Friday, January 30, 2009

The tools of the trade...

Having reached my first two (2) months with braces I have found these things to be time savers and ameliorate the nasty things of wearing braces...
  • Using regular flossing which is time consuming with braces? struggling with the threader? well, get yourself the Super Floss from Oral B! it comes in a box with 50 of them, each having a built-in threader, a thick floss section for the brackets and a regular floss section for the flossing. A time saver! a bit expensive but well worth it!
  • Get the WaterPik! nothing like a jet of water to help cleaning those teeth and brackets!
  • A good mouth wash without alcohol. IF you are given a special mouth wash such as PerioGard for use after a periodontal treatment or oral surgery, use it only for no more than a week or it will stain your teeth! it happened to me because I thought I could just finish the bottle.
  • Get a pack of mini-brushes.

The purpose of it all

Well some people criticize adults with braces as if one were to do it for fun. Let me tell you there is no fun to it. Also, those people either never wore them or never think there is a FUNCTIONAL purpose to all of that. In my case I view it this way:

Visual or Physical and Improvements:
  • Eliminate the growing gap between the two frontal teeth on the upper jaw. Requires fraenum surgery (see earlier post).
  • Terminate the movement of the frontal teeth towards outside and the sides which has been causing a lot of tear and wear. Requires the installation of braces and tooth restoration with resin.
  • Align the 5th tooth on the left side of the lower jaw which was nearly 40% pushed towards the inside (the tongue) by its two neighbours. Done by the braces.
  • Push the front teeth back and straighten them in general. This was getting worse over the years.
  • Fix the lower jaw which did not grow enough. Requires orthognathic surgery :(
Health Improvements:
  • Put an end to the nearly extreme wearing off of all the teeth. In particular the upper/lower frontal teeth were so worn out that it was reaching the core and losing shape. These need to be restored to their original grace.
  • Improve speech, the position of the upper two was so far out that it hinders the pronunciation of sounds that require the tongue to establish contact with the front teeth
  • Eliminate the problem with the jaw joints making cracking noises when moving (TMJ).
  • Eliminate over stressing neck and jaw muscles
Other improvements:
  • To finally gain confidence for smiling normally and without shame, what else?! I have not done that for as long as I can remember.

Sunday, January 25, 2009

Oops! wires popped out, who can help me?

It was bound to happen though I was hoping not so soon... Given that I can no longer eat the delicious things in life I was having some natural fiber in the form of Mango chunks I bought as a salad in the supermarket.

Apparently some chunks were not as ripe and as a result the arches (archwire) that terminates on the very last molar has popped out of its hole. To my surprise this happened on both sides of the lower jaw so both ends of the archwire are now lose.

I hope some orthodontist here can help me because I won't be seen my "home" orthodontist for another 5 months! I can't manipulate them (the back teeth!) myself and I don't have any tools for that. I also wonder if doing that might cause any further damage.

Friday, January 9, 2009

New wire and remove stitches!

Tomorrow I am heading back to my home country so my follow up was scheduled for today.

At 17:00 we had the appointment with the periodontist and orthodontist. They examined my mouth and were happy that the skin graft had held well and that the tissues have been scaring properly. The diastema has been closed 100% for the first time in around 10+ years I had no gap on my front teeth!

The orthodontist removed the rubber that was forcing the two upper teeth towards each other. We were all happy the gap had been closed, because the graft well it meant the fraenum would not grow back. However, they could see that it was already trying to grow there but thanks to the graft it could not grow further. Then he removed the wire that ran through all the brackets of the upper teeth. This removal involved opening the Damon brackets, something was was very painful on some teeth. My God, to imagine I have to go through some more of these wire changes!

The periodontist did a full clean up and it was easier on the upper teeth because the wire wasn´t there for now. Unfortunately I kept on using the medicated mouth wash a bit too long on two ocassions which caused the teeth to be stained :( I will have to wait for the whitening when my orthodontic treatment is over. Some of the cleaning was painful because there was no anesthetic applied and doing that with brackets installed is quite a shore that makes the instruments of torture come very close to the gums. I am a chicken for these things remember, specially when there is more pain than my threshold, my legs where trembling like mad and I had a hard time controlling them. I was relieved when this part of the procedure was done. Pfew! I can breathe!

The plastic-like paste that was covering the open wound on my gum where the graft was taken was removed. The stitches from there too but that was not very painful. Normally they would have removed them some days later but I was leaving tomorrow so no other option. Luckily it had held well and healing well too.

The stitches that held the graft over where the labial fraenum was were removed. How many I don´t know but some where hard to remove because the fraenum was trying to grow back and thus making removal more difficult. This was a VERY painful part where I sweat a lot and suffered but the only alternative was to apply an injection (anesthetic) to the gums and that I judged was going to be probably more painful. I had to hold myself together. When it was over I was GLAD.

Then the easiest part that did not cause much pain or distress. The new thicker wire was installed across the brackets of my upper teeth to align them further. This new one can hold up to a year but I will keep it for 6 months until my next appointment in June.

The diastema being closed and the lower molar aligning further into place it is expected that in June I will have a lot of progress and be ready for the two extractions :(

The next few days were the usual nightmare. An open wound on my palate that still needs to heal further makes eating a challenge, I can chew on the side of my two crowns so I have to be careful. I have been eating very soft things such as creamy soup, bread and the like. In addition to that thanks to the new wire adjustment my teeth and molars are on the move again and thus every bite is not only a challenge but also very very painful making eating something unpleasant. Naturally I did not enjoy the food on the plane nor any food for the coming days. I took pain medication only for a day (Dolex and Apronax which is based on Naproxeno).

Saturday, January 3, 2009

Labial fraenum surgery (Frenectomy) and new wire

My experience so far is that having braces takes out the joy of savouring and enjoying food the way you used to. Nevertheless given this limitation I managed to enjoy the Xmas and New Year celebrations. For that reason this appointment was moved from December 30th to January 3rd.

So at 11:00 AM I was together with my fiancée at the orthodontists clinic ready for "labial fraenum surgery" (frenillo labial). This is that relatively thin strip of flesh that extends from the upper lip down to the palatal vault. It also exists on the lower lip but there it isn´t a problem for me.

In my case my upper labial fraenum was the culprit which over the years created and enlarged a so called diastema. A diastema is when your two front teeth (in my case the upper two) are separated from each other more than the usual, I had a diastema of about 2.5mm. This is because the fraenum grows and extends in between the two teeth thus creating a force to separate them from each other.

Today´s surgery was designed to solve that problem by doing this:
  • Replace the wire that runs across all the brackets of the lower jaw
  • Cutting the upper labial fraenum
  • Placing a gum graft on the open area above the two teeth
  • Installing a small chain or rubber around the brackets of those two teeth to push the together (painful).
So I embarked on this, luckily I was not aware of all the gory details until it was too late hahaha. I am chicken for those things.
I was placed on a horizontal position on the chair of torture and observed him doing all those things until I decided it was better to close my eyes. Some painful anesthetic injections where applied on my palate vault (ouch), very painful, yes, painful.
Then a long procedure started of around 1:15 hours started. First my orthodontist removed the wire that holds the brackets of the lower jaw together (november) and replaced it with a new wire now that the teeth were better aligned. Previously there was a discontinued part where a small wire had to be put because I had a molar that was pushed in between its two neighbours. Now it was more in line -but not totally- and he was able to use a wire frame on the whole length. The opening of the damon bracktets was painful.
In the 2nd part of this procedure the fraenum was cut including the extra gum that was forcing the two upper teeth apart. To protect this open wound above the two teeth and prevent growth of a new fraenum (yes, it always tries to fill up the space) a skin graft had to be placed. For this my palate was scraped to obtain the skin graft from it. I could hear the blade grafting but felt no pain (thanks to the painful injection).
The graft fell down and a new one had to be scraped. The 2nd one installed correctly. Then stitches where applies on the gum above the teeth to keep the graft in place.
A special plastic-like paste was applied to the palate near the molars to cover the open wound from where the skin graft was taken so that my tongue would not cause unnecessary pain and help it heal. To ensure it would remain in place some other stitches were placed on my upper palate to fix it.
Last but not least a small rubber tube size 5 was placed holding the brackets of my two upper front teeth. Thanks to the aneesthetic this time I did not feel much pain when this rubber was applied. This would take care than in this short period the rubber would push both teeth together to close the gap so that they appear as in any normal smile.
My fiancée was shown the results of the surgery while I was still on the chair. I was given a pain killer to swallow and a recipe to have one every 12 hours for 2-3 days.
On the way home I could see my upper lip was swollen as if I had been given a punch. At home someone came to visit and the situation made me smile or laugh and oh my God! what a painful experience, I could feel the stitches nearly coming apart, blood started dripping down my teeth. Ironically my fiancées sisters are very cheerful in their conversations so many times I had to use my fingers to hold my upper lip pressed to keep the pain down and avoid as much as possible break the stitches. Nevertheless, many painful smiles.
I went for lunch which was a painful experience, from now on I would only eat light things because the graft was taken from the side I can actually chew harder objects. Lots of cold drinks to reduce swelling. I started feeling the anesthethic fading away and that burning sensation come to my mouth. Luckily this kind of sensation and pain faded away with the medication.
My orthodontist gave me the "happy" news that I would need some exodental treathment after all. So in June two molars will be extracted from my upper jaw to make some space to fit with the lower jaw. This in turn will delay the orthognatic surgery further 6 months, so about June 2010 instead of December 2009.
The picture on the left shows how it ended up after today´s procedure:
1. Not very easy to see but these are the stitches holding up the graft where the fraenum was cut off.
2. The rubber that pulled the two frontal brackets together to close the gap. It also helped straightening them.
3. The paste covering the wound from which the graft was taken. You can also see the "rope" of the cross-stitching to hold it in place.
4. The actual stitch on the palate. The two front teeth already show quite an improvement.
See Frenillo labial