Adventures in Adult Orthodontics

My life as a 32 year old metal mouth

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Chapter 7. My Dentist is a liar.

My mother once likened giving birth to having the most satisfying bowel movement imaginable. I was five or six years old, so this seemed both mildly terrifying, given my tenuous understanding of anatomy at that age, and quite reasonable, likely due to the tendency of conversations to be disproportionately skewed towards bowel movements for the first several years of any child’s life. As an child, the simile stuck with me because it was gross and relatable. As an adult, it sticks with me because I know childbirth is more accurately described as having a bowel movement while pushing a nine pound human and an internal organ out of the centre of your body in a marothon of agony. So I forgive my mother the trauma and confusion, because that is clearly something that should merely be intimated to a preschooler, and not described in detail.

I cannot forgive my dentist, however, for telling me that wearing braces would feel as if I were pressing as hard as possible on my teeth with my thumb.  He looked me right in the eye and lied through his perfect teeth. Surely his younger patients must need to be spared the trauma of anticipation, but I am clearly an reasonably stable adult, who would have appreciated the warning.

Wearing braces feels nothing like pressing on your teeth, because pressing on your teeth now feels like being punched in the face. A more veracious description would be to say that braces feel as if someone took a pair of plyers to each of my teeth. loosening them just enough so that even air passing over them causes discomfort, and then buried popcorn kernels between them. That my tongue, once strong and confident.is now held prisoner by a phalanx of porcelain guards, each equipped with a tiny spear at the ready should the tongue attempt to escape the confines of my palate for a chance encounter with a morsel of food lodged in the darker recesses of my mouth. What hell is this, to have razor blades glued to my teeth, resting casually against the tender cheek and lips, waiting to slice at the first syllable of speech or spoonful of pureed victuals. That my toothbrush is now more necessary than ever before and also one of the greatest causes of anguish, second only to the chemical burn occurring when toothpaste makes contact with the open sores.

Pressing on your teeth accurately describes the torture that is having your teeth bonded just as much as having a bowel movement accurately describes childbirth. The reality is that orthodontics and childbirth both result in a huge reward at the end of your struggle. That’s not to say that straight teeth and an infant are equal rewards, since they’re clearly not... the infant comes with a lifetime of love and happiness, and the braces with a $6000 bill to pay.

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Chapter 6, wherein I obsessively worry that this isn’t working.

I cannot stop looking at myself in the mirror. Not because I am narcissistic, nor because I am horrified at my new appearance, but because I am waiting for a gap to develop between my front teeth, a sign that my palatal suture has separated. I have been told that this may not happen, as adult sutures sometimes open from the back only, where the hard and soft palates meet on the roof of the mouth. I probe the junction multiple times per day with a finger, and almost constantly with my tongue, trying to gauge whether it is tender because of the expansion or because I keep harassing it. I floss between my front teeth twice a day, trying to convince myself that the contact is ever-so-slightly more open than it was six hours earlier. I press on my teeth, the bridge of my nose and my cheekbones in an attempt to ascertain the presence of discomfort that would indicate successful transfer of force to the suture lines between the facial bones. I search online and read every forum Q&A I can find on the subject of adult palatal expansion, extrapolating strangers’ experiences to fit my own level of pessimism or optimism, depending on the hour. I realize how badly I want to be an adult palatal expansion success story, to single-handedly prove wrong all of those silly orthodontists who think the palatal suture fuses around the initial onset of menses in young women. My palate will be different. My palate will be nymphal, supple and pliable. I turn the expansion key and relish in the discomfort it causes, the headache that results is a sure sign of my gradual accomplishment. I decide to start a blog,

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Chapter 5. For the love of everything holy, get this damn thing out of my mouth!

While the flow of saliva finally starts to ebb, days 3 and 4 come with their own problem; namely, that my teeth feel like they were broken. They ache in the way that a bad cavity aches in the days leading up to a root canal. Biting down causes a sharp pain that feels just like my fractured premolar did. I am unconvinced that I have not irreparably injured myself, no matter how rationally my husband supposes that the dentist would have warned me if the palate expander could spontaneously crack the teeth it is cemented to. I find solace in some heavy-duty (albeit expired) painkillers leftover from my wisdom tooth extraction two years ago. I am back on a liquid diet and have lost three pounds since having the palate expander installed, which I am disturbed by but not in the least upset about. I tell my husband that I cannot possibly live with this thing in my mouth for six months. He makes me a cup of tea, hands me an Advil, and tells me to suck it up... at least until my next appointment.

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Chapter 4. This isn’t funny anymore.

If day one was annoyingly over-lubricated, day two was impossibly so. I went to work at the busy massage therapy clinic that I own and practice at, worried that I would drool on my clients during their treatments, While that did not, in fact, happen, I found myself horribly self-conscious of the frequency and volume of my newly-learned swallowing skills. As hard as I tried to just rest my tongue quietly in my mouth, I couldn’t resist the primal urge to suck on the crossbar that rests across the roof of my mouth like a lozenge. This triggered even more saliva, and a few times throughout the day, I had to bite down on a handkerchief to absorb what I could not swallow. 

Talking proved to be an even bigger challenge, my considerable lisp muddled my speech, and the brackets on the outside of the acrylic, which will later have brace wires attached, mercilessly scraped the insides of my lips and cheeks while I struggled to make myself understood. With three of my five clients that day being new and requiring assessments,  and the other two being chatty regulars, I essentially spoke non-stop for 8 hours. By the time I got home, my face was puffy and swollen, my mouth stung with sores, and I was exhausted. 

My loving husband arrived home from the grocery store with two things that I never thought I would be so happy to see: salmon and Orajel numbing gel. For 48 hours, I had eaten no solid foods. Not yet accustomed to the limitations of biting and swallowing, smoothies and soups were the only thing I could manage, and once my painkillers kicked in and my mouth didn’t hurt as much, I realized that I was starving. I applied the numbing gel to the inside of my cheeks and lips while we made dinner. More saliva, fueled in part by the gel and part by my hunger. I managed to eat one or two ounces of salmon in the time it took my husband to eat his entire meal. Each bite was tentatively pressed between teeth and acrylic before essentially being mashed against the crossbar with my tongue and swallowed whole. I felt simultaneously like a snake swallowing its prey and a dog with peanut butter stuck to the roof of its mouth. I gave up after a while, and opted to get my calories from the better half of a bottle of wine, which offered its own pleasant numbing effect  

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Chapter 3. And so it begins:  my first day with a palate expander.

One week after my initially scheduled installation appointment, I arrived back in the dentist’s office to have the palate expander cemented in. The fit was perfect and the installation a relative breeze, the worst part being the cutting and scraping of excess bonding glue from my gums where it oozed out and immediately hardened. 

The day that my palate expander was installed, I had to tilt my head back to swallow, since the action of sweeping the tongue toward the throat is inhibited by the bar crossing the roof of my mouth. This was further complicated by the excess saliva produced in response to having a foreign object in your mouth. The body assumes that you’re eating and floods the mouth with extra fluid. It takes a few days for it to stop acknowledging the appliance as something to be dissolved and devoured. The first 24 hours or so is a constant battle of trying to relearn to swallow an amount of saliva you’ve never previously had to cope with. I had the day off, and busied myself first with errands and later with a furniture refinishing project at home. Scraping and sanding my coffee table down to its beautiful, original walnut was a two-fold satisfaction: not only did it keep my mind and body occupied, it mimicked my own transformational undertaking. I too, would be restored at the end of my adventure. 

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Chapter 2. Rapid Palate Expansion: The plan, the process, the problems

Upon deciding to proceed with palate expansion, the previously-made molds of my mouth were sent to the lab and a custom appliance formed. The expander is essentially a partial mouth-guard. There are two acrylic wings that each fit over three posterior teeth (two plus the empty space between on the side of the missing premolar). A metal bar that connects them in the center of my mouth is fitted with a barrel-shaped screw. When the screw is turned, the bars push out on the acrylic and the teeth it is cemented to, and the force is, ideally, directed to the centre of the roof of the mouth, along the midline suture of the maxilla. This expansion happens at an approximate rate of 0.25 mm per crank, each crank being one quarter of a full rotation of the barrel. The dentist directed me to activate the expander once each day, and so the rate of expansion is slightly less than 2 mm per week. It is expected that I will activate it daily for approximately one month, until an increase of 8 mm in arch width is accomplished. There is generally some relapse after expansion stops, due to the highly elastic nature of gum tissue, so the initial 8 mm expansion should yield 6 mm of usable space after the teeth resettle. After the expansion phase, the barrel of the appliance is locked, and the expander remains in place for another 4-5 months, allowing for the newly remodeled bone along the suture to solidify.

I was caught a little off guard by the bulkiness of the expander when I went in to have it fitted. My front teeth can no longer make contact with my bottom row, and my tongue cannot rest on the roof of my mouth. This is hugely disruptive, making swallowing, speaking and eating all much more challenging. I am embarrassed to admit that I teared up at the fitting, the reality of having an non-removable expander in my mouth for six straight months setting in for the first time. I composed myself while the dentist performed an uncomfortably long procedure to seal an open contact between two molars, remodeling the edges until a length of dental floss snapped characteristically between the two back teeth. This would ensure that no space remained for food to lodge itself, festering for half of a year while inaccessible because of the acrylic covering. The procedure, which would normally take about 20 minutes, took almost 2 hours. My jaw felt sprained and my gums were bloodied, results of complications due to the position of my upper molar and the limitations of my temporomandibular joint - when my mouth is fully open, the mandible pushes forward and hits the back molar, making it nearly impossible to access. I was dismissed for the day, to allow my mouth to heal before proceeding with the installation of my new torture device. I was simultaneously relieved and dismayed; now that I knew what I was in for, waiting another week to have the palate expander attached felt akin to the childhood agony of waiting for your parents to get home when you know you’ll be in trouble.

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Chapter 1. Extraction vs. Expansion

  I’m not sure what lead me to believe that getting braces would be as simple as walking into the office and asking for them to be installed, but that is certainly not the case. My initial meetings with the orthodontist were intensive assessment sessions. Panoramic and bite-wing X-rays were taken, along with multiple photographs of my teeth, jaw and smile in different positions, all under the same unflattering lighting. My mouth and teeth were measured and remeasured. The fullness of my lips and width of my cheekbones were discussed. Impressions were taken and molds made. A periodontist poked and prodded my tender gums to rule out bone loss and gum disease. I was asked to open and close my jaw until it ached while the dentist palpated the movement of my temporomandibular joint.  When the dentist finally had enough data, I was called back in to the office for another consultation, this time to explain what all the tests had revealed. 

My teeth and gums were deemed healthy enough to proceed, but I was warned of several possible complications, including bone loss, gum recession, tooth collapse, and the potential failure of two previously root-canal treated teeth to budge from their comfortable little sockets, no matter how gently eased by the wires. I was told that the crown I had just spent $1500 on would probably be damaged and need to be replaced after treatment, that I will need veneers to lengthen my upper incisors, and of course, will have to finally get that implant to replace my lost premolar. 

The dentist then presented me with three options in order to make room in my mouth for my teeth to align properly. Either my upper (maxillary) dental arch has to be widened to accommodate my teeth, or there need to be fewer teeth to accommodate. My options were to try a lengthy treatment with thick specialty wires that would slowly expand the arch by pulling the outside surfaces of my teeth toward my cheeks; to use a palatal expander to push my teeth outward and open the midline suture of the hard palate; or to undergo multiple extractions, sacrificing my three remaining premolars to open up space to be occupied. 

With different risks and benefits associated with each treatment, ultimately the choice came down to identifying the best possible outcome that could be achieved, with the fewest complications. Extractions would be simple, but likely to make my small chin look sunken and weaken the appearance of my jawline.  The palate expander is commonly used in children and adolescents, but is not always effective in adults, whose palates are oft believed to be fused after puberty.The wire-only approach would be complicated, slow, and carry a higher risk of the bottom incisors collapsing from the required force. With the advice and input from my dentist, I chose to attempt palatal expansion. In the event that treatment fails to achieve separation of the two halves of the maxilla, we will move on to wire-only expansion, leaving extractions as an absolute last resort.  

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Prologue

     I have always dreamed of having perfectly straight, white, beautiful teeth like the actors in toothpaste commercials. Alas, blessed with neither the genetics nor the total household income for that to be made a reality in my youth, I have spent the past 32 years as an exemplary model of an orthodontic “before” picture. My canines never had quite enough room to descend, my lower teeth are a little snaggled, I have a crossbite and a narrow maxillary arch. You wouldn’t cringe at the sight of my dentition, per se; people don’t stare in horrified wonder at my mouth while I speak, but my smile has been progressively worsening over the last decade or so. An uncrowned root canal led to a fractured, and subsequently extracted, premolar when I was 18 years old. Without the means to have an implant installed in it place, I had no choice but to accept the gap that remained. Fast-forward 15 years, and my crowded teeth have shifted toward the extra space made available. My front teeth no longer line up with the centre of my face - leaving me with a crooked smile to match my crooked teeth. And so, in October 2015, armed with an impressive extended health benefits plan, I met with an orthodontist for the first time.