what remains to be done as soon as he has had time to look at the new model of my biteand work out a plan for the next surgery.

August: The braces go to Chile for a week! Also, the boyfriend is back for a month between missions. He will leave for Jordan in September.

September: A much reassured Foxface has another appointment with Dr. S. The chainsaw has phoned him with his recommendations, as promised. Blue thingies that look like buckles are placed on my teeth to close the remaining gaps between two pairs of teeths in my lower and upper jaw. After another cleaning appointment at the dentist's (Dr L-quote of the month: 'morning hour hath gold in its mouth and lead in its arse'), I finally get permission to call the hospital for a surgery date.

----------------------

So, why did I bother to write this all down in excruciating detail? Even before I started the big teef makeover project, I found it very helpful that other people on the net put up realistic accounts of what their own time in braces and before and after surgery was like. I think it's important to point out that the big challenge during such a project may not be the physical discomfort, but also the psychological difficulties you face when you feel like your treatment progress is not what you hoped it would be, or when you're uncertain whether you can trust your doctor to handle a problem correctly.

While the physical difficulties I've had so far were not negligible - it was quite difficult to speak clearly, eat and get restful sleep for months after SARPE, and my teeth always hurt for a couple days each time my ortho changes my wires - I found the emotional ups and downs that came with the treatment far more annoying. There's no ibuprofen for overthinking things and worrying.

As with everything, your mileage may vary. My boyfriend and my family are very supportive, but they live much too far away to talk me through every little problem. Having people around you to take care of you during the less pleasant stages of the treatment is probably a big plus.

Foxface is lazy

2009-01-16T16:12:00.002Z

Howdy!

I hope you haven't given up on me. Last time I updated I was pretty frustrated since the Chainsaw's henchmen sent me home and declared the expansion process incomplete.

A week later, I wandered back to my ortho, still fuming and pretty upset about the extra week I spent cranking my expander (which, I knew, was completely useless- the ortho had told me that the screw would refuse to budge at some point, but turning the damn thing still worked just fine, it just didn't help me width-wise). It must have been obvious to them that I was close to explosion, so everyone was extra nice with me. The witch told me that, although 3, or 5(?) millimetres were still missing to complete the expansion, they would not replace my expander by a new one and continue expansion that way, but seal the current expander, start the healing process, maybe gain another 2 millimetres through the braces and do the rest during the second surgery. She said that integrating a second expander while the upper jaw was still instable was not advisable.

I was still sceptical, but it didn't sound too ludicrous - my molars in the left upper jaw are tipped slightly inwards in comparison to the rest of my teeth on that side, so moving them with braces could really make another 2 millimetres of difference.
To confirm this new theory, I made a second follow up appointment at the hospital during the week before Christmas. Another one of the Chainsaw's assistants was on call that day - he must have been one of the youngest doctors there, and he was looking slightly panicked that the other surgeons had left him alone with all the mirrors and drills and the plaster teeth models wearing santa hats.

Junior won a prize - he listened attentively to my orthognatic tale of woe and measured and re-measured my long-suffering palate. When he saw that I was very close to the maximum of what could be achieved during a second surgery (5 mm - not a lot of margin for error there), he decided, with trembling fingers, to (GASP!) phone my ortho to discuss whether they shouldn't go for a second round of RPE expansion instead. Of course, he just needed a phone joker because he didn't want to make a decision on his own, but I was chuffed - up to now, direct communication between my orthodontist and the surgeons at the hospital was close to nil, so it was always me who had to paraphrase, inexpertly, whatever the other doctor had said during my previous appointment.
In the end, Junior signed off on my ortho's plan as it stood after remeasuring and declaring that I was in fact still missing just 2 millimetres, but before I left, I was as thoroughly x-rayed, photographed (both my profile and my teeth) as never before. He may just be worried about his end-of-term grades, but nice work, Junior.
I came across the assistant that examined me last time around in the hallway. He spotted me at once and nervously scanned my face for signs of an imminent nervous breakdown. I flashed a gappy smile at him.

Since then, it has been business as usual - the Gap of Legend is slowly being closed with a powerchain (I strangely got one on my lower teeth as well), and my pronounshsshiation has improved slightly. It's nothing like it used to be right after surgery, but a slight gargoyle factor will definitely stick with me until I get rid of the blasted RPE. Junior implored my ortho to keep the RPE on as long as possible during the healing phase, at least the full 6 months, to stop my palate from losing another crucial millimeter in width. Damn. I'm keeping my fingers crossed for a removal in April, but I'm not holding my breath. Last time around my ortho had to remove a bit of the added plastic to close the gap further - hooray! It feels good to know that Madonna is on the way out.

Eating chewy things is still a pain, although I hardly think about those things during work days. Last Saturday I finally cracked and decided that I would die of SCURVY that very second if I didn't get some nice apples in non-mushified form, no matter in how many pieces I would have to cut it to get it down. Since then, solid fruit is back on the menu.

I will post pictures of the teef soon(have been lazy about taking new ones), you people are the only factor that still motivates me to keep them clean and shiny. I got ridiculously lazy about flossing and brushing (usually no more than twice a day with two kinds of brushes) on ordinary work days. I never use the blender, and very rarely my waterpik. If last week's new powerchain hadn't come with a ridiculously poky edge, I'd still be able to say that I never once used wax so far either - way too much work.
I hope catching up on my fellow orthobloggers' blogs will shame me into doing better on that front.

Screwed

2008-11-30T19:27:00.002Z

So, the last 2 weeks in orthodontia have not beeen good. Last time I saw the ortho, neither him nor the witch in his employment were entirely happy with my expansion progress. They put a mouthpiece-like measuring thingie in my mouth numerous times, doubted, debated and measured again.

Their verdict: their are still some millimetres missing on the left.

Me and the witch were both worried that I might max out the expander before the necessary breadth was reached, especially since the screw is supposed to have no more than 30 turns in it, and I was already at 32 when I last saw the ortho. Since the screw was still moving, the ortho told me to keep expanding until next week / until the screw would no longer budge and see the surgeon as planned.

So I kept expanding for another week (actually more), went back to the hospital, had probably unnecessary x-rays taken and then one of the Chainsaw's assistants took one brief look at my mouth and said:

"No, there's still some millimetres missing, your ortho should really tell you when you're finished. We'll be seeing you then."

I'm happy to say I handled this like an adult. I burst into tears of frustration AFTER I was out of earshot.

I'm really scared now that I did something wrong or that I will never reach the necessary width without a new expander or (worse) a second surgery, and I'll only get to see the ortho next Tuesday.

My surgery was nearly a month ago already, and my ortho seemed unwilling to put in a second hyrax screw since my jaw is obviously still quite unstable. He thought I could get the necessary extra millimetres (last time I saw him, there were about 4 or 5 still missing) through braces alone.
The screw is still moving without problem, will keep moving forever, and I can't tell if anything is happening at all. I'm so fucked.

In less neurotic news, the ortho put a rubber band across my two front teeth to keep the gap from spreading. I must say when I first heard you people talk about 'power chains', I imagined something much more impressive than a flimsy rubber band. It seems to be in above his head with its job.

As a final thank you to all visitors so far, I took some photos of me and the patron saint of this blog, the joker (and will put them up as soon as I find the time) I may have gotten a bit carried away with the mascara, so let me remind you that I'm the pale girl at the front.

One month, one surgery down...

2008-11-15T01:32:00.000Z

Another update before I go back to the orthodontist on Tuesday.

I thought I was over the worst, but I had some bad jaw- and headaches during my first week back at work. It was joined by a near-constant pain in my right ear three days ago. The ear ache has subsided a little since then, so I figure I can wait until my next appointment with the oral surgeon to ask about this. I found out it gets better when I shift my jaw a little to the right and focus on relaxing the muscles in my face. I guess it was a little naive of me to assume that my recovery is almost over and done with while I'm still expanding.

I don't regret going back to work this early either. This week has passed a lot more quickly than the one I spent at home, and most everyone at work has been nice and understanding. Some colleagues have complained they can hardly understand me, though. I do sound a little better than last week when I remember to speak slowly and make an effort to enunciate very clearly, but as soon as the discussion gets heated, irate hamster goesh right back to the gargoyle shlurp and gurgle. Itch shucks to be me.

Not so favourite coworker lady beat her past insensitivity record today by standing much too close to my face and asking 'Is there something wrong with your nose as well? you sound weird.'
Nosh shitch, sherlock.

The gap between my magically broadened front teeth has become a little larger, but it's not very noticeable - so there is a certain gerbil-esque component to my smile, but I'd still say it beats the week I spent trying to hide the non-masked gap behind lips that wouldn't close.

The constant jaw clicking when I swallow has gone as well, and I can do quite a lot of chewing now, although only on soft foods. I never once blenderized a thing - I'm just that lazy. (My flatmates were thrilled to take the new toy for a spin though and ended up with onion sauce, which was not quite what they expected).

I'm thrilled to notice the upper and lower molars now touch on both sides AT ONCE when I bite down. Previously unheard of and luxurious! Also, the back of my front teeth feels all smooth and round lately - the crowding is definitely history. Not too shabby for less than a month in braces.

Tadaaaaa, it's gone!

2008-11-15T01:25:00.000Z

I think I'm on my way to instant ortho blogger fame with this post. (I realize it's rather a sad dorky type of fame, like owning the most Magic The Gathering cards, but still). I get to amaze my coworkers with the Amazing Morphing Teeth again tomorrow.

When I saw the ortho today, she measured my gap and commented that it looked as if I had to keep expanding for another two weeks. So no appointment with the Chainsaw next Tuesday.
Shoot me now! If I still have to expand when December rolls around, I'll impale myself with the damn expander key.

And then she told me that the assistant would now put a bit of tooth-coloured plastic between my front teeth to make the gap less noticeable. I had no idea what the plan was, but seconds later, I had a lip holder in my mouth and could see three ladies in white move in on my grill like the three witches in Macbeth.

Purple goo, some scraping.
First witch: ahhh, so that's how it's done.
White goo and more scraping.
Witches snigger.
Second witch: They're pretty broad already!
Third witch: Nahh, put on some more.
More molding and scraping.
First witch: Now that's like Madonna.
More laughing.
Second witch: if you don't look at it too closely.

I looked at myself in the mirror, and this is what I saw:

It was either the webcam or hysteria. And the gerbil-tastic closeup:

Crazy, right? My ortho is a loon. Right now, this is pretty good, since people on the street don't get the impression that a tooth is missing. But I hope the gap doesn't move at the same rate as before, or my newly broadened front teeth will make me look like Barry the Bucktoothed Beaver next week. Notice that there's a wire across my front teeth - no idea whether that'll hold anything in place. I hope it does, since I can use all the extra stability I can get.
My jaw is still moving all over the place when I swallow, and it feels like my tongue is still too big for my mouth, although I have an overbite.

I'm going to be extra specially good tonight and treat my teeth to some extra fluoride. Let's see if the plastic survives a toothbrush attack.

Mind the gap

2008-11-15T01:06:00.001Z

You guys, girlfriend has cojones.

I went back to work this morning and put on feel-good music in my ipod to put myself in the mood for the impact my new goofy chic would make among my colleagues. Then, I went around all morning pointing out and explaining the gap to everyone I met so they wouldn't have to stare in wonderment and not ask. They mostly made fun of me for a minute and took it in stride. (I was too late in the case of one of my not-so-favourite coworkers who needed all of three seconds to spot it and exclaim 'You have a huge gap in your teeth! Are you missing a tooth? Oh GOD!' That lady's a natural, though. Last time we had a company barbecue, she admonished a Turkish coworker for eating during Ramadan and asked one of my colleagues why she was cold, seeing that she's 'not exactly slim, is she'. )

Speaking is a bit better, mostly because I bit the bullet (as if...) and asked my sister and Mom to phone me last night so I could practise with them for a bit. I shtill shound funny, but the gargoyle drool has left the building.

I hope the worst gap anxiety is over, and I'm looking forward to my appointment with the ortho late this afternoon. My upper jaw is still hurting and shifting all over the place when I swallow, which is not always painful, but unnerving. Last night my face hurt so much from
me speaking and trying to keep my mouth shut together (still not easy to pretty much impossible to do for long) I could hardly sleep until I took some more painkillers and put ice on my face. I hope the ortho tells me I can stop expanding next week, I can't wait for the bones to fuse back together - feeling them move has to be the ickiest part of my journey so far, even if the gap of legend stays with me for a while. Carnival season starts on 11/11,let's see if I stay in costume as Spongebob all the way through to February.

Some photos of the remaining swelling, the expander key and me having fun with the emerging gap. Take heart, for they be grainy:

And the closeup: The teef in braces after surgery and 1-2 turns, and now after 14-16 turns of the expander:

Sorry again about the poor quality (I realize I'm a sad excuse for an ortho blogger), but the webcam is all I have for now to document my progress. Maybe it's just wishful thinking, but I think my palate looks a little more spacious and rounded out already.

Every turn of the screw brings me nearer to you

2008-11-15T01:02:00.000Z

If you must know: the expander sucks. Also and especially the flimsy blue key with the pointy end that they give you to turn it. I spent a good portion of last evening, this morning and this evening trying to turn the screw, and I have no freaking idea whether I really managed to turn the screw no, a half, one or two times in total. I did, however, nearly break the key in two and managed to ram the pointy bit down into my throat numerous times. OWW! I think the gap between my front teeth is slightly bigger (around 2.5 and 3 mm) than before, and I can feel the expander putting pressure on my jaw bones, but I have no clue whether I'm doing it right. Will save my big freakout for tomorrow, when I'll pay a surprise visit to the orthodontist. They said I could come by anytime when I think I am screwing up (mwaha!).

At this point, I must mention that my doctor situation could really be worse. I'm kind of annoyed that both my regular orthodontist and most of the assistants at the hospital are always rushing you in and out of the room so you don't really feel like there's time for questions, but I do understand that they're doing their best in a rather stressful job, and I have the feeling that they know what they're doing. My surgeon is brilliant, really patient and kind, and he really tried to help me when I got to see him.
The assistants at my orthodontists are legion (it is a big surgery), and I don't have my favourites yet, but they've all been good about explaining what they were doing while I was being treated. Also, he's got this second motherly doctor working for him, who can be a bit insincere in her way, but who won an award for fitting the stupid expander into my mouth when the assistants had forgotten to put me in spacers. She made me bite down bit by bit on every single metal band so it wouldn't hurt as much, and for that alone, I salute her.
Also, she took some time to answer my expander issues when the doctors in the hospital had ushered me out with my two bags, a lot of questions and this bizarre key thing in hand.

In other news, I only noticed today how tired I still am after the surgery. Just sitting and going out shopping for groceries once a day makes me want to take a nap. I think I've overdone it a little on my first day. I'm still drooling like a faucet, but I think my speech will get better, I know it improved a lot a week after I got the braces.

Unfortunately, I just remembered that my ID card needs to be renewed ASAP - it's been invalid for 3 months already, and I didn't get around to do anything about it. The good news: the law requires me to NOT open my mouth for the picture.

The bad news: I still have a hard time closing it right now. I can close my lips, but I look like a pouting chipmunk if I do. The sides of my face are still a bit swollen, and the ever-expanding overbite doesn't help, but seriously, fellow SARPE people, please tell me that this gets better. Walking around open mouthed and drooling for the next 5 months is NOT an option.

Recovery

2008-11-15T00:57:00.000Z

The next days passed with eating, sleeping and cooling my face under a watercooled mask that made me look like Jason . Very fitting for Halloween. The hospital food was disgusting, but I got to take my antibiotics via pill and not via IV a day early for being a good patient... and because the IV drip started to leak. I got a brief checkup by a doctor every day, and the first morning after surgery, I woke up just in time to find the whole ward round rush past again. Reason tells me they shouldn't, but they do look freakishly like the people on Grey's anatomy.

Today was finally the big day - I got discharged from the hospital and I got to try out my brand new expander! It's still difficult, but I finally got there with the help of a mirror and the Chainsaw, who was amazingly patient again. Getting them to give me enough information how to deal with this thing in my mouth afterwards was more difficult. I got quite angry at one of the assistants for not taking the time to answer my questions properly. I mean, this whole DIY bone expansion part of the surgery IS a bit freaky for somebody who wouldn't trust herself to cut her own bangs on a dare. It doesn't seem to be painful, but I'd rather get it right.

I went to the ortho instead to double check on my instructions and went shopping for a good-sized torch and mirror to help me in my expansion progress. I'm still a bit worried since I never know how far to turn the bloody thing, but if I don't see any progress around Thursday (there is a small gap already, but is it moving?), I can always ask the ortho again. Must scoure the internet and ask the good people at archwired to find out how other people fared.

S Day

2008-11-15T00:56:00.001Z

Surgery day was extremely weird. Before anything was done, I was called in for a short pre-surgery appointment, and the whole room was WHITE with doctors. The head doctor, all his assistants, and even a visiting doctor from Brazil. I was so taken aback I nearly stumbled back out again.

I found out again that there really is such a thing as a chain of command in a hospital - this time, the big cheese was there, my surgeon's boss, and everybody else kept their heads down while he was poking fun at their earlier diagnoses. Like a bad Scrubs episode. Of course, after carting the stupid RPE expander around all previous day and living in fear of losing it, I had left it in my room this time, and the senior physician made me get it. Fun was had by all but me as he too tried to get the screw to move, and it wouldn't budge.
They joked around about buttering up the screw, and the head doctor wondered aloud which presidential candidate it was who didn't get elected because he didn't know the price of a pound of butter and guessed it was Al Gore. I'm pretty sure it was John Kerry, but you don't argue with the chainsaw guy two hours before surgery.

After taking a parting shot at my ortho for not smoothing the edges down a bit better, I was dismissed and could put on my sexy surgery gear at my leisure, since my surgery was scheduled for 12 and I wasn't allowed to eat or do anything else in the meantime.

I was mainly afraid of general anesthesia, I thought I'd panic, but the people were extremely nice. The anesthesiologist fussed about putting my hair under the hairnet thingie, and one of the surgeons squeezed my feet in passing and promised to turn up the heating since I was so cold. You just go in there wearing basically nothing but these bizarre garter-length anti-thrombosis stockings and a sheet. The surgeon asked me to name a place I'd want to dream about, and while I was still talking 'Sudaaaa...' , they already put the mask on my face and I was out like a light. I hope I just hallucinated his answer ('oh, that's a nice place' he said completely unfazed.)

Waking up was pretty horrible, I was snivelling like a baby and didn't stop whingeing until they put the second round of painkillers in my IV and promised to give me some tea for my sore throat (they put a tube in my nose and throat while I was out, so afterwards you feel that it's been there). My gums hurt a lot for like an hour or a bit less, but I wasn't sick, and afterwards, I never was in much pain, either. So, the moral of the story is, don't be afraid of general anesthesia. Do start making a fuss quickly and effectively after surgery, and you will be served.

I slept for most of the rest of that day.

Foxface meets the Chainsaw*

2008-11-15T00:50:00.000Z

The week after getting braces just flew past because I've been so busy at work and the boyfriend was so close to leaving for his humanitarian mission in Sudan. There was a minor scare when the ortho found out that my teeth weren't in spacers for a second week although that was necessary to fit the RPE appliance in. I ended up getting extra thick spacers between my teeth for a quarter of an hour, a first slow and extra painful fitting session with the appliance, and a second one the next day.

Before the surgery, I was perfectly calm, because my mind was still on all the other things I had to think about from work. My boyfriend brought me to the hospital and stayed while I got my hospital bed and visit to the anesthesiologist (he took one look at my list of ailments and allergies and said the equivalent of 'run along and play, you're perfectly healthy') .

I also got to meet the oral surgeon, Dr. Z., before bedtime. He's rather patient and friendly for a chainsaw-wielding maniac, but I wasn't fooled.

He took pictures of my pre-surgery bite (if only I could get my hands on them, I never took any others...), did a blood test, made some additional molds, and, unfortunately, explained to me in greater detail which bones he was about to detach. Pretty much all of them between upper lip and chin except for my nose, it turns out. I wasn't sure I needed to know that. Secondly, he was slightly worried about the size of my RPE and managed to wreck one of his own keys trying to demonstrate how the screw was supposed to be turned. 'Are you sure there's no one who could turn the appliance for you?'

Uh, no, but thanks for asking.

On the plus side, I asked him what he thinks he needs to saw in half next time we meet, and he said I might get off just getting my upper jaw moved during the second surgery. That's got to be a lot better than having both of them moved, riiight?

* I can't remember who came up with that term, but I assume it was Chris. It's a handy moniker.

A word on SARPE

2008-11-15T00:28:00.002Z

I realize I didn't explain at all what SARPE is supposed to accomplish. I'll go with a layman's explanation for the impatient since googling SARPE will invariably yield better descriptions than anything I could come up with. For completeness' sake:

The orthodontist takes molds for a custom-made expander screw (RPE appliance) that is held in place by four metal bands that fit around your teeth.
This appliance, which will seriously impede your ability to talk and eat, is cemented in either before or during SARPE surgery
During surgery, facial bones between nose and upper lip (including the middle of the palate which fuses at some point during adolescence) will be detached (buzzsawed apart...) or weakened to make expansion possible.
The fun part! Over a period of 1-4 weeks, the patient gets to turn the expander screw with a tiny wrench that looks like a glorified paperclip. The screw expands the palate by a couple of millimeters each turn. Repeat as needed. Yes, it's Do-it-yourself facial bone movement!
Patient develops a massive gap between front teeth and self esteem issues.
The waiting game: active expansion over, now the expander is left in to hold the palate in its newly broadened state while the bones heal.
Roughly 3-6 months after finishing active expansion: Ortho convinced bones have healed enough to take the expander out. Patient thrilled! But still desperate for gap to be fully closed by braces.
Oh, the palate. It's supposed to have expanded to the right size by now.

Coming out

2008-11-15T00:16:00.000Z

Day 1 in braces here. Argh.

Before the braces went in I spent a lot of time warning practically everyone I know about the braces-to-come. That's what coming out of the closet must feel like, a little. Not as traumatic and permanent, but you still get to have a lot of awkward but necessary conversations. ("So, my jaw is all crooked and freaky, that's why I'll get braces, disappear for two weeks and come back with a smile like spongebob...") Maybe we wired people could get at least a little street cred and have them stitch some braces onto the rainbow flag?

Putting on the braces was a piece of cake compared to the first days in spacers (just when they stopped killing me, they went out again) and getting the RPE appliance fitted.

Nothing like getting ten different size metal bands jammed over teeth that are still sore from the spacers. With poky spiky metal things. Who of you was asleep at the switch there, fellow orthobloggers? I wasn't PREPARED that might hurt!

Some hardware geekery for the wired crowd:

Enchanted by Michelle's SARPE pictures with clear braces, I told the ortho I would go with sapphire on top, damon on the lowers. Actually, I only have sapphire ones on the first few upper teeth - the ortho asked whether I would go with damons on the rest from where the frontal metal bands from my RPE appliance will show. That was a good decision - actually, I ought to either have asked for full damon or (better!) ceramic ones on top, since my teeth are not naturally pearly white, even though they just came back from a full cleaning. They looked much whiter set against the blue spacers...

I think I will get used to how the sapphires look (and they will look better on me when my front teeth are even and rounder, i.e. in about 4 months...), but to anyone who was planning on getting them - the ceramic ones (such as in-ovation c) might blend in better if your teeth look like mine. If you judge from the pics, though, bear in mind that the wire and the ligatures that are on my teeth right now are not quite the right colour to make the sapphire brackets 'disappear'. I didn't pitch a fit about this but will ask the assistants next time around. I figure it won't make much of a difference either way since the ginormous gap that's about to appear between my front teeth will steal the show for the first few months.
(the oral surgeon said something about 10 mm expansion. I might get THE GAP THAT ATE TOKYO.)

Anyway, I'm now convinced that in-ovations on the front teeth plus damons on the back teeth are the way to go for SARPE people. If the sapphire ones give me any additional trouble, I might use that as an excuse to have them changed (can't be that big of a deal for just 8 teeth? or 4?), but I won't bother if they're okay otherwise.

The braces don't hurt so far, but they shouldn't, since my wires are light and cut into pieces in the case of the uppers, so the braces are mostly just sitting there waiting for the star of the show (also known as The Chainsaw) to make his grand entrance.I can already tell that I'm going to enjoy myself more when they're changing the lower wire - everything is already quite nicely aligned, and they just have to click the brackets open and jam them shut again instead of jamming ligatures between tooth and bracket. I realize I sound like a Damon commercial, but rest assured, they're practical, but fugly.

I was a bit taken aback when I looked at myself in the mirror afterwards, but nothing major - the braces do feel bulky, and I have an embarrassing lisp if I don't enunciate very clearly. My lithp will be EPIC after SARPE and RPE appliance... When I'm out on the street I don't feel self-conscious about the braces, I've seen so many people with them in the last few days (one girl notably had the combination I was about to get!).
Meeting the colleagues made me a bit nervous, but I think I'm mostly over it. Still went with a very conservative meal option (soup and yoghurt). Will try something more complicated tonight.

Meet Foxface

2008-11-14T23:49:00.000Z

Welcome!

Now this is the story all about how
my bite was changed, turned upside down...

Ahem. I finally decided to venture out into the wonderful world of ortho blogging to keep track of my ongoing jaw & smile makeover.

I'm 26 years old, and I just decided to finally do something about my frankenbite. Over the years, many dentists have told me that I needed braces, but I was scared to get them. My parents (now aged 66 and 76) have naturally straight teeth, and both hail from a time where anyone with a full set of teeth had an edge over most of the population. They are amazed that I'm prepared to put up with all the hassle now. I guess the problems were not as obvious when I was younger, and my teeth have been good to me otherwise. I think I have no more than two or three fillings, although I hate flossing. (and so would you if there was no space whatsoever between your upper teeth...).

My older sister, however, understands completely. Her problems were less severe, but she was in braces between the ages of 26 and 28 as well. (Oddly enough, so was the phd student supervising my MA thesis at uni...)

What is wrong with my bite?

To give you an idea where I'm at now, the pre-brace mug shot:

Lovely, isn't it?

In the upper two pictures, I'm sticking out my chin so my upper and lower front teeth are at the same height. Third one is a picture of my usual smile. If my jaws are in their usual position, I have an anterior open bite you can nearly put a finger in (although I'd rather you didn't). I can't bite down at all. The one moment in this brace journey I'm really looking forward to is the moment of FIRST CONTACT when my lower and upper front teeth meet at last.

The treatment plan as it stands

Unfortunately, braces won't be enough to fix my bite. My current ortho told me what two of his colleagues had told me already: My palate needs to be expanded through surgically assisted rapid palate expansion (SARPE), then I'll spend 12- 18 months in braces, then I might need another surgery (BSSO) during which they will move one or both of my jaws to fix the open bite. Not that the idea of having my face buzzsawed into pieces is terribly attractive, but I first heard this when I was 17 and had 9 years to get used to the idea.
I'm the clearest case for SARPE surgery you could wish for, I won't need to have healthy teeth pulled, and I hope my lower teeth won't give me too much trouble.

My health insurance took one good look at my x-rays and sent me a very friendly letter that basically said 'be strong, we'll pay'. You know that things are bad with your teeth if public health insurance won't even put up a fight before they fork over the money.

I decided to go ahead with it now because I might change jobs pretty soon, and don't want to wait another 6 months before I'm comfortable enough there to spring the SARPE gap (more about this later) and braces on my new colleagues.

Also, the boyfriend just decided to accept a job with the international red cross, which means he will move to some less than touristy arabic speaking destination for a year or two next month. I should probably be worried, but I'm mostly excited for him, and, to be frank, kind of relieved that I get to do the most icky parts of the treatment without him. I'd rather ask the flatmates or parents for help if I have to look and talk like the deranged cousin of the easter bunny until next spring.

We decided that we'll step on the scales before he leaves and before I get the braces on, and meet again in a year to see what braces/jaw surgery and the international red cross can do for your waistline... :]

Here's the timeline as it stands:

Oct:
7th: going to the dentist for final preparations and a professional cleaning. Also, the boyfriend leaves for Geneva.
13th: spacers and fluoridi..something. Prep.
20th: braces ( I think? If only I could decide which kind I should get!)
27th: expander cemented in
29th/30th: admission to the hospital, SARPE. Boyfriend on plane to his new country of residence.

Wish me luck.