The frankel appliance had been hell for Ellie and she was grateful to get rid of it. Everytime she spoke, it moved around in her mouth and hurt her jaw.
John had informed Ellie and Jessica on Friday that after the weekend, she would be getting a new appliance. When Ellie had asked what it was, John simply replied “exactly the same as the treatment plan I laid out to you many months ago”
Jessica smirked but Ellie couldn’t remember so she sighed, knowing she was in for a surprise.
On Monday morning, when Jessica dropped Ellie off – she called down the corridor “see you with your van beek on Friday honey!”
Ellie forced a smile and nodded. A van beek – she wished Jessica had told her that earlier so she could have googled it over the weekend.
As John led her down to the chair, Ellie asked him tentatively “what is the van beek?”
John smiled at her “a magnificent appliance to help your overjet. Now obviously because you are older, we don’t know how much difference it will make – but that’s all part of the learning isn’t it?!”
It didn’t really answer her question but hearing it might be unnecessary anyway just angered Ellie.
John sat her down, clipping a bib over her chest, he chucked “you might want to keep this on later!” Ellie wasn’t sure what he meant but smiled politely – not wanting to anger the men.
The new trainees filed in and Ellie smiled awkwardly at them all.
John had them crowd round the chair as he laid Ellie down
“alright Ellie – you’re well practiced at this now, lip spreader in…”
She opened her mouth – allowing him to insert the lip spreader. John had Ellie open and close, he turned to the trainee’s “you see her pronounced overjet?”
They all nodded and hummed, john continued “well Ellie gets her new appliance to deal with this today. She is getting her van beek”
Ellie could swear a couple of them had a shocked expression but they returned to normal so quickly she couldn’t be sure.
John held it up proudly for Ellie to see, her own eyes widened “I have to wear that?!”
John nodded proudly “hopefully for only 5-6 months…”
Ellie’s cheeks burned red as he made her open her mouth wide and slipped it in.
She could immediately feel the metal facebow arms poking out. John slipped it out quickly and made a couple of adjustments.
John turned on the camera – filming his webinar - making sure the camera was trained on Ellie’s face. He held the appliance in front of her face – giving a clear view of the monstrosity.
John looked up at the trainees “This is a van beek activator – it is a monobloc activator with facebow arms for extra oral traction which helps to reduce an overjet.”
They all looked at her with sympathy.
John spoke up again “ This activator will help to strengthen the muscles attached to Ellie’s lower jaw – she will likely have some muscle pain while they adapt – like training muscles at the gym but over time they will adapt and grow strong then I won’t hurt and the jaw will be held in a better position.” The trainees all nodded along again.
John tapped Ellie’s chin “open up”, Ellie did as she was told and john slipped it in. Somehow the camera capturing this was even more embarrassing and Ellie had to focus on one spot on the ceiling to stop herself crying.
John’s voice was smug “ Usually the van beek has a wear time of 14 hours but Ellie here will be 24 hours as we need to try and maximise any jaw growth we have left”
John pointed out the features of the appliance – since Ellie had the lip spreaders in, she hadn’t felt it fully for herself yet and listening to John ramble just increased her anxiety.
“Now you can see this appliance covers the front teeth but there is a small hole Ellie will breathe out of. Ellie’s palate here is slightly thicker than normal to address the tongue thrust early on in her treatment journey. We have also added extra acrylic above the teeth over the gums so Ellie’s appliance goes right up to her upper and lower lips – you can see from the front all teeth and tissue is covered. “ Ellie’s eyes widened as she heard this – knowing it was going to be more of a nightmare to wear than her frankel.
Joh continued speaking to the camera “The aim of this extra material is to stop Ellie from pressure her lips onto the facebow and changing the traction.”
At that moment, a trail of spit dribbled down Ellie’s chin and she wanted the ground to open up and swallow her. A trainee dabbed it gently before it dripped further. John removed the lip spreaders.
John used that opportunity to explain “You can see here Ellie is unable to closer her mouth and lips – this is a big adjustment but she will get used to it eventually. The main issue is one you’ve just witnessed – increased saliva production. It’s important to remind patients not to slurp – just swallow their saliva to train their muscles. The second problem patients encounter is speech – this may be even more challenging for Ellie due to the extra acrylic and it’s likely this will be for the entirety of treatment but for more patients as they don’t wear the appliance full time – it won't be a huge issue.”
John attached the high pull straps – a neon pink – and address the camera for the final time “the facebows and straps help to hold this in place in addition to the patients bite. Now how is it Ellie?”
Despite what John said, Ellie slurped her saliva back “ahh, eeesss ok”
John looked at her “it’s ok?” she nodded – of course it wasn’t but she couldn’t admit that on camera. He turned back “there you have it – despite how it looks, it’s a comfortable appliance and gets great results!”
As Ellie sat there, all the trainees looked at her, a slightly shell shocked expression on their faces. John smirked at her “it’s a lot to get used to Ellie, but it’ll be worth it to get that perfect smile. Like I said 24/7 wear – except of course eating and brushing. Same rules apply – nurses will take it in and out, Jessica will do it for you at weekends. We will see you back in the chair tomorrow! But first – let’s get some updated photos…”
He forced Ellie to smile, showing off the luminous pink acrylic that took over her mouth. She asked for a mirror and when he passed it to her, she almost fainted. Her jaw was being held open about 2cm, her lips nowhere near touched – she had saliva dripping down her chin and the headgear straps were messing up her hair. She cried immediately – begging him to change it but John smirked – “it’s the compliance programme, you had your chance with easy appliances – you couldn’t do it so we are starting from the basics. Now, I am worried about those lip pads rubbing, I am going to have you take a seat in the waiting room and I’ll check on you in an hour or so. Ellie’s eyes widened and she pointed to the appliance, “like thith?”
John smiled, “it’s full time wear – everyone is going to see you soon anyway!”
She didn’t know what he meant but she sat up, trying to stop the tears from flowing. The more the cried, the more she dribbled and she used her sleeve to wipe her chin. John handed her a tissue with a smirk on his face “I told you that it would be handy to have the bib – shall we leave it on?”
Ellie looked down, seeing the drool soaked bib and shook her head – too embarrassed – she kept the tissue pressed to her chin as she walked out.
There were quite a few patients in the waiting room and her new appliance gathered a lot of attention. Her eyes were red from crying and her slurping interrupted the silence. She heard a mother say to her daughter “see? You’ll end up like that if you don’t wear your appliance properly – you know John will do it!”
Ellie’s face flushed red with embarrassment as she dabbed her chin again, trying to pretend she hadn’t heard the cruel words.
After about 90 minutes, John came back out. Ellie stood up – expecting to follow him back to an exam room but he waved his hand “oh just stay sitting there, a quick check – no need to come back”
He parted her lips, checking the acrylic on the gum tissue – feeling around. Ellie glanced around the room, all eyes were on her and her eyes welled with tears again.
After around 30 seconds, John announced loudly “that looks great! Right – remember no trying to cheat – I always know!” the other patients looked down, trying to pretend they hadn’t heard but Ellie nodded.
John smiled “see you tomorrow!”
Ellie trudged back to the ward, all the nurses eyes widened as they saw her. She sat on her bed and cried, looking in her phone mirror at her horrendous appearance now.
After an hour or so of crying, she couldn’t bare it anymore and took the appliance out – setting it back in its box.
Soon a nurse came by, glaring at her – “you know the rules, appliance in”
Ellie grumbled “it hurts so much!”
The nurse sighed “I can get you some pain relief – but it needs to go back in”
Ellie argued she couldn’t yet. The nurse rolled her eyes “you’re going to make it so much worse for yourself!”
Ellie scoffed “worse? How can it get wose than this? I can’t speak, I am drooling, my teeth are covered in plastic and I have metal bars poking out my mouth with neon pink straps. IT CAN’T GET WORSE”
The nurse shrugged, mumbling “on your head be it”
10 minutes later, John stormed up to the ward, a package in his hand.
He held out the appliance and Ellie took it, nervous of the repercussion.
He sighed “I don’t want to have to punish you Ellie…you’re not a child. But you were warned. He pulled out new headgear straps, interlandi headgear – still neon pink but MUCH larger than before.
Ellie cried as he attached it – begging to be put back in the old one – this had plastic all in front of her ears and was uncomfortable. John stopped her “I cannot understand you Ellie. You need to stick to this for 2 weeks, then we will consider going back. Actually your speech is terrible – we will have you read out loud to the team daily to check your progress”
Ellie nodded glumly, not able to protest. Just as he was walking away – John smiled “thanks for the promo!”
Ellie was unsure what he meant but a few minutes later her phone buzzed – John’s orthodontic practice had tagged her in a post. It was the video and photos of her with the new appliance ON FACEBOOK for everyone to see. She nearly untagged herself then realised there would be more punishment so she turned her phone off, ready to ignore the world.
She laid down, crying again – fearing the weekend with Jessica and her bright ideas – she betted Jessica would make her go out the house this weekend and the dread was building already.