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.