Monday, January 30, 2017

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.


Monday, January 23, 2017

Monday January 23, 2017
Week 20

I am very happy with my orthodontic progress thus far. It is particularly interesting to note that the care I am receiving is top-notch. Dr. Jusino's office runs on-schedule and everyone who works there is well informed, pleasant and professional. As a clinician, I have always received positive feedback from my patients about the care they receive and the quality communication that is provided to them. Dr. Jusino sends regular updates to all of his referring dentists so they are well informed about the progress of care for each of their patients. This is very important and helpful to me and my team. 
Regarding my own personal care, I mentioned earlier how I Love 'my' assistant at Dr. Jusino's office, Mary Margaret, who has worked there for over ten years. I don't know if she has been 'assigned' to me or if I just luck-out every time I am scheduled to have her provide my care that is directed by Dr. Jusino.

This is a photo of Mary Margaret, on the left, at Dr. Jusino's Holiday Skating Party at Bonaventure Skating Rink in Farmington Hills. Judy, in the middle, has been with Dr. Jusino Forever. The Holiday Skating Party was held this past December 2 for the 28th consecutive year. All of Dr. Jusino's patients, family and friends are invited to the party and if they choose to bring a gift of food or toys, they are donated to the Farmington Goodfellows for distribution to needy families in the community. I remember coming to this with my kids 'back in the day' when they were undergoing orthodontic treatment and it was always a lot of fun. I recall that back then, Dr. Jusino and his entire team were on rollerblades, out on the floor with all the kids. I didn't see any of the All-Star team on skates this year. Perhaps there were too many people on the rink?????
While I was at the skating party and, no, I was Not on skates, I was introduced to a couple who are parents of one of Dr. Jusino's patients and who are both all too rare combination. As it turns out, I met the husband once before and discovered that we both teach at the University of Michigan School of Dentistry. Mom practices in Royal Oak. We had a delightful time sharing stories. Even though none of us were skating, we still had a great time. Thank you, Dr. Jusino for sponsoring this wonderful event and  community service opportunity for us. 

Monday, January 16, 2017

Monday January 16, 2017
Week 19

Last week I told you about my new rectangular wire and elastics so now it is time to report on my adjustment to these additions to my hardware. Dr. Jusino and my assistant, Mary Margaret, both informed me that my teeth were going to be sore for 5-7 days and that I would want to eat a soft diet. When I left the office I felt the tugging on my teeth from both the wire and the elastics which was to be expected. Within an hour I noticed that my bite felt different (ever changing, ever improving) and made me realize that the tugging and pulling was becoming uncomfortable and it was time for some ibuprofen. 400 mg and about 15 minutes later I felt just fine.

After 24 hours, the most notable change I could identify was from the elastics rubbing against the inside corners of my mouth. True confession here: my oral tissues were very sore...but not so much that it interfered with eating. Previously, I wrote about a connection between sore tissues and sugar consumption so this time, I was careful about my diet to keep sugars to a minimum. This helped a lot. I also used a wonderful mouth rinse called Healthy Gums which has aloe as a significant ingredient. It soothed the tissues and aided in healing. Once I began using it several times a day, the soreness disappeared in 36 hours. It is an over-the-counter product and can be purchased at Bed, Bath and Beyond. Make sure to take a coupon to get 20% off!
I'd like to make a comment about the ibuprofen I used this time. It was the Walgreen's house brand, labeled as ibuprofen sodium and gluten free. As more people are recognizing a personal intolerance to gluten (me being one of them), anything they consume can trigger a response if it is not gluten-free. People think about looking for gluten-free foods but don't consider gluten-containing binders that are used in products such as pain relievers. Walgreens has begun to label house brands that are gluten-free. Their ibuprofen sodium is a formulation of ibuprofen that is chemically more active than traditional ibuprofen, is absorbed more rapidly and takes effect sooner. Perhaps that's why I felt so good just 15 minutes after taking the ibuprofen sodium. It costs a bit more for the rapid onset feature but I was willing to pay the premium for the gluten-free element of the product. The next time you find yourself in a discussion with family, friends or co-workers about the quickly emerging gluten-free element of our society, you can impress them with your knowledge of how to identify gluten-free products outside the realm of food for consumption.

Monday, January 9, 2017

Monday January 9, 2017
Week 18

My second post-bracket-placement evaluation with Dr. Jusino was on Tuesday, January 3, just last week. I was eager to see how my oral hygiene was assessed this time and to find out if it was time for 'elastics', known commonly as rubber bands. Dr. Jusino had mentioned that he might begin the elastics in January and I saw that as a measure of more progress. 
January 3, 2017 was a great afternoon!
First, I received a 5 ⭐⭐⭐⭐⭐rating on my oral hygiene! For all the brushing, flossing, rinsing, and more brushing that I do every day, I am confident that my brackets sparkle. As a dentist, I have always felt that my oral hygiene was very good but I have to say that it is even better now.  The thing to evaluate is the pink gum tissue around the teeth, It should be just that-pink. No redness, no puffiness. Just pink. 
My appointment on January 3 was in two parts. I went in for a short visit to have the wires removed so that I could have my professional dental cleaning done without the wires in place. I went back to my office and Nichole did my cleaning. She was very happy to not have to work around the wires and the overall result was far superior to anything she could have accomplished with the wires in place. We encourage all of our orthodontic patients to have the wires removed prior to their professional dental cleaning. It means two trips to the orthodontist that day but it is well worth the better result.
 After my cleaning, I returned to Dr. Jusino's office for him to look at the current state of affairs of my orthodontic progress and determine the next 'move'. I hit the jackpot with a new, stronger, heavier rectangular wire AND elastics. If I sound excited it's because I am! All of this means I'm making progress and it's on a schedule much faster than I anticipated. My assistant at Dr. Jusino's office, Mary Margaret (yes, I feel like she has been my personally assigned assistant to work on my treatment and I love her!), told me that eventually, the elastics will bring my upper teeth down to the point that they will touch the brackets on the lower teeth. This will close my bite and improve my 'occlusion' teeth will fit together better....which is one of the key reasons I am having this treatment done. I am VERY happy with my progress in just four and a half months! Stay tuned for my report next week on how I am adjusting to the elastics and heavier wire.

Monday, January 2, 2017

Monday January 2, 2017
Middle of Week 17

Happy New Year!
Several inquiries have come my way about my blogging lapse along with comments that people have missed my entries. There are still many things to update but life has gotten in the way. Mostly, though, it has been the Christmas holidays that have kept me away from 'blogging about my braces'. I am back on track and will try to post something on a weekly basis moving forward.
Somehow my comments continue to focus on what to eat or in this case, what Not to eat.

During the holidays, many people and businesses send treats to our office as a way of saying thank you for the care and support we have provided during the year. Most of the goodies were of the sticky,gooey, brace-busting type which I quickly dismissed, being protective of my dental hardware. Around the 15th of December this large tin of popcorn arrived as a gift from, none other than, Dr. Jusino. Ugh! Caramel corn is my favorite and this container had a generous amount of it. Every time I passed it in our office kitchen, I heard it calling my name but resisted the temptation! 

The holidays also provided reinforcement to another theme from an earlier blog. I'm feeling there is a direct relationship between the amount/concentration of sugar I consume and the comfort level of my oral tissues. On days that I had 'quite a few' sweet treats, I noticed canker sores start to develop around some of the more prominent areas of my brackets. I would have to research the 'physiology' behind this phenomenon in order to explain how it happens but until I do, I am convinced that keeping my sugar consumption to a minimum will be the ideal solution to preventing the development of sores. Teenage orthodontic patients may not be bothered by sugar consumption but I'm confident it is a factor for adults to consider during orthodontic treatment.
Until next time......