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
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

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

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
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 photo....it'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!

Monday February 6, 2017

Week 22

I continue to be amazed at the effects the elastics are having on my bite and my appearance. I Like what I see and it's happening Fast. My biggest challenge is to keep in mind what Mary Margaret, Dr. Jusino's assistant, told me; "take the elastics out only for ten minutes when you eat a meal or brush your teeth and remember to put them back in right away". I am a slow eater and with all this hardware in my mouth, I'm even slower now, taking care not to bite my lips. So, my elastics might be out for 30 minutes at a time...but I am diligent about putting them back in place (with a fresh set!) when the meal is over. Since things continue to change, I have to believe that my system is working. I'll find out for sure at my next visit when I am 'evaluated' (numerically scored) for compliance with elastics. I'm hoping for a "1" !

Today's entry is brief so I am using it to give a 'shout-out' to all of my adult patients who are also undergoing orthodontic treatment. I am pictured here with Marylou, who gave hearty consent for the use of her photo in my blog. When she was in the office recently and saw my 'new' brackets in place, she welcomed me into the Club. As adults, we are kindred spirits in this process and feel a connection with one another because we 'get-it'.  We understand the commitment, we understand the challenges and we understand the benefits to be reaped. As more of my patients see me wearing my brackets with pride, more of them are taking our adult-orthodontic recommendations to heart; if they are not yet making the commitment, they are a little closer to embracing the long-term health benefits that can be achieved.  As I told one person recently, there is no self-interest in my recommending orthodontic treatment for them; Dr. Clark and I do not provide orthodontic treatment in our office so the only benefit is truly for the patient!

Monday January 30, 2017
Week 21

The update this week is about my new 'elastics' (aka rubber bands). As an 'undergraduate' dental student, we were presented with very little information about orthodontics. We learned a few techniques, did some practice exercises and graduated with only a vague understanding of how teeth could be moved into better positions. Over my career, I have observed my patients undergoing orthodontic treatment and have marveled at the transformation that occurs. As a patient now, I have high hopes that I experience the same transformative effects. I am not disappointed.
Elastics are designed to move segments of teeth as a unit. My assistant at Dr. Jusino's office, Mary Margaret, explained that the goal of this first phase of elastics is to move/'pull' all of my upper front teeth downwards to give more overlap with my lower front teeth. I thought, 'yeah, right'. Mary Margaret was right and it is happening FAST! I don't analyze my teeth on a daily basis but it is hard to ignore a changing bite and a changing smile, all for the better. As dentists, one thing we hope to find in an ideal dentition is something called canine/cuspid guidance. Simply put, it means that the canine teeth (eye teeth) bear the load when the jaw moves right and left, forward and back, when the teeth are held/closed together during these movements. The canines have long roots and thick enamel which bears up well under function over the lifetime of an individual. Canine guidance helps protect the front and back teeth by acting as a shock-absorber during movements.  Without canine guidance, the front teeth and back teeth can wear down more rapidly over time, especially in someone who habitually clenches or grinds their teeth. My bite fell into this category. I have never had canine guidance.....until last week!

 Even as a well trained and experienced dentist, I was skeptical that anyone could effect enough tooth movement to achieve canine guidance for me. I had many potential outcomes in mind for this orthodontic adventure but canine guidance was not on the list because I did not think it could be achieved. I am now a believer and continue to be more than pleased with my decision to pursue orthodontics as an adult.

When I was harnessed with elastics at my last appointment, Mary Margaret gave me four packets of elastics, each one containing about 50 pairs. She said to replace them three to four times daily...when I ate meals and at bedtime. I thought four packets was a lot but then discovered that keeping one in strategic locations was very helpful to the process. I keep one with my toothbrush upstairs at home, downstairs at home, at the office and in my purse. I am never far from a fresh set, as you can see in this photo taken in a computer center at the University of Michigan, early one morning as I was creating this blog entry. 

The key with the elastics is to keep them fresh and KEEP THEM IN! Surprisingly, they stretch out quickly and after about three hours, I don't feel much tugging. To keep them working well, the teeth need to experience a sustained steady force. It does no good to wear 'exhausted' elastics for an entire day; while they maybe in place, they aren't working and in fact, all that had been achieved when they were attached, fresh out of the pouch, may be lost by not keeping good tension on the teeth.
Successful orthodontics is all about compliance. As much as I love my braces, I don't want them on my teeth any longer than absolutely necessary. I'd like to think that I am Very compliant and that Dr. Jusino is pleased with my progress when I next see him in early March.