Orthodontic treatment - 2nd & 3rd adjustments

Orthodontic Treatment - 2nd & 3rd adjustments

I have been a bit (well OK, very) slow in updating on my treatment despite regular nags of encouragement from my wife.  It is fair to say that progress is slow and there didn't seem to be much to write about.  I'm not known for wasting words so I've been silent for a while.

I have my 4th adjustment in a few weeks and so decided that a quick post was in order to bring everything up to date.

In April I moved up to a 18/25 Niti wire on the top and a 016 Stainless steel on the lower arch.  The idea is that the upper wire will open my arch more and level my right hand teeth.  The stainless steel wire is apparently more rigid than Niti and so will open up the lower arch to match the upper arch.  The round wire allows force to be applied to move the teeth both outwards (widening the arch) but also laterally (to continue to close the extraction gaps) without applying the force that effectively tips your teeth forward.  Because of the gaps I still have powerchain LL7-7.  The main drawback of this is a) it seems to attract food and so you get more food stuck in the brace b) it discolours which the pearl ligatures don't seem to.  Its not a big issue since you can rarely see my lower teeth.

  You can see where the top archwire dips from my UR canine onwards which is the cause of my continued inability to get my bite together.

The lower arch is progressing nicely, closing up the gaps, but its slow work.  All my teeth were a bit tender for a couple of days but nothing serious.


In May I was back again for my 3rd adjustment.  The company running my orthodontic practice was sold to a large corporate at the beginning of April and having completed the handover this was my first appointment as a genuine 100% patient (have I mentioned that I was the Finance Director for the group of practices I attend?).  It was an interesting perspective.  I'd never felt particularly stressed before when attending appointments but it was noticeably more relaxed being just a patient and not being involved in any of the general hustle and bustle that is a feature of a busy mixed NHS / private practice.

I was still having difficulty with my bite so I asked how long it would take for this to correct.  You quickly get used to having brackets and wires on and you hardly notice them but I'm getting really impatient for my bite to correct so that I can eat with confidence again.

The news was not what I wanted, 4-6 months!  I'm hoping it will fly by (at the time of writing one month has already passed).  I shouldn't be surprised really, what took a split second to disrupt in my accident took several years to settle down to a manageable state so properly correcting and repairing the damage isn't going to be quick.

Darren decided to keep the same wire on the bottom as it was still working well and changed to top to a 19/25 Niti.  Again, powerchain LL7-7.

Its odd that you don't feel the pressure the wire exerts day to day and when you go into the surgery you can't feel any pressure at all.  Then they take the wire out, to either change or replace with new ligs, and you can suddenly tell the difference and miss the control, all your teeth feel loose.  When the ligs go back on everything feels tightly held in place again.  By the next day you can't feel it again.

You can see the wire still dipping ,y upper right arch and the molars are clashing which is preventing my bite being functional. It changes day to day but this was a particularly bad day as you can see!

What I'm surprised by is the amount of staining on my teeth that has accumulated.  This definitely isn't from lack of cleaning - between inter dental brushed, long bristled brushes for the bracket side of my teeth and around the brackets and a standard brush for the tops and back cleaning is not a 2 minute job twice a day! I'm sure it will all polish out once I have the brackets off finally but that could be 12 months from now.

As I'm more used to having brackets and wire now I alternate between a standard sensitive / whitening toothpaste and the specialist Vitis Orthodontic toothpaste.

Lower arch just closing the gaps slowly.

Patience has never been my strong point but I'm getting more impatient with this now and want to see some improvement in my bite but I must persevere.  You can't rush these things (well you can but I've seen photos of the results - not pretty and require more serious dental intervention to repair).

If you missed the last instalment then you can find it here.  Orthodontic treatment - first adjustment

If you want to go back to the start then its here.   Orthodontic Treatment - the first step on a long journey

Orthodontic treatment - second adjustment

Already I'm feeling an old hand at this brace malarkey.  I've had them for almost three months and apart from the wire pokeing out of the lower buccal tubes and a small amount of discomfort when eating I've had practically no trouble with them.  At Christmas the 15-18 month treatment estimate seemed like a lifetime but now its feeling more manageable.

Middle of March and its time for my second adjustment.  Its fairly routine.  Quick check on how its going, inspection and then a change of wires.  I've gone up to a 16/22 Niti on the top as its apparently time to start opening out the top arch and and 0.016 Niti on the bottom as they are pretty straight now.  Power chain LL7-7 to pull the lower teeth back and close the extraction gaps now that the lower canines are standing up.

Two things are noticable from the latest photos.  The first is that my upper arch seems a lot flatter on the right (left as you look at the picture).  I must check with Darren why this is but it might be as a result of me face-planting the Mendips as this is the side that took the brunt of my landing.

Secondly, the obvious gap between top and bottom arches.  You migth assume that this is jsut the way I'm smiling, slightly open mouthed, but actually this is currently as close as I can get my front teeth.  My rear molars are clamped tight together.  Darren tells me that the L7s on both sides (molar before your wisdon teeth) have tipped up slightly due to the previous power chain pulling on them to straighten the canines.  Its likely that next visit he will have to bond up my L8s (wisdom teeth) in order to straighten this out.

It makes biting anything very difficult and so eating in public somthing to be avoided unless I can use a knife and fork.

My molars were quite sore for a few days after the appointment but all back to normal now.

If you missed my last instalment you can read it here.  Orthodontic Treatment - first adjustment

Orthodontic treatment - first adjustment

Its taken a while to get around to writing about my 2nd appointment which was in January.  This is the first time I'd have had an adjustment so it was still relatively new ground.

Having abstained from anything that might stain the ligatures (you are given quite a list of food and drink to avoid) I decided that since they were gong to be changed anyway I would treat myself to a curry.  Horror stories abound as to how this will ruin the look of your braces but I knew I'd only have to live with them for a couple of days.

I'd not been avoiding tea and coffee (that would be a step too far for me!) and so a small amount  of staining was inevitable but curry was reported to be one of the biggest potential dangers.

I'm not a lover of searingly hot curies but I do like them to be tasty rather than creamy.  Hence my curry of choice for this experiment was a Chicken Jalfrezi.  This threatened to be doubly bad as cooked tomato is also on the list of serious stainers.

I was pleasantly surprised that the damage was minimal.

Apologies for the curry remnants still stuck in the brace (these went once I'd brushed) but you can see that apart from a small amount of yellowing I got away unscathed.  The worst affected was the power chain (both sides between lower 3 & 5) which went quite yellow.

Overall, it doesn't look too bad until you compare it with the new ligs lower down.

This was a shop purchased ready meal curry and, since I've another appointment this week to have my second adjustment, I've recently had a proper restaurant takeaway Chicken balti.  As well as being much nicer it also turned everything a day-glo yellow for 24 hours before subsiding to a similar residual stain.

Anyhow, my opinion is to not worry too much about the food stains, they aren't as bad or as noticeable as you fear when you contemplate a year without your favourite foods.

So, in late January I had my first adjustment.  "Adjustment" conjures up images of tightening and moving etc but in reality all they do is have a look at how its going and change the arch wire for a different size, or in the case of my lower arch, refit the same wire with new ligs and power chain.

I'd been in for a quick 5 minute "emergency appointment" to have the lower wire trimmed as it was sticking out of the back and the end was incredibly sharp and uncomfortable.  Literally a 2 minute procedure and instant relief.

The Vitis orthodontic products had continued to give relief and in stark comparison with my wife's experience I had suffered from no mouth ulcers at all even when teh wire was protruding and catching on my cheek.  I can't guarantee it was etirely down teo the Vitis products but I believe it certainly helped a lot.

My top arch went up to a 0.16 NiTi but, as I say, the lower arch was deemed to be still able to benefit from the original 0.14 NiTi so it was refitted.

It was a new experience as when the first arch wires were fitted I had been completely numb from the extractions 5 minutes before.  It didn't hurt as such but you can feel the orthodontist pulling on the lig to stretch it over the bracket.  Once its done all of your teeth feel tightly tied in, surprisingly even the ones where the wire wasn't changed.

Power chain was again attached LL3-7 to try to stand my canines up and move them back into the space left by the extraction.  I had hoped they'd be there by now but that is just my over optimistic impatience.  Darren wasn't expecting that and said they were on track.

Shiny new ligs and power chain and a new upper arch wire.  All set for another 6 weeks but the difference is showing already.

If you missed the previous blog you can read it here.  Three weeks in and I'm getting used to them

Three weeks in and I'm just getting used to them now..

Three weeks and one day ago I had my braces fitted (see Orthodontic treatment the first step on a long journey for the first instalment) and I'm just starting to get used to them.

I didn't have a picture of my two extracted teeth when I posted before so here they are.  For some reason I didn't want to give them up.  I'm not sure what the gong rate with the Tooth Fairy is nowadays anyway.

By Christmas day I was able to chew "normal" food (nothing too hard or challenging but Christmas Dinner was fine) but couldn't bite as that was still quite painful.  On Boxing Day we visited my parents and after dinner I tried to bite a Crispbread cheese cracker which I thought would just crumble or crack at the slightest pressure (they do when you try to butter them!).  It didn't give and I needed to apply more and more pressure.  By the time it gave in I was very close to tears, it was THAT painful.  Boy, I wasn't going to try that again in a hurry.

Keeping everything clean is getting easier.  Cleaning before bed is still a 10 minute job but I'm less stressed about food getting caught up and having to clean thoroughly after every meal.

As I said previously, I've had an easy run with rubbing brackets.  I stopped the salt mouthwashes after a week because the extraction sites had healed and still no ulcers.  The SmileSuite (the practice treating me) has started recommending Vitis oral hygiene products which contain (alongside the usual fluoride levels) Allantoin which promotes soft tissue repair and Aloe Vera which soothes inflammation.  I don't have a control case to compare with (I have never had a brace and not used these products) so can't attribute conclusively to these products but I feel they must be helping.  A good test will be when my wife starts using them as she is still suffering from ulcers and discomfort 3 months in.

Whilst I haven't been ridiculous I haven't been that restrictive with my meals after the first week of soup and mashed potato.  I've had proper meals, drunk tea and coffee, even red wine and my ligs still look reasonably clean.  The first curry will be a test but if it stains the ligs then I can live with that until the next check up.

Last night I had takaway pizza without using a knife and fork.  After the Boxing Day cheese cracker incident I had been trying to avoid biting anything but I decided that I had to push myself.  I was slower than I was pre-brace (but that's no bad thing) but I managed to eat a whole pizza without resorting to cutting it into mouth sized bits.  Pizza crust is on the "avoid" list of foods but this was quite soft so I risked it and survived.

Teeth are apparently supposed to move (under treatment) 1mm per month.  I understand though that initial rotating and levelling can be quicker as it involves less root movement through the jaw.  From the pictures below you can see that after 3 weeks my upper teeth are slightly straighter and the upper left incisor that was set back has pulled forward.  On the lower jaw the incisors are much straighter and an even height and they are more upright.  I think the only thing stopping them moving into a perfect line is the canines which have not moved very much at all.  They have quite a way to go.

I still have three weeks to go before my first check up and adjustment but it seems to be going OK.  I'm feeling pretty bored of having them on now but its an inconvenience rather than being painful and I keep telling myself it will be worth it.  There's already an improvement in my bite which is a help when motivation wanes.

If you missed teh start of the story you can see it here.  Orthodontic treatment - the start of a journey

Orthodontic treatment - the first step on a long journey

I suppose my collision course with Orthodontics started back in May 2005 with a freak accident but its taken until 2012 to get this far.  I'm probably not a typical case for braces as I don't care enough about my teeth's appearance to have treatment and yet here I am.

My teeth have never been that bad.  My top arch, whilst not perfect (in a Hollywood sense) is better than many peoples with balanced, reasonably straight teeth.  My bottom arch has always been crowded and the teeth crooked but it didn't bother me at all.

When I was growing up, in the 70's and 80's, the only kids wearing braces were the ones with truly terrible teeth and as such were quite rare and mercilessly teased at school by those whose natural good looks made them feel superior.  Short, tubby and bespectacled from age 5 but with reasonable teeth I fitted into neither group.

Anyhow, I'd accepted my dental lot years ago and didn't spare it a thought.  In May 2005 I took part in a charity mountain biking event in the Mendips called "Clic 24" in aid of Clic Sargent, a charity which supports the families of children with cancer.  It is fair to say that it wasn't a charity close to my heart (although I have taken part in other fundraising events for them since) with my interest being in the mountain biking more than the fund raising.  I did however easily exceed the minimum fund raising target for entry.  If something is worth doing its worth doing well.

As part of a team of four I had three much fitter and capable companions.  The aim is to complete as many laps of a 10 mile cross country course as possible in 24 hours.  Considering the athletic prowess of my friends I suggested I go fourth in our relay team with the aim of potentially doing fewer laps and holding the others up less.  In true gentleman fashion they agreed without argument "if I felt that was fair" but we've been friends long enough to know that they had been thinking along the same lines.

Three laps down and it was my turn to go.  The course was close to my home in Bristol so I had trained on it and knew it quite well.  It would obviously be a different challenge with all the other bikers there as well but I wasn't fazed.  From here on I only have one memory.  I passed a young lady on the first climb and offered her some encouragement as she pushed her bike up the rather steep incline.  Next thing I remember clearly is the day they released me from hospital, I had to prove I could get up a flight of stairs unaided before they would discharge me.  That was four days later.

On a downhill section of the course I'd come off.  An eye witness said that the front wheel seemed to buckle under me and I flew over the handlebars landing face down on some rocky ground.  I was still not moving when that witness made it to me although by the time the Air Ambulance had arrived I was screaming loudly, apparently.

Four days on a neuro ward in Frenchay, I'd smashed my face quite well, stitches in my eyebrow, fractured right orbital, and I'd stripped the flesh and skin off a large portion of my right knee.  Despite this it was the serious cerebral contusion that had kept me in hospital.

I was in quite a lot of pain, that much I remember from my first days at home, and my teeth were quite painful.  My jaws also weren't parallel meaning I couldn't get my teeth together.  Despite it being the case at several follow up out patient appointments the maxfax consultant put it down to bruising and assured me it would be fine.

The bruising persisted and the situation didn't improve so I asked my dentist to refer me to the Dental Hospital which he did.  By this time I was getting some discomfort in my jaw joint due to the misalignment.  After several visits the consultants at the Dental Hospital concluded that my jaw was misaligned and the three potential treatments were

1. Break my jaw again and try to get it to heal closer to the correct position.  They told me that the margin of error was greater than my current misalignment though.
2. Grind down my teeth where they were meeting until all my teeth met.
3. Do nothing and hope it fixed itself.

Being more than a little phobic about hospitals at the best of times and  getting no reassurance that options 1 or 2 would work I opted for 3.

Over the next few years it did settle down and I vowed to just get on with life putting it down as one of those things.  As time went by my lower teeth got more crooked and started overlapping, one in particular was heading backward significantly and they began resembling old tombstones.  My top teeth were also starting to move but it still didn't bother me that much.  I was getting more pain and discomfort from my jaw joint but accepted that there was nothing that could be done.

In January 2011 chance had me starting a job with Darren and Lynne Hills, the owners of a number of orthodontic practices.  They were growing, incorporating and becoming more corporate and in need of an FD.

At first I thought that it might be a bit like Ugly Betty of the Dental world and I'd stand out because everyone else would have perfect teeth but I was relieved when it was nothing like that.  It was probably another 18 months or so before fate get me another gentle prod, although not directly.

My wife had a routine trip to the dentist and he had no nurse that day so she couldn't have her usual scale and polish.  We have a hygienist who works part time with us so I suggested that she pop in and see her for a quick clean up.

Apparently its not quite as simple as that and my wife had to have a quick appointment with Darren first to "prescribe" the scale and polish.  My wife is terrified of dentists but Darren put her at ease and even managed to broach the subject of treatment.  Rachel has always been unhappy with her teeth but didn't agree to anything.

It took several months for Rachel to decide that she'd have treatment and partly due to her fear of dentists and partly out of an interest to see what our company actually did I accompanied her to her initial appointments.  Whilst she was out of the room having x-rays and photos Darren and I naturally started talking about whether I would ever have treatment.  I outlined my history as above, not caring that greatly the aesthetics but concerned a little about discomfort and functionality going forwards.  To my surprise Darren said he could do something about that.

After a proper consultation Darren said that he would ideally like to extract 4 teeth, 2 top 2 bottom, to make room for the required movement.  He couldn't tell from my x-rays but in his opinion I probably broke my bottom jaw in 1 or 2 places as well as by cheekbone / eye socket  and that would explain the problem with my teeth.

I was very reluctant to have any teeth out since I was quite proud to still have 32 but eventually we compromised and agreed on losing the lower 4's on each side, the first premolars.

With Christmas approaching and little time for multiple appointments with different dentists Darren agreed to do the extractions at the same time as the initial bond up.  Rachel thought I was mad but my theory was to get it all out of the way at the same time.

Prior to bond up I had a thorough clean with the practice hygienist.  It was the most thorough clean I'd ever had and felt like I ought to be noticeably lighter after all the scraping and polishing!

The day finally came, 21 December.  Darren bonded the brackets first and then extracted the two teeth.  The anaesthetic numbed the whole bottom jaw and I didn't feel a thing.  It took a matter of seconds for each tooth.

Wires went on once the bleeding had stopped.  014 Niti for the first period.  I could immediately feel the pulling on my teeth even though the anaesthetic hadn't worn off yet.  After a couple of hours feeling was almost back in my face and it was surprisingly pain free.

Over the next few days my teeth became progressively more uncomfortable, best described a bruised gums, only sore when eating.  After every meal I had to have salt mouthwashes to help the healing of the extraction holes.  Whether due to the salt washes, the shape of my mouth or the location of my teeth I've not had to use wax so far as the brackets are not rubbing.  Occasionally I feel them but nothing too serious.

I think I've had it quite easy so far but it still feels like the first steps on  a very long journey which I'm hoping will go quicker once I can eat without thinking about it.