Monday, November 28, 2016

Monday November 7, 2016
Middle of Week 9

       You may notice that I have given up counting 'days' for my blog entries and am now marking time by the number of weeks I have consumed in my journey through orthodontics. If I have 18-24 months of treatment ahead of me, that translates into 78-104 weeks. I think I'd rather start counting the weeks...I have lost count of the days.
Today was the day for my first wire change. I was pretty excited to see if Dr. Jusino was happy with the results so far AND to see if I got 5 STARS for my oral hygiene! The appointment was simple. Mary Margaret opened the 'doors' on the brackets, removed the wires and sent me to the brushing station for a much anticipated encounter with floss (unencumbered by the wires). That felt oh-so-good!
      Dr. Jusino's exam was thorough; he is a thinker and an anlyzer so while he was looking at the position of the teeth he didn't have many comments other than an occasional 'hmm...good... nice" etc. He directed Mary Margaret to put on a new,heavier wire. That process was very quick and I was on my way back to my own patients at the office ( I had blocked out an hour in my schedule for this appointment so no one was left waiting for me to return!). The entire appointment took less than 20 minutes.
      My only disappointment was that I didn't get "5 Stars" for my oral hygiene. Before I went to the appointment, I had one of my hygienists check the brackets and wires for any plaque or food debris that I had missed and she said everything sparkled and looked fantastic. She said the gum tissues looked great and there was no sign of inflammation or gingivitis. Well, I will keep trying for that "5 Star" rating!
     For those of you following this blog closely, the photo was taken October 30 at the Plymouth Wicked Halloween 10K run with my daughter, Meredith. Meredith 'ropes me into' these races thinking they will motivate her to train. The weather was awful and we ran most of the race in the pouring rain. As far as any effect on my braces? No problems!

Thursday, November 3, 2016

Day 56
Thursday November 3, 2016
End of week 8

My teeth have been very comfortable for the past two weeks and I have ventured into more dense, firm foods in my diet that my teeth tolerate very well.I have an appointment coming up next week with  Dr. Jusino and I am anxious to see what's next.
As a dentist, I can appreciate the subtle changes in the positions of my teeth that are evident from day to day. Sometimes it is a visual change and other times it is something I perceive with my bite as different teeth move into or out of contact. Considering that a change in my bite was one of the biggest motivators for me to pursue orthodontics, I am happy with what I am feeling.
Next Monday, I return to Dr. Jusino for my first follow-up appointment. I will be evaluated in several categories regarding 'patient compliance'. The most significant one to me is oral hygiene: how well am I doing keeping the brackets and wires clean and my gum tissues healthy. I am hoping for a top score of "5" since my night time routine is now embedded into my lifestyle. I have the flossing down from eight and a half minutes to just under six minutes (while carrying on a conversation). 
While there are many aids to flossing, nothing beats the feel of squeaky clean teeth that I get from using Superfloss. It is a stiff floss-threader, stretchy fuzzy filament and plain floss all connected into a single strand for easy use. The stiff end is threaded under the wires, then the other parts are gently teased between the teeth for cleaning. I always floss before brushing to loosen up debris. By the time I finish rinsing, flossing, brushing and applying fluoride, my teeth are Clean and the brackets sparkle.

Friday, October 28, 2016

Day 33
Tuesday, October 10, 2016

Sometimes, as I count the days, I wonder if I will have enough information to keep this journal interesting for everyone to read. Then something different happens and I think “Ahhh; I need to tell people about this!”
So many postings have centered on food, what to eat, what not to eat and how to take care of the hardware after you eat. Let’s face it, eating is a big part of our day. We eat when we are happy, sad, jubilant, depressed or celebrating an event. For people wearing braces, it might not be so fun because so many celebration foods are on the Do Not Eat list I received from Dr. Jusino.
Birthday cake, however, is not a forbidden food and in our
office, with 11 team members, there is usually a birthday to celebrate every time we blink an eye. Recently, we celebrated Terrie’s special day with an amazingly soft cake with perfectly whipped frosting that was like eating a cloud. It was an enormous cake allowing generous slices for everyone. It was my lunch that day and I enjoyed every morsel.

About an hour after eating my slice of cake, my mouth felt very dry and the cheek tissues started sticking to my braces. After another hour, the braces felt like they were brand new, bugging my lips and sending me to look for wax to put over the brackets that were causing irritation. After much thought, I am convinced that the concentration of sugar in the cake and frosting dried the skin on the inside of my mouth so that it was no longer slippery and the braces felt rough.  Though the cake was outstanding, the amount of sugar in it was too much to handle. Even though I brushed right away, the sugar must have pulled all the moisture from the tissue in my mouth. It was pretty sore for the next 36 hours but was manageable with strategically placed wax. It’s likely that a teenager going through braces would never notice the impact of sugar on their oral tissue. However, as a adults, our bodies are much less adaptable to ‘drama’ in our foods (sugar, spice, heat etc.) and respond poorly when they are on input overload. Note to self…watch the food extremes because they can change the oral environment.

Wednesday, October 26, 2016

Day 30
Friday, October 7, 2016

One month down, only 17-23 yet to go!

I can see and feel a difference in the alignment of my teeth and the feel of my bite. What amazes me is that things are constantly changing on at least a daily basis and in some cases, hourly!  Admittedly, I am more aware of what’s going on with my teeth than the average patient but it is soooo energizing to be aware that the changes I hoped would result from my orthodontic journey are actually happening. The potential for success with adult orthodontics is very good as long as one is patient. However, there is always a chance that the outcome will not be ideal because tooth movement is more difficult with ‘aging’ bone. When I feel that my bite is different or that my teeth feel more ‘flush’ when I run my tongue across them, I am convinced that my outcome with Dr. Jusino will be great!

Monday, October 24, 2016

Day 26
Monday, October 3, 2016

It has been a quiet two weeks with no broken brackets and a greater confidence in my food choices. I find I gravitate towards soft foods like ground meats, fish and chopped stir-fry or well cooked vegetables. Forget bite does not work well enough to grind up all the pieces and parts found in a salad. Planning for meals has been a little challenging because after a while, for people around me without braces on their teeth, looking at another plate of ground, soft or finely diced foods can be boring.  My husband is a good cook and has been very mindful of my need to select my diet carefully to avoid breaking my ‘hardware’. The trade-off with soft/ground/diced foods is to cook something meatier, knowing that it’s just going to take me longer to cut pieces into the proper size and eat my meal!

I have to admit that balancing a snack with braces is hard to
do. Not only is eating a compelling reason to find a toothbrush immediately, but also there are few snack-foods-on-the-go that are on the allowed list. True confessions here: I have a sweet tooth. When I get that mid-morning ‘low’ and need a boost, even a few M&M’s feel too hard and crunchy. After a little thought, I discovered that Junior Mints are just the thing on the go. They are soft and packed with that boost that can keep me going until lunch at 1. I have my serving and then immediately brush. Candy has a lot of sugar so it’s important to dilute it and brush it away promptly so it won’t harm the enamel around the brackets and cause white spots or worse, decay. Dr. Jusino will be very pleased with your oral health care!

Friday, October 21, 2016

Day 12
Monday, September 19, 2016

With deepest humility I made the phone call to Dr. Jusino’s
office to report my broken bracket. There was no “scolding” for damaging my hardware in the first week and the entire team was more than reassuring that ‘stuff happens’. I didn’t feel so bad when Dr. Jusino told me he was expecting the bond on a totally different tooth would eventually break. 
Repairing the broken bracket required removal of the wire to be able to access the part to be replaced. Dr. Jusino does not simply re-use the broken bracket but places a completely new one to assure that it gets the best bond. I was in to see Dr. Jusino for the repair and back in my office in less than 45 minutes. (Ok, so my office is a short drive to Dr. Jusino’s and I did not have to fight traffic). 
The moral of this story is that I will be much more careful in the future. My porcelain crowns won’t hold a bonded bracket as well as a natural tooth so I will need to be more discerning about crunchy foods, like Oreo Thins!

Wednesday, October 19, 2016

Day 8
Thursday, September 15, 2016

It’s the end of the first week. If I have 24 months of this process that means I have only another 103 weeks left!  But, it really seems like time will fly by quickly and I am adjusting well. No complaints from me! I am VERY happy with my decision to do something for Me!

Day 9
Friday, September 16, 2016

Disaster Strikes! OH NO! Remember on Day 1 when I said I wasn’t going to be ‘one of THOSE patients who breaks wires and brackets”?  It happened last night, WHILE FLOSSING!!!!!! I am crushed and feeling that I have failed after only a week. To be fair, the bracket that came loose was bonded to a porcelain crown and Dr. Jusino told me (and I also know from my own treatment experiences with patients) that things DON’T bond well to porcelain.  It happened late last night and of course I did not call Dr. Jusino at that hour because there was nothing to be done until Monday. A loose bracket for four days will not interfere with the treatment outcome…at least I don’t think so. I don’t want to give anyone the idea that you should delay telling your orthodontist if a bracket comes loose but a couple of days should not be a game changer. I will correct my opinion if I hear otherwise when I go in for the repair. BUT, I DO NOT really want to make that call Monday morning. I should have known better than to predict that I would sail through this without a blip…but I’m disappointed in myself after only a week.

I reviewed my diet and, if confessions are required, I will admit to eating some ‘Oreo Thins’ over the past week. They are a thinner version of the regular Oreo….thinner cookie part and thinner filling part…..and thus thinner calorie part. The cookie part is crunchy but I thought I was getting it pretty soft before biting it. I even started putting them in the microwave for 20 seconds the past few days to pre-soften them. I guess that was not good enough. No more Oreo Thins for a couple of years!

Monday, October 17, 2016

Day 7
Wednesday, September 13, 2016

I’m still eating soft foods but I love things like oatmeal, quinoa, black bean burgers, sweet potato burgers, spaghetti squash with meat sauce and ice cream! My teeth are less sensitive so there is an equilibrium I am reaching with my teeth and my diet. One thing that has changed a lot is snacking. Honestly, at work, in our stressful jobs, we often eat our way through the stress of the day. Monthly, our team members rotate responsibility to shop for necessities…cleaning products, paper towel, Kleenex and the like. Within the budget is an allowance for ‘snacks’. Each person gets to choose treats for the team to stock the pantry cupboard with on-the-go eats that are quick to consume. Skinny Pop popcorn, M&M’s (yes, we love our chocolate and no, as sugar goes, it’s not too bad for your teeth in small amounts), chips/salsa, chips/ hummus, almonds, string cheese and pretzels. Everything listed in italics is on the forbidden food list for people wearing braces but more importantly, any food I eat sticks to the braces. 

The concept of a snack-on-the-go is being redefined by my experience. There is no ‘on-the-go’ when you wear braces. It’s more like this: if you snack, you must immediately brush so no one has to look at the remnants of your snack hanging from your brackets. It’s just easier not to snack if I don’t have time to brush too. I’m hoping I will lose a few pound in the process but if you remember my reference to FDP on Day 2, I think I will make up for the lost calories from a reduction in snacking!

Thursday, October 13, 2016

Day 5
Monday, September 12, 2016

It was back to the office today and lots of curiosity from patients about my new look. I never imagined that by undertaking orthodontics for my personal oral health it could be a motivator for my patients to more seriously consider it
for themselves. After thirty years of caring for people, most of who feel like family, I am always conscious of their changing dentition and gently suggest orthodontic treatment when it’s needed. Most of the time they laugh me off and say that they are too old. I can turn myself blue educating them on the long term benefits of a better bite and straight teeth as they transition into their Golden Years but it falls on deaf ears. Things are different all of a sudden now that I am ‘walking my talk’. It will be interesting to see if more adults are motivated to seriously pursue orthodontics when I recommend it. Because I refer to amazingly talented orthodontists like Dr. Jusino, there is no self-interest in the recommendation. I hope the story of my experience helps others!

Tuesday, October 11, 2016

Day 4
Sunday September 11, 2016
Progress! My tooth tenderness is decreasing by the hour and a dose of Motrin is far from my thoughts.

I forgot to mention yesterday’s lifestyle changing experience: a trip to the apple orchard for our fall ritual of apple picking. Part of the fun is deciding which apples to pick….Empire? Gala? Jonathan? I can never remember from year to year and always rely on picking ones from the trees for an on-the-spot taste test. That process was out of the question for me. Not only is biting into a whole apple one of the forbidden activities ( as demonstrated here by my daughter) because it breaks brackets but also, even if it were allowed, the firm fruit would definitely be uncomfortable to bite with tender teeth. Not to dismay! With apple orchards come cider mills and fresh DONUTS…..warm, soft, cinnamony, yummy donuts that literally melt in your mouth! Let’s just say the donut consumption on this day was an epic event! Who needs to eat whole apples when there are fresh donuts to eat?!

Today’s lifestyle experiment was running. I am an aging triathlete who has not quite retired from training for the sport though I have not raced an event for several years. But swimming and running (and biking) are all part of the training program and I wondered how ortho brackets and wires would feel when one is hot and parched on a long run. Once again I was really surprised. I imagined my dry mouth sticking to every nook, cranny and corner created by the wires and brackets leaving permanent indentations in my cheeks but nothing of the sort happened! Oh, Happy Day! Maybe it was because of the Dr. Jusino t-shirt I wore!  I needed to rehydrate after the run but there were no sustained ill effects in my mouth.  Life is GOOD!

Thursday, October 6, 2016

Day 3
Saturday September 10, 2016

I slept like a baby last night and woke up feeling much better. Bedtime Motrin and a long day both contributed to a good night’s sleep. Speaking of nighttime, I want to talk about the bedtime brushing routine that has morphed into an Olympic
event. No longer does a quick 2-minute brushing do the work needed to keep this mouthful of hardware clean! Though I and the two teenage boys were given the same detailed oral hygiene home care instructions for brushing, flossing, rinsing and fluoride application, I would be surprised if the average teen follows what is recommended. I have been doing dentistry for over thirty years and have been witness to the teenager-in-orthodontics and 98% of them do little more than add an extra 20 seconds to their normal 30 second brushing routine. Most end up with gum problems (mushy, red and swollen) after the braces are removed. As a dentist, I hold myself to the highest standard (and will certainly hear about it from Dr. Jusino and his entire All Star team otherwise). First, there’s the rinse with Peroxyl which bubbles out ‘gunk’ from
tiny spaces….and gets any big pieces of food loosened up. When your cheeks are sore the first few days, the Peroxyl stings but it’s a ‘good’ sting because you know it’s working! I am AMAZED at what it gets loose! Then there’s the flossing. I like to floss before brushing and always recommend it. Dr. Jusino gave me tiny flossers called a Platypus that slips pretty easily under the wire to help remove plaque. This is the part I know most teens
won’t do. It took me over 8 minutes to do just the flossing! This is longer than most people brush! When I couldn’t get the flossers into the back corners, I had to use different tactics which I won’t detail here because I can’t imagine most people would even try. Admittedly, it was hard to do even for the well trained dentist that I am.  A magnifying mirror helped this process a lot and I could not have done it without it. After these two steps, brushing with my electric brush was easy! It has a timer and does all the work. I gobbed a lot of toothpaste on the brush to make sure it had a lot of cleaning power. After the brushing, the last step is to apply the fluoride gel to sit on your teeth overnight to help prevent cavities creeping into the nooks and crannies that even the best brushing routine might miss. The gel is squished around for a minute or so and then left, un-rinsed, for the rest of the night.

Insert routine-buster step here. I always take my allergy meds, supplements and vitamins at night after brushing, right before I go to bed. The first three nights in a row, I goofed up because you’re not supposed to rinse or drink after the fluoride. So, I took the pills then did the fluoride again. I have now made a note for myself to see before I begin my nighttime brushing to remind me to take the vitamins First!

Yes, the bedtime routine is an Olympic event.  So far my PR is 18 minutes!

Monday, October 3, 2016

Day 2
Friday September 9, 2016

I’m feeling more tugging!  And I have to admit my teeth are a little sore but taking Motrin helps a lot and I really am not aware of the braces. Sleeping was awkward because I have worn a bite guard for nearly 30 years (remember what I said about needing braces because my bite has been abused with tooth clenching and grinding for a long time?) When you are used to sleeping a certain way for 30 years, your brain knows something is different so sleep was not restful. In spite of
this, I got up at my regular time of 4:30 am for the first ‘test’ of the effect of my braces on lifestyle activities that I enjoy (besides eating). Today it was swimming. I wasn’t sure how I’d feel in the pool trying to maintain rhythmic breathing with a mouth full of hardware. Not a problem! I put in my full workout and was ready to take on the day!

After swimming on Tuesday and Friday,teach dental students at the University of Michigan School of Dentistry and in the process, do a lot of talking. Admittedly, my cheeks rubbing against the braces took a toll and by the end of the day, having forgotten all about my stash of Motrin, I was pretty sore.
On a scale of 1-10, it was a 7. When I lunched midday with my colleagues, the omelet that I customized with soft grilled peppers, tomatoes and cheese was difficult to chew. The chef threw in some wonderful mushrooms that I didn’t order but was happy to (try to) enjoy.  But, it turned out that they were too dense to chew. I had to pretty much let the small pieces of omelet slither past my teeth without chewing. Indeed, my teeth were sore. But I did not leave the table hungry and I was already planning an easy treat to eat later in the day. There are suitable food rewards in this process and ‘frozen dairy product (FDP for
short) is on that list. Whether it is ice cream, fro-yo or Dairy Queen, as long as you don’t crunch the cone, it’s endorsed by Dr. Jusino!

Wednesday, September 28, 2016

September 8, 2016

Day 1
I’ve done some wild and crazy things in life but deciding to go through orthodontics as a 50-something dentist was never on my list of things to do…until about six months ago. A close look in the mirror showed my teeth were shifting and I didn’t like the smile that was looking back at me. In this picture, you might think my smile is perfect but up close, problems were becoming evident. I had orthodontic treatment as a teenager, was compliant throughout the process and had an outcome that was pretty darn good. But, things change with time and here I was, unhappy with my look. To the casual observer, my teeth looked great. However, to my husband dentist, I was losing bite stability from years of clenching and grinding my teeth (dentistry is stressful! are most forms of gainful employment)  and my smile esthetic was declining.   For nearly thirty years I have referred many patients to Dr. Thomas Jusino and have been very pleased with the results he achieves. I decided that it was my turn to see what he could do for my case. After two discussions with Dr. Jusino over 8 months, it was clear that my teeth needed an Intervention.

So here I am today, that 50-something dentist (ok, closer to the bit Six-O number), sitting alongside two teenage boys, all of us awaiting the beginning of our orthodontic treatment. I probably knew more about what to expect than the other teens waiting their turn but I was still a little anxious and certainly out of MY element. I am usually the one ‘in charge’ but today, I was ‘the patient’. For me it was a bit of an out-of-body-experience. But, I went into the process determined to be a totally compliant patient who wasn’t going to complain and who fiercely protected their brackets and wires from breaking. As a dentist, I didn’t want to be THAT person who gnawed on Bavarian pretzels, ate Gummy Bears without a thought or consumed fistfuls of whole almonds mindlessly; all forbidden foods that will destroy the bond of the bracket, frustrate the orthodontist and delay progress.

I will insert here that I had a fair amount of advice from three experienced people… kids, now aged 21, 25 and 28. Go ahead and Zoom in on the photo and check out their smiles. All three breezed through their ortho with Dr. Jusino as young teens and were impressively compliant, without nagging from their dentist parents. The common theme in their advice was to ‘make sure you take some Motrin before your appointment and keep it nearby for the first couple of days’.  I had a flashback to 2003, getting a call from the middle school secretary telling me that my ‘middle’ child was having headaches and that her teeth hurt after having an ortho appointment the day before. Of course, the good parent that I was found an opening in my schedule between patients and dashed off to school with a bottle of Motrin and a snack-sized container of applesauce (this child could not swallow pills) to provide relief. I won’t go into detail about how I managed to pummel the pills into a powder to mix into the applesauce in the school office but by the end of the school day, this child of mine was headache free and all smiles. I refer to Motrin as “Vitamin M”. So, for this, my first, visit to the orthodontist, I pre-medicated with 800mg of Motrin….a very smart move.

Back to reality and my first appointment to get started. First there was the ceph x-ray; a lateral view of my skull and jaws…most cool to see what’s inside your head! Next was the impression taking…yes that funky goop we place in what seems to be a gorilla-sized metal tray to take a mold of your teeth. BUT! The material allows for customized flavoring in at least a dozen choices and you can have separate flavors for upper and lower molds!  Once mixed, it was only in my mouth about 20 seconds because they used the FAST SET goop! The flavoring and quick set material made this a breeze! So far, so good.

Onto placing the brackets…gluing the braces to my teeth.
So, this part took a long time but mostly because Dr. Jusino is both an artist and an engineer. Precise placement of the brackets allows him to easily work his magic over the next several months to create a smile that will last for a very long time. You lay in comfy chairs with funny lip-stretchers (that we call cheek retractors) to keep everything dry. The glue doesn’t like to be wet (makes sense). So while your cheeks feel stretched from one side of the room to the other, please know that they bounce back quickly and no one will ever be able to tell you had anything done when it is over. The best part? None of this hurts. (Remember, the Motrin?) It feels funny and I suppose if you looked in a mirror it might Look funny for the time you’re there, but nothing hurts. Once the brackets are positioned, placing the wires that actually move the teeth is quick..just a couple of minutes. Then, you’re done!  For the two teenage boys, they were off to school and for me it was back to the office to see scheduled patients.

My braces are a big hit at the office. All of my patients think it’s great to see their fully grown adult dentist with teeth that look like they belong to a teenager. I have to admit, I feel younger and don’t mind the attention. But, you might ask, how does it feel? Not nearly what you might think!

My lips do not feel big, and my smile is just as confident as always. Dr. Jusino gave me clear brackets for my front teeth and most people don’t even notice at first. For this afternoon of Day 1, I was prepared with soup for lunch and a reserve of Motrin which I did not need. For me, the best part was feeling the gentle tug on my teeth that told me ‘It’s Working’. I am pretty excited!