Sunday, January 28, 2018

Tuesday October 10, 2017
Week 57

Today was another office visit with Dr. Jusino. I am into month 13 of my treatment, estimated to be 18-24 months. When I look in the mirror, I have to admit thinking what so many people think at this point in their care: "My teeth look great and I can’t imagine what more needs to be done”. Am I anxious to finish? Absolutely!  I know that root and tooth stability is key to long term success but, this stage of allowing the teeth to ‘set’ in the bone seems to be endless. As an adult patient, this takes longer than with teens. Every time I look in the mirror, I have to remind myself to be patient.

During my visit, I was told that Dr. Jusino was working on ‘centering the midline’. He wants the point of contact between the two upper middle front teeth to line up perfectly with the point of contact of the two lower middle front teeth. In this photo, you can see the offset midline at the beginning of treatment. Elastics do a lot of different things over the course of care and for the next several weeks, he has me wearing only one elastic on the right side to try to ‘pull’ the midline to the right. The alignment is off by about 2.0 mm. It doesn’t seem like a lot but to a dentist, it might as well be a foot. Dentists have been trained to see this kind of detail so, using something like midline alignment (or non-alignment) is a measure of success. Dr. Jusino works very hard to achieve balanced midlines.  I’m curious to see the effectiveness of a single small elastic.

Wednesday, September 27, 2017

Tuesday September 19, 2017
Week 54

It's my One Year Orthoversary! I began treatment September 8, 2016 and cannot believe that a year has passed.  I am at least halfway to the finish line! For those of you who don't think you could wear braces as an adult because it takes too long, think again. The older we get, the faster time flies; the days pass quickly even while wearing orthodontic appliances and it seems like I started this process just last week. 
My recent visit to Dr. Jusino on August 27 was a day to remember because I received a FIVE STAR oral hygiene first one ever and it took nearly a year to achieve. Honestly, I don't think I did anything differently for the past several weeks but I am glad to know that I finally got FIVE STARS! Perhaps it helped that my visit on the 27th was in two parts; an appointment in the morning to remove the wire so my dental hygienist could do a professional cleaning and a second appointment in the afternoon for the wire to be adjusted and replaced. Dr. Jusino is happy to do a two-step appointment to accommodate professional cleanings that can be much more effective when the wires are not in place. It takes some advance planning and coordination of appointments but well worth the effort. 

There was other good news at the August 27 appointment. The elastics have done their job well and I am now in a 'holding pattern' to see if the teeth will remain stable in the current bite relationship. Dr. Jusino thinks I may be ahead of schedule due to my diligence in wearing the elastics.
For those of you who think elastics could be a nuisance, I challenge you to think of them differently; the more you wear them, the faster your orthodontic treatment proceeds. It is possible that I may have shaved 6 months or more from the projected treatment time of 18-24 months! I have kept packets of elastics in strategic locations around the house, in my desk at work, in my purse and in my car. I always have fresh ones available and change them often. There are times that I don't even remove them for eating (simple things like bananas or oatmeal) and put in a fresh pair after brushing away the snack from my teeth. There is no guilt factor at work prodding me to wear the elastics but rather an acquired sense of something missing when they are not in place. 

Here's a true confession. I did Not wear my elastics for five hours during the Michigan-Air Force football game on September 16. It happened by accident and was something I don't care to repeat.  When you go into Michigan Stadium, you cannot bring in any items besides a single stadium cushion. I stuffed my car keys, ID cash and game ticket into my pockets and headed to the stadium from a parking spot three miles away. Why would I need a packet of elastics? Well, when you arrive at the stadium at lunchtime, food is on your mind. I found a naked bratwurst (no bun) to eat from the concession stand and immediately removed my elastics and dumped them into a trash receptacle. Within seconds I realized my mistake but I drew a line at fishing through the trash bin to retrieve my elastics. So, I sat through one very long and boring game feeling like I was missing a body part. When I returned to the car, the first thing I did was replace the elastics. Life was good again. Since beginning the use of elastics in January, the five hours I didn't wear my elastics on September 16 was probably longer than all other times combined that I did not have elastics in place. 
My next appointment is on October 10 and I hope I will have more good news to report.  

Tuesday, July 25, 2017

Tuesday July 25, 2017
Week 46

My last progress-check appointment with Dr. Jusino on June 29 had more good news. The new arrangement for elastics worked just as planned and there was good movement of the teeth. Every time I think my bite has changed and improved, I am amazed with how great it feels. I could be quite happy with the bite as it is right now but Dr. Jusino knows it can be better. It's at this point where people in the middle of orthodontic treatment, both teens and adults, look in the mirror at the great alignment and think they must be close to the finish line. 
If I were a patient in one of many other orthodontic offices, it's likely the projected time line for my care would have been shorter than with Dr. Jusino and indeed the end would be near. However, after having watched my patients for over thirty years (yes, I know, I don't look that old) progress through orthodontics, the endpoint is variable, depending on the cooperation of the patient and equally important, the skill of the orthodontist. Dr. Jusino's mechanical engineering background allows him to Really Understand the physics behind tooth movement and tooth stability. It is for this reason that I am Not at the endpoint in my treatment and neither would any other patient of Dr. Jusino's who looked in the mirror, saw straight teeth and thought they were done.
Treatment completion is achieved when the bite is right, the teeth are straight and are stable in the bone. This last point is key to long-term success of orthodontics. If  braces are removed before the teeth are well anchored in their final position, they will easily move, regardless of how diligent the patient is wearing retainers.
Think of it this way: if you dig a hole, plant a tree and backfill the hole with dirt, the tree will look beautiful.....until the first storm. Wind and rain will cause the newly planted tree to bend and shift in the relatively loose soil, changing how it looks. If you had staked the tree to provide support while the roots anchored into the surrounding soil, the wind and rain likely would have had no effect on the position of the tree.
The same thing happens with tooth movement.  Once the teeth are in their final position, they need to be stabilized by leaving the braces in place until the roots are fully secured to the bone. This takes time and patience for both the individual wearing the braces and the orthodontist supervising their care. 
When selecting an orthodontist for yourself or a child, you need to be cautious about providers offering a seemingly great deal for a rapid process and a low fee. "You get what you pay for' is an apt descriptor when it comes to orthodontics.  When orthodontics is done fast, the treatment cost diminishes.  What's not to like about that?  However, it's likely that tooth stability will be lacking in the end and the result will collapse.  When it happens, it will always be blamed on the patient for not wearing their retainers as prescribed, whether or not it's true. Any correction of the collapsed result will require additional time and cost often surpassing what it might have been otherwise if a more slow and steady approach had been chosen.  A few years ago, a young patient, wise beyond his years, told me 'quality takes time'. This could not be more true when it comes to orthodontic treatment for you or your child.
The photo at the left is my daughter Meredith, a second year student at the University of Michigan School of Dentistry. I chose this photo today because of her beautiful smile. Dr. Jusino provided her orthodontic care when she was in middle school and the alignment of her teeth is as perfect today as it was the day her braces were removed.  Quality orthodontics sustained over time is what drives Dr. Jusino and his team to provide outstanding care.

Tuesday, July 11, 2017

Tuesday July 11, 2017
Week 44

Today's topic is about travelling while in the middle of orthodontic care. Being 'on the road' is different from being at home for a number of reasons. With a little advance planning, your orthodontic treatment will fit seamlessly into your travels away from home.

First, be aware that your routine is disrupted.  While at home in familiar surroundings, brushing (and flossing!) in the morning, throughout the day and at night is often triggered by routine; getting out of bed, eating lunch, going to bed etc. While traveling, these routines and familiar sights are altered so your mental triggers may no longer be in place. You'll know quickly when this happens but being aware of it in advance can help you plan.  Setting an alarm on your phone, sending an email to yourself or other digital reminder options can help you keep up with your regular oral hygiene care.

Second, you need to make sure you have enough of your home-care products (toothbrush, toothpaste, fluoride, flossers, superfloss, elastics etc.) to last for your entire absence from home  plus enough for a couple of days of 'insurance' in the event your travel plans are disrupted. If traveling by air, carry these items with you onto the plane so they are always within reach. Recently, I had the good fortune to travel to London but had the misfortune to be delayed by weather conditions. I found myself sitting in the airport for 10 hours, long after expecting to be ready to land at my destination. After snacks and meaIs at the airport, I was glad to have my toothpaste, brush and floss in my carry-on bag. While I also had these items in my checked luggage, it was nice to be able to brush-up while waiting....and it gave me something to do besides sit and watch the clock. Fear not being embarassed with brushing etc in public restrooms. I discovered at least one other person doing the same thing every time I was tending to my own oral hygiene needs. 

Finally, even if you get thrown from your routine and oral hygiene care, remember to at least change your prescribed elastics frequently throughout the day or at least when enjoying a snack or a meal.  Keeping a package in your purse, pocket or backpack will make this easy to do. You will be able to discreetly remove the ones your are currently wearing, discard them in a napkin and slide in a new set at the end of the snack or meal. Your travelling companions will not mind and Dr. Jusino will be very pleased with your effort! 

Hopefully the information in my blogs is helpful but I am also realistic to know that the photos I post keep it interesting! Today's photos depict the following: Above: morning tea and snack with elastics ready for replacing when I'm done. Below left: Discovering my friend's signature on the ceiling at White Horse Inn, Dover, England. She was the fastest US swimmer to cross the English Channel in 2011 in 11 hours, 31 minutes (21 miles). All swimmers who successfully cross the channel are invited to autograph the walls/ceiling at White Horse Inn. It is the oldest pub in Dover with the building dating to 1365! The food was delicious and the menu offered the most authentic English fare I have seen on any of my three trips to the UK. Below right: I am standing atop Dover Castle which is the largest castle in England and dates to the 11th century. Dover Castle has been of defensive significance to England throughout history. Its underground tunnels and bunkers were strategic command and operation centers during WWII. Below: a charming 'shingle' identifying dental care available near historic Covent Garden, London.

Tuesday, June 6, 2017

Tuesday June 6, 2017
Week 39
It's been five weeks since my last visit to Dr. Jusino and my last blog entry. New elastics in a different configuration required only a small adjustment period of three days. Mary Margaret said three days and she was spot-on with her prediction. 
When she first showed me how to lace and wrap the new elastic configuration, I was mystified but, like all normal people, expressed confidence in my ability to reproduce the arrangement at home. It wasn't as easy as I thought and it took a lot of practice to get it right. Even as a dentist with great hand-eye coordination, I found it challenging which made me understand how difficult it could be for other orthodontic patients.
Since my last appointment, I haven't had the visual feedback about my progress when looking in the mirror but I know things are moving properly because I 'feel' the difference in my bite. Since my incentive to pursue orthodontic treatment was bite improvement, I am happy. The esthetics keeps changing and getting better and better. For me, that's a bonus and one that I am happy to embrace!
On the lighter side, when you become a patient with Dr. Jusino, he gives you several products and materials to help with your treatment while away from the office; an electric toothbrush, Platypus flossers, fluoride gel, wax AND a really nice t-shirt. Dr. Jusino offers many incentives for patients to remain engaged with the orthodontic process and one of those incentives is 'wooden nickels'. With each visit, patients are given wooden nickels based on their oral hygiene,care of their appliances and overall cooperation. The higher the patient scores in each of these categories, the greater the number of nickels they receive. Patients accumulate nickels over time and trade them in for nice prizes such as gift cards, movie tickets or toys. I have heard rumors that he give a bonus nickel for wearing the Smile Engineer t-shirt to appointments. Since I usually come from a professional engagement (teaching at the university or treating patients in my office), the t-shirt cannot be part of my attire for the day.
Nonetheless, I find opportunities to wear the shirt running or working outside. Pictured here, I am wearing the shirt over Memorial Day weekend when I helped my brother dig a 3 foot trench around the inside of his new pole barn in order to place sheets of styrofoam insulation. I smiled for the photo but it was otherwise hard work. The weekend was not all work and no play because I was able to spend three peaceful hours on the AuSable River alone in a kayak. Yes, I am wearing my elastics! Do you notice the change in my smile? I do!
Life is Good! 

Tuesday, May 2, 2017

Tuesday May 2, 2017
Week 34

The absence of blogging posts in the past several weeks in no way reflects on my progress and attitude about my orthodontic journey.  My usual Tuesday morning routine for creative writing was interrupted by a series of Grand Rounds presentations by the D1 (first year) students at the University of Michigan School of Dentistry.  As many of you know, I am an  Adjunct Clinical Assistant Professor at the University of Michigan School of Dentistry on Tuesday and Friday. My primary responsibility is to oversee the clinical care provided to patients by students. Occasionally, adjunct faculty are invited to attend special presentations and lectures prior to the clinic session. This is what happened to my Tuesday mornings. I always enjoy watching the students' presentation skills progress from their D1 introduction researching a CAT (Critically Assessed Topic) to their final D4 Pathways Project. To miss one of these is like not being present for a son's or daughter's fine arts or sporting event. Consequently, the time I set aside for blogging was absorbed by other professional pursuits. As we begin settling into the summer routine at work, school and home, I can reclaim my blogging time and keep you posted on my progress.

Today was 'appointment day' with Dr. Jusino. As always, I looked forward to this visit to hear the measure of my progress. The past three months have focused on little more than wearing my elastics and keeping the appliances clean. Admittedly, the nightly flossing routine is getting old and I look forward to the day when the dental hardware is gone and I can easily access every tooth with dental floss. For those of you skeptics out there, I have lived up to my commitment to full daily flossing between every tooth, feeding Superfloss under the wire to access each area. I have not missed a single day. Even when exhausted, the 'hours of practice' early on developed an efficiency that plays out when I'm tired. I can still do the entire process in less than three minutes.

The report today was Great! Dr. Jusino is pleased with how well my teeth have moved and can tell I have been compliant with the elastics. I graduated to new archwires which takes me into the next phase of treatment: to establish an ideal Class I bite relationship. The only thing you need to know here is that there are three general classifications to bites; Class I, Class II and Class III. You want end up with a Class I bite when your orthodontic journey is over. This is a photo I took while Mary Margaret was adapting the new archwires. I also received a different size and weight of elastics that require them to be placed in a new configuration. The new arrangement was not hard to replicate on my own and gives me a little more room up front to sneak in my morning snack without having to remove the elastics. In theory, the ability to snack easier sounds like an improvement but in reality, I always brush and change out the elastics after a snack so I'm not sure why the new configuration excites me....... I guess it's something different.

Mary Margaret asked Dr. Jusino to reevaluate his estimated time of treatment for my case and at first, he gracefully sidestepped a real answer. To be honest, it's not a really fair question to ask only 8 months into treatment but.....I quietly chuckled about his "evasive" answer so she asked the question again....ever so nicely and very professionally. He gave me an ever so nicely phrased and very professional response...'at least six to eight to ten months for sure; maybe 12, depending on how stable the bite remains in the Class I position'.  I took that as good-enough because it places me at a total time of less than 24 months from start to finish for which I would be happy!

Here is my report card from today's visit. Alas, only 4 stars for my oral hygiene.  

One final note directs you back to the top of this blog page and first photo presented. This is a group of D1 students at the University of Michigan School of Dentistry on the occasion of receiving their White Coats. These are some of the same D1's that drew me away from blogging to listen to their research presentations during February, March and April. Don't they all have beautiful smiles? One of them, my daughter in navy, second from the right, was treated by Dr. Jusino and completed active care in 2008. Such a great smile many years later!  She still wears her retainers faithfully! Thanks for the good work, Dr. Jusino!

Monday, February 13, 2017

Monday February 13, 2017
Week 23

Today I have a few random thoughts to share. The first is that as I continue to be diligent about wearing my elastics, my teeth continue to surprise me with their movement. I even had a couple of days last week when they were really sore, for no obvious reason. They were sore enough that I took 400 mg of ibuprofen and got plenty of relief.
The second thing to share is the improvement in my flossing efficiency. I have felt for several weeks that the process of feeding Superfloss under the arch wire between each tooth has become less time consuming. Last week I decided to time the process and was amazed at my speed. Check out the's legit and included a few additional seconds that were recorded while I fumbled with the phone to stop the timer. This is a huge improvement from mid November when was just under 6 minutes.
The last thing I want to share is how the elastics feel when I am training. My significant winter activity is US Masters Swimming, in the pool several time each week and competing on the occasional weekend.  February 4 I trained with my group from FAST (Ford Athletic Swim and Tri Club) for 90 minutes covering 2900 yards (that's about a mile and a half) and the following day I swam four events in a competition meet for another 1600 yards. With all that intense pool time and exposure to chlorine, I noticed the elastics started to squeak when I talked. Yes, I had been swapping out the spent elastics for new ones every 5-6 hours but I still had the squeak, though I was the only one who noticed. 
Mary Margaret at Dr. Jusino's office mentioned that other swimmers have commented in the past about squeaky

elastics while pool swimming and now I can add that experience to my journal of events during orthodontic treatment. In the photo above I am showing off four ribbons; a second place in the 500 yard freestyle and first place in the 100 yard breaststroke, 200 yard breaststroke and 200 yard backstroke. It is significant to note these are all age-group awards which is what I like best about Master's Swimming!