Story
I started treatment in my 20s with a 17mm overjet and lots of crowding, with some teeth overlapping and sideways. My front teeth stuck out and my side teeth pushed in and my mouth was very narrow. I disliked how my profile looked from the side because my jaw and chin were not distinct. The first orthodontist I saw said I needed jaw surgery. I saw another orthodontist to get another opinion. After walking in, I was greeted and xrays and photos were taken.
Dr. Angie greeted me and after a consultation said: "you have quite a severe overbite and overjet. In most cases, I would say we need to do surgery, however, I know you are very hesitant about surgery, and I think we can correct a lot of your issues with appliances. You have a deficient lower jaw because your low jaw is too far back. This is causing TMJ issues, sleep apnea, and affects your facial profile, giving you a lack of a defined jawline and no chin. We need to move your lower jaw forward to correct your bite and improve your facial profile while pulling in the overjet. You also have a tongue thrusting and sucking habit that has led to a lot of your orthodontic problems and we need to correct your tongue thrust. Your lower lip sometimes gets stuck under your front teeth, creating a lip sucking habit."
I began partial braces and a lower lip bumper for the first six months. It wasn't too bad, just a bit sore and the lip bumper was sorta bulky, and I had to bring my lower lip around it.
Then my dentist extracted two upper teeth. My orthodontist said we couldn't extract any on the bottom because of my lower jaw deficiency and she didn't want to take away any more bone structure. She said we would use expansion on the bottom.
After the extractions, I went back to my orthodontist. She took impressions and put on full upper and lower braces. She said I would come back in 2 weeks to get the twin blocks and the rest of my appliances
Two weeks later I came back for the twin blocks. She brought out two retainer type pieces with plastic blocks on the sides and stuff in the middle that I didn't get a good look at.
Dr Angie: "Ok, now open up real wide. I'm going to place the twin blocks." She placed a lip and tongue retractor in my mouth to insert the twin blocks.
I felt a lot of pressure. She pushed really hard and the top piece of the twin block clicked tightly in the roof of my mouth. I felt pain radiate. She pressed more and took a tool and bent a few wires to adjust it and pressed it harder. She then did the same with the bottom piece. She removed the retractors.
Dr Angie: "Ok, close your mouth to make sure I've positioned these correctly."
I tried to close my mouth and found that I couldn't. My jaw had to go way forward until the blocks met, but my mouth was still open an inch. When my jaw wasn't far forward, my mouth was wide open. I tried to push my tongue forward but it hit a huge metal piece that hung down and also hit something in the roof of my mouth.
Dr Angie: "Open up again."
She took a wire and wired the blocks to my bands.
Dr. Angie: "These are normally removable. Yours might be eventually. But everyone finds the first weeks and months to be the most difficult, so I am making yours not removable until you've adjusted. There are two expanders that you will turn with a key every other day. There is also a tongue crib appliance built into your upper twin block to address your thumb sucking and tongue thrust habit. It will keep your tongue back behind your front teeth and you'll have to learn to speak and swallow with your tongue in that position.
During this time, I wasn't able to swallow and started drooling. She said I will learn to swallow and placed a suction in my mouth that I held.
She walked away and came back with a bent metal piece and a black strap.
Dr Angie: "We're also starting you with headgear to hold back your molars because of the extractions and to help pull in your overjet and overbite."
She inserted the metal part to my back molar bands. Took it out and bent it and adjusted it and put it back. Then she placed the back cap around the top of my head and another piece around the back of my head, attaching it to the metal piece. I felt a lot of pressure. She pulled on it a little to make sure it felt like it was snug. She then showed me how to take it on and off and I practiced.
Dr. Angie: "Now it is important that you wear this 16 hours a day. You can wear it more if you'd like. But not less than 16. How does it all feel?"
I shrugged my shoulders and tried to speak: "I fewlth weawy o an isth har o thpeak."
Dr. Angie: "Your speech will be difficult for the first several weeks. That and eating are the most difficult things for patients to adjust to, but you will eventually. It's normal to have difficulty speaking with lisping and hissing speech and excess saliva."
Me: "I can't cloth my mowth."
Dr. Angie: "You'll get used to that and it will be easier to close over time. Keep your teeth together in the blocks when you speak and at all times to make it easier. I am going to set you up with a speech therapist to help with adjusting to the appliances and addressing the tongue thrust so that you relearn to swallow and speak with your tongue in a new position."
She handed me a mirror and showed me a view of my jaw from the side in the twin blocks. My jaw and face look much better with my teeth in the appliance,
Dr. Angie: "You have a more distinct jawline with the appliances. We will need to reactivate the twin blocks later to bring your jaw further forward. You may get more of a chin, but we can also discuss the option of a genioplasty or chin implant if you want more of a chin after treatment."
Me: "he tongue cwib..."
Dr. Angie "...hold your teeth together in the blocks when you speak."
Me: "he tongue cwib feewlth lie i hangth dow oo low. I ca thpeak o tush my teeth."
Dr. Angie: "That's where it needs to be to be effective with your teeth in the blocks."
I began to take out my headgear.
Dr. Angie: "No, that needs to stay in. You must wear at all times while at the office."
I got up to leave and felt myself blush as others saw me and I walked to the front counter to check out.
Receptionist: "Ms. Smith?"
Me: nods
Receptionist: "Dr. Angie would like to see you back next week to activate your expanders. Do you prefer a morning or afternoon?"
Me: "aghfternoo"
Receptionist: "I can do Wednesday the 10th at 4 or Thursday the 11th at 3:30 or 4:30."
Me: "hurthay at reethirdy"
Receptionist: "Thursday at 3:30?"
Me: nods
Receptionist: "It looks like Dr. Angie is setting you up with a speech therapist too. I called and she has an appointment tomorrow if you could make that at 2:00."
Me: nods
Dr. Angie walks back over. Ellen is really great. I have told her and also want you to know that in speech therapy, I want you to wear your headgear to all appointments. She will be working with you on adjusting to the headgear too, so it's really important to wear.
Receptionist: "And is the 123 number the best one to reach you at?"
Me: "Ashually, i shanget" slurp
"I go a new number"
"Ith one-two-thwee, five-stheben-thicth-eicth"
Receptionist: "I'm sorry, I didn't catch all of that"
123-5?
Me: "Stheben" slurp
The receptionist looked confused
7?
Me: nods
"thicth"
Receptionist: 6?
Me: nods
"eicth"
Receptionist: I'm sorry, what was that?
I hold up 8 fingers. My face had turned bright red by then.
Me: "I'm thorry, I have a lo of new applianthes."
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The next day, I had my first speech therapy appointment. I debated wearing my headgear, but decided to do it. It was still tight from the adjustments and I didn't know if I could get it out. My mouth was aching. I could feel people looking at me. I walked to the reception desk.
Receptionist: name?
Me: "Alith Thmith"
Receptionist: "Ah, yes, Dr. Angie's office called yesterday for your appointment. Here's some paperwork to fill out."
After a while, my speech therapist, Ellen, came out to get me.
Ellen: "Hello, you must be Alice."
Me: "yeah"
Ellen: "I talked to Dr. Angie. It looks like you have some new appliances right now and are tying to get adjusted to them? We are also looking at a tongue thrust to correct? I'm glad you wore your headgear. A lot of patients aren't compliant on that, but Dr. Angie insists and I do my best to encourage headgear to be worn. So let's see. You are in braces and Dr. Angie installed a twin block appliance yesterday, is that right? It has upper and lower expanders and an upper tongue crib. And you also got headgear."
Me: nods
Ellen: "So we will be doing a lot of speaking. It's important to practice and talk as confidently as you can. You have to practice. So we are going to jump right in. We will also practice swallowing and eating too, as you have to get used to eating with the twin blocks in. It's normal to have a very difficult time speaking and eating at first, so we will practice."
I had my follow-up orthodontic appointment the next week. After checking in, Dr. Angie greeted me.
Dr. Angie: "How's the first week been?"
Me: "har" slurp
Dr. Angie: "It always is but you will adjust. Have you been wearing your headgear?"
Me: "A wil. May thee houwth a ay."
Dr. Angie: "I know it's a lot to adjust to, but you need to be wearing it a lot more than that. It must be in for 16 hours a day."
She activated my expanders and I felt a sharp tightness. I scheduled my next appointment for the following month.
When I left the receptionist, I tried to go to the bathroom to take my headgear out, so I could get on with my day, but it was so tight I couldn't get it out. I went back to the receptionist desk.
Me: "I'm thorry, but I can't ge my headgeaw out. Ith oo tight"
Assistant: "Let me get Dr. Angie."
A few min later, Dr. Angie comes out.
Dr. Angie: "Your headgear should stay in for the next 18 hours. After activating the expander, it will be tight and you won't be able to get it out. It's important to get used to it."
--------------
My next orthodontic appointment arrived. The first month with the twin blocks was extremely difficult but I adjusted some to holding my jaw in the appliances. I still had difficulty speaking, and I had a large lisp around many words and a hissing sound when I speak, but my speech had improved some. I have had a hard time wearing my headgear. It is painful, and I maybe wear it about 4 hours a day.
Dr. Angie: "I'm glad to see you have you headgear in."
She begins examining me.
"How often do you wear your headgear?"
Me: "Well, maybe fowh howth a day."
Dr. Angie looked at me. "That's not enough. It needs to be in 16-18 hours a day. Every hour you miss, you have to make up. Your molars are shifting and the teeth are shifting forward at the places of the extractions. Your canines and front teeth are also moving further forward. The headgear is essential. It will get easier to wear as you get used to it."
She took out my facebow, made some adjustments, and replaced it. It fit snugly. When she reattached the strip, I felt pressure.
Dr. Angie: "It also looks like you sleep with your mouth open. I'm concerned your teeth are not closed in the blocks at night."
She walked away and came back with a facebow that had a hook on the front.
Dr. Angie: "I am going to fit you with a second facebow that you will wear at night for a total of 10 hours a day. You need to total 16-18 hours a day with your headgear to address your overjet and overbite. If you were to wear the facebow with the hook all the time, you can. But otherwise, you need to wear the other facebow the remaining time to make up your hours."
She placed the new facebow. Took it out and bent it. Then replaced it. It fit snugly. She then had me bite in the twin blocks and attached a very thick and tight elastic from the hook in the front of the facebow to hooks on my bottom braces. She took it out and said she was also putting in a lower lip bumper to help move back my lower molars and make space. She placed it, and it was hard to get my lower lip around. Then she activated my expanders, and I felt a tight sensation. She said she was also starting me with two elastics, one in a tight triangle on each side to try to help with some of the movement that had occurred from not wearing my headgear and to address the overjet. She then hooked the tight elastic from the facebow to my lower braces. With the elastics and that elastic, I could hardly open my mouth, it was so tight.
I wore the new facebow to speech therapy later that afternoon. I could feel people staring at me in the waiting room. Ellen came out to get me and greeted me with a smile.
Ellen: "I see you have a new part of your headgear and also a new lip bumper and elastics. Dr. Angie called and updated me on your treatment. It's really important to wear your headgear the recommended amount of time. She wants me to start checking your headgear wear on your time chart at our appointments. I understand that your new facebow needs to be worn all night for a total of 10 hours a day and your other facebow can be worn the other 6-8 hours if you prefer. But you need to total 16-18 hours of wear a day. 18 would be better to make up for the time you've missed. Your molars have started moving, so you now have elastics too that need to be worn all the time except when you eat."
I tried to bring my lower lip around the lip bumper and was able to for a minute, but it fell back down. Dr. Angie had said it would take time for my lip to close around it. I still wasn't sure how to hold my lip with the new facebow and elastic in the middle. I showed her my new elastics.
Ellen: "You need to wear your elastics during our appointment unless you're eating."
The headgear was hurting a lot by that point. I had taken some advil but it was very sore.
Me: "Wif he elathith and new heagea, I can't open my mowf at all."
Ellen: "We've talked about how it's important for you to speak with your teeth together in the blocks and with your tongue behind the tongue crib, so this is actually forcing you to do what we've been practicing."
Me: "He ton cwib felwth lie ith in he way. I can't ge my ton awon it."
Ellen: "Your tongue is supposed to stay behind the crib. Now with the elastics, it is kept entirely behind the crib and you can learn to speak with your tongue in a new position. It is important to note that because of your tongue crib and blocks there are some sounds like s, sh, ch, z, j sounds, you won't be able to say as long as you have these appliances. We practice them so you can get used to the altered versions in your speech. I have a list of common words with these sounds that you can practice to get used to saying the word so it can be understood, even when you can't say a certain part of it. There are some other sounds and words, like t, d, n, l that are very difficult for you to say and that you won't be able to say perfectly with the crib and blocks but that with practice, you can improve. It's important that you get used to your tongue hitting the roof of your mouth instead of your teeth. When your tongue crib is eventually removed in it sounds like a year or so, we will work on relearning to position your tongue to say these sounds properly. Your tongue thrust and thumb sucking habit were so severe that the tongue crib is a necessary intervention to make sure the habit is broken."
Me: "My heagea and elathith hurth a lo now."
Ellen: "You've taken advil for pain?"
Me: "Yeah"
Ellen: "The pain will go away as you adjust to the new headgear and elastics, which is probably about 24 -48 hours and I think it would be best to try to leave it all in for that period to help yourself adjust. I'd recommend drinking smoothies during this time and maybe eating some soft food if you can."
She got a drink with a straw.
Ellen: "Let's practice your drinking this with a straw."
I unsteadily inserted the straw in my mouth and tried to make a suction and drink. Water went down my chin and face. I kept practicing and was able to drink some.
We practiced some of our normal conversations that we always do. Ellen wants me to try to speak with confidence.
Ellen: "Don't resist the appliances. Let you teeth be in the blocks. Let your tongue be behind the tongue crib. Let it be stopped by the crib. Don't try to come around it. That will cut your tongue. Accept that you can't say "s, sh, ch, th, z, and j." Allow yourself to say an altered version. Let yourself have a lisp. Then your speech will actually flow better. Also, with your teeth together in the blocks, work to speak slowly and enunciate. By practicing even the sounds you can't say, when you're speaking and the word comes up, you can say your version and it doesn't disrupt my sentence as much. Your speech will improve as you practice more."
After we finished, I walked to the receptionist desk.
Receptionist: "Ellen wants to see you again this week. Would Friday work?"
I nod.
Receptionist: "I have a 2:30 or 3:30."
Me: "Thee-thirty ith good"
Receptionist: "Do you have insurance that we are using?"
Me: nods and looks for my card
"I lef my card at home."
Receptionist: "We can get it next time. I don't think we have a good phone number for you in here."
Me: ""Ith one-two-thwee, five-stheben-thicth-eicth"
Receptionist: "1-2-3-5-7 what?"
Me: I hold up six fingers, "thicth" and then hold up eight fingers, "eicth"
My face was turning red again.
Receptionist: Got it. Thank you. We'll see you Friday at 3:30.
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At home, I call my sister.
Me: "Hey, wou you be able o go o he thore and get me thom thuff to make a thoomthie. My mowf ith hurting and I am not thoppothed o take ou my elathith for two dayth. I altho don want o go becath I have my heagea in and don't want anyone o thee me."
Becca: "Alice, I'm so sorry to hear you are in pain. I didn't realize you got more appliances. I wish I could go for you but this is the weekend I went on my trip that I told you about. I won't be back until Sunday."
I groan.
Becca: "I bet you could just go to the store. Put on a beanie and I bet no one will see you. Or go to the drive-in for a smoothie."
I decided to go to the drive-in. I drove up and tried to order.
Drive-in: "How can I help you?"
Me: "I'll take one peath thoomthie"
Drive-in: "Sorry, I didn't catch that."
Me: "A peath thoomthie"
Drive-in: silence. I can't understand you.
Me: more slowly and enunciating more: "A peath thoomthie"
Drive-in: "A smoothie?"
Me: "Yeah, peath"
Drive-in: "Peach?"
Me: "Yeah"
Drive-in: "Is that all?"
Me: "Altho thum tomato thoup"
Drive-in: "Tomato soup?"
Me: "Yeah"
Drive-in: "Is that all?"
Me: "Yeah"
When I drove around to the window, I could see the person staring at my headgear and elastic attached to the new facebow. I took the food and drove off.
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Back at speech therapy on Friday.
Ellen: "Hi Alice. I'm really glad to see you are wearing your new headgear with elastic and your elastics. How has your headgear and elastic wear been the past few days? Did you bring your timesheet?"
I pulled it out.
Me: "I've worn my heagea wif thith fathbow and elathith for 2 dayth thraight after our lath appointment. I took the elathith out onth yetherday for 10 minuth. I have been eating all liquid food. I did canthel my appointment with my thychiatrith."
Ellen: "I am glad you are wearing your headgear and elastics. When do you activate your expanders?"
Me: "On Thaturdayth and Wenthdayth"
Ellen: "And you do that with your new facebow in? And it means you need to leave it in for about 18 hours after?
Me: "Yeah"
Ellen: "I would like for you to reschedule your appointment with your psychiatrist."
Me: "I haven't talkth on he phone bethith to my thisther thinth I got my applianthes."
Ellen: "I think this would be a great time to practice. Do you think you could call now?"
Me: "I don't know."
Ellen: "You will have these appliances for a while and must practice and continue with your life. Why don't you call and this can be a practice.
I take out my phone and find and dial the number.
Receptionist: "Hello, Dr. Sharensen's office. How can I help you?
Me: "Hi, I waned o thedule an appoinmen wif Dr. Tharenthen."
Pause
Receptionist: "You want to schedule an appointment?"
Me: "Yeah."
Receptionist: "Are you a patient here?"
Me: Yeah"
Receptionist: "What's your name?"
Me: "Alith Thmith"
Receptionist: "I'm sorry, I didn't catch that.'
Me: more slowly and enunciating, "Alith Thmith"
Receptionist: pause, oh, Alice Smith?
Me: "Yeah"
Receptionist: I'm sorry about that Alice. It looks like you missed an appointment this week.
Me: "I'm thorry. I'd like o rethedule."
Receptionist: I'm having some trouble understanding you and didn't catch that. Could you repeat that?
Ellen whispered to me that it could be helpful at times like this to explain to the other person that I have some orthodontic appliances or a brace that is making it difficult for me to speak and thank them for their patience. She said this could make it less awkward.
Me: "I am happy to repeat mythelf but juth wanted o let you know tha I have thum new orthodonic applianthes tha are making it more difficult for me to thpeak. Thath altho he rethon I canthelled lath week. I would like o rethedule an appointment."
Receptionist: "I see and am sorry about all of that."
We schedule the appointment.
Ellen: "How are you feeling about going back to work this week?"
Me: "I'm dreading it. I mothly work from home but thomtimes have o go o the offith. I do have o talk on the phone thumtimeth."
Ellen: "You need to keep practicing. And remember it's ok to tell something to be patient with you because you have some orthodontic appliances or a brace."
----------------
I was back at a speech therapy appointment on Wednesday of the next week.
Ellen: "How has work been?"
Me: "I cawed out. I tod them I wath thick."
Ellen: "I understand why you'd want to do that, but that is not going to help you adjust to your appliances and speech."
Me: "I tod them I'd be gone untiw nexth week."
Ellen: "Well I want you to be practicing until then."
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Speech therapy appointment the following week.
Ellen: "How has it been to be back to work?"
Me: "I cawed out again and thaid I wath thiwl not fewin wewl."
Ellen: "You will have to go back. You will have to be able to speak to people and be in society with your appliances. When do you see your psychiatrist again? Do you think some adjustment to your meds will help with some of your anxiety?"
Me: "I am thuppoth to thee Dr. Tharenthen neth week. He hath been waning to up the med I'm on and hath altho talked about puttin me on a new med o help with antheithy. Thith wath before I got the new applianthes. I'm nervath to go with the new applianthes."
Ellen: "It will be ok. You're getting more used to holding your teeth in the blocks and you are having less saliva and issues with swallowing and drooling."
Me: "Yeah, but my thpeeeth ithnt better."
Ellen: "You are able to speak more steadily and with more confidence. That was what we wanted. That lisp goes along with some of your appliances and we want you to be more comfortable with that."
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The next week I had another appointment at the orthodontist. I wore my elastics and headgear with the facebow and elastic to the appointment.
Dr. Angie: "I spoke to Ellen earlier, and she says that you have been wearing your headgear, including with the new facebow and elastic and elastics to every appointment and that according to your chart, you've been wearing it on average 16-18 hours a day, sometimes even more."
I nod.
Dr. Angie: "I'm really pleased to hear that. Let's take a look."
She examines my teeth with my lower jaw forward in the headgear with the elastic. She takes off the elastic and the elastics on the sides. She examines my teeth and sighs.
Dr. Angie: "Are you really wearing your headgear 16-18 hours a day?"
Me: "Yeah!"
Dr. Angie: "Well you are not responding to the treatment in the way I had thought. I think I need to put you in a different kind of headgear. We'll keep the same facebows."
She walked off and came back with a headcap of straps and canvas panels down the sides. She placed the cap around my head and adjusted the straps. It had three straps that went around my head and some up and down in the back and the canvas parts down the side. When she attached the facebow to the cap, I felt the most intense pressure I had yet felt that went through my teeth and upper jaw.
Dr. Angie: "How does that feel?"
Me: "Ith oo tigh"
Dr. Angie: "It's supposed to feel really tight and you're supposed to feel pressure."
Me: "Ith too mush"
Dr. Angie: "It's supposed to feel that way. It will feel like less as you get accustomed to it. I want you to wear this headgear 18-20 hours a day."
I had a sinking thought that I couldn't. This was worse than the other one. I felt humiliated and my whole head was covered.
Dr. Angie: "We need to use your head as anchorage to help pull your jaw back. The other headgear we were using wasn't enough."
She left and came back with two pieces of metal on a tray. She tightened my braces.
Dr. Angie: "I'm also going to place an upper lip bumper. You're teeth are not responding enough to the expander."
It looked like a zigzagged metal wire that went at the top of and above my upper teeth along my gum. I felt pressure when she placed it and it felt difficult to comfortably place my lip over it.
Dr. Angie: "Now that we are addressing your thumb sucking and tongue thrust habit with your current tongue crib, I can now see that you are thrusting your tongue against your bottom teeth. We have to address this. I have the upper tongue crib as low as we can bring it. But with your teeth in the blocks, you can still reach beneath it a bit and touch your lower teeth. You're now pushing against them, and I am going to place a lower tongue crib today."
After she placed the lower crib, I started drooling again. She placed the suction again.
Dr. Angie: "You'll have extra saliva for a few days until you adjust, as you did with the other tongue crib. I'm going to activate your expanders and place two more elastics that you need to wear in addition to the ones you already wear. These are going to help work with your headgear and address your overjet."
When she activated my expanders this time, I felt intense pressure and pain throughout my mouth, more than ever before. She then placed two new elastics that went from the front of my upper teeth to the back of my lower teeth. She placed the two elastic triangles and the elastic to my facebow."
Dr. Angie: "I activated your expanders. As usual, your headgear will be very tight. Leave it in for the next 24-48 hours. I recommend leaving all your elastics in for the same amount of time in order to adjust and the pain will lessen. You can drink smoothies and soft foods out of a straw during that time. Your upper lip will need to get used to the lip bumper and you may find that it feels difficult to fully close your lip over it. Try to anyway and it will get easier as you adjust. Speech will be more difficult but you will adjust."
I couldn't keep my lips closed over my teeth because of the lip bumpers and couldn't open my mouth because of the elastics, even though with my teeth together, my mouth was open. I was drooling and still had a suction in my mouth.
I also would like to set you up an appointment with an oral surgeon. I don't think you're going to need jaw surgery if you are able to wear these appliances, but I do think you will need a genioplasty or chin implant. They usually like to do these procedures while you are still in braces and have the appliances in so we can adjust if necessary. I'd like you to at least get in to see the surgeon sometime this month or next. The twin blocks are definitely helping you have a more defined facial profile and jaw, but you still don't have much of a chin. We are going to activate your twin blocks and bring them further forward in about six months, but I think you are still going to need the genioplasty or implant."
I nodded.
Dr. Angie: "I'm going to update Ellen on your treatment. Just ask Lisa to give you some names of surgeons that I recommend when you check out in a minute so you can get the appointment set up."
Receptionist: "All ready to check out?"
I nodded.
Receptionist: "She wants to see you back in a month. Would Wednesday the 10th work for you?"
I nodded.
I noticed another patient standing behind me and staring at my headgear.
Receptionist: "3:30 or 4:45?"
Me: Slurp, slurp. I grab a kleenex and wipe drool over my face. "Fow fowty fie."
Receptionist: "Ok, I have you down for then."
Me: Slurp, slurp. "Dottor Andie tol me o as you abou namth of thum thurgeonth tha the recomenth."
Receptionist: looks confused. "I'm sorry?"
My face went red and I started crying.
Me: Slurp, slurp. "Thith new heagea an ton cwib ith too mush. I can't thpeak at aw."
The receptionist got Dr. Angie. She came over while the receptionist helped the patient behind me.
Dr. Angie: "You'll adjust to these appliances. This headgear is necessary for your treatment and you'll get used to the tongue crib. Ellen said she could see you for an appointment in an hour if you would like."
Me: "I wan it ou."
Dr. Angie: "Why don't you go see Ellen and try to make it a month. If you still feel that way, we can discuss then. (To the receptionist): Alice needs the names of the surgeons I recommend."
She looks at the list.
"Dr. Samuelson and Dr. Messer are two good surgeons that I'd recommend for genioplasty or chin implants. Here are their numbers. Try to call sometime this week or next."
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At speech therapy in the waiting room, I feel lots of people staring at my new, much more obvious headgear cap. Also, with the twin blocks opening my mouth, every time someone looks at me, they can see the tongue cribs between my teeth. The lower crib makes it more obvious and makes it much more difficult to speak. I was also struggling to close my lips with the lip bumper.
Ellen greeted me: "Hi, Alice."
I rushed back and quickly said: "I hate he new heagea and ton cwib and lip bumper." slurp, slurp. I grabbed a kleenex to wipe my face as drool came down. "I can't thwallow an I can't thpeak a aw."
Ellen: "It will take some more getting used to. But you were able to adjust some to the other appliances."
Me: "My thpeath ith tho mush worth now."
Ellen: "It will take more practice."
Me: "I'm thupposth to go back to work thith week and I have an appointment with my thychithrith toay. I can take my heagea out for importan work meetingth but I can't toay for my appointment. And I can't thepeath."
Ellen: "I think you should keep that appointment. It's really important that your meds are managed and he can maybe give you some meds that help with your anxiety. I think you should call the office before you go to let them know about your new appliances. I think that will help you feel less anxious about going today. Let's do our practice for today, and I want you to call at the end of our appointment."
A little later, I got my phone out to call Dr. Sharenson's office.
Receptionist: "Thank you for calling Dr. Sharenson's office, how can I help you?"
I paused. Ellen nodded for me to speak.
Me: "Hi, my name ith Alith Thmith and I have a appoinment toay wif Dottor Tharenthen."
Pause.
Receptionist: "Yes, Alice, will you be able to make your appointment?"
Me: "I thin tho. I juth waned to caw and thay tha I had anover orthodonic appointment toay and got thum new applianthes. Ith wewlly har for me to thpeak. I altho got a new heagea brathe tha I have to wear and can't take it out wight now and I fewl embawrassth to wear it."
Receptionist: "We understand but would still like you to come in for your appointment if you can."
Me: "Okay, I will twy to be there."
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Later at the psychiatrist
As soon as I walk in the office, I feel other people stare at me. I walk to the receptionist desk. She looks.
Me: Alith Thmith.
Receptionist: "Hi, Alice."
I saw her stare and when I opened my mouth to speak, I saw her look at my teeth and rubber bands and appliances. I had considered taking off my headgear cap, but it looks almost odder to have the facebow in with no cap. I had tried to pull it out but it was very tight and the pain was intense. I had considered taking off my elastics too but my teeth were throbbing and I didn't think I could get them back on.
I took a seat. My face went red and I wanted to leave. Just as I was deciding to take off my elastics and headgear cap, Dr. Sorensen came out to greet me.
My face went redder.
Dr. Sorensen: "Hi, Alice."
Me: "Hi."
Dr. Sorensen: "Come on back."
I'd been coming since before I got braces. When I got braces, he'd upped my dose on my anxiety med. He'd upped it again later. But I hadn't been back since I got all of these appliances and headgear.
Me: Crying. "I can't thpeak. I have aw teth new applianthes and heagea that I hate."
I pointed to my headgear and opened my lips to show in my braces, elastics, twin blocks, and tongue cribs.
Dr. Sorensen: "That's definitely a lot going on, but I think you are doing something that will ultimately be good for you, and I'm proud of you for that. You can handle some discomfort along the way.
Me: "I do like my fathial prowfiw better now. I have more of a daw and I'm thupposed to mee with a theredon thong to thee about getting a denioplathy or thin implant." I pointed to my chin so he knew what I was talking about. I had an orthodontis appointment toay and the tighten my ethpandeth tho I can't take out my headgear.
Dr. Sorensen: "You are feeling more anxious now?"
Me: "Yeah, I haven't been going in public or working."
Dr. Sorensen: "I know it's situational in many ways, but I think some more meds can help you through this. I know we've been talking a while about starting you on a different medication. Given your situation now, I think it's good time to try this. These meds should take off a major edge, like for social situations.
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Later that week, I had an appointment with the oral surgeon.
Me to the receptionist: Alith Thmith.
Receptionist: Hi, Alice. We need you to fill out some paperwork.
The nurse came back to get to me to take me to Dr. Green's office.
Dr. Green: Hi, Alice, nice to meet you. Dr. Angie has filled me in on your treatment. You're responding very well to the treatment. The twin blocks have moved your jaw a lot further forward and are improving your bite. You'll need to have them activated once again.
He examines my face and bite.
Dr. Green: I don't think you'll need jaw surgery, if you can keep up with these appliances and your treatment as you've been doing. We are moving your jaw forward and you have a more distinct jawline but we could help you have a chin. I think you could benefit from a genioplasty procedure. Has Dr. Angie discussed this with you?
Nurse comes in the room: We are going to do some pictures for your consultation. Can you remove your headgear so we can see your face better?
I go to the mirror and take out my headgear. They have me sit in different positions and take photos at all angles.
Dr. Green: Go ahead and put your headgear back on while I get these photos ready.
Dr. Green came back and showed me the photos.
Dr. Green: The appliances are balancing your facial profile, but we will need to give you more of a chin. Twin blocks are great for giving a jawline, but in cases like yours, when there is such an overbite and lack of a jawline and chin before treatment, moving the jaw forward still doesn't give you a chin. We can only get that with a genioplasty or implant. I am going to contact your orthodontist to discuss. I want you to continue your treatment and come back again after your twin blocks have been activated again so we can better see what position your teeth will be in. We want to get your bite aligned and then we will bring your chin forward.
At my next orthodontist appointment, I had my special headgear in. When I got there, Dr. Angie said she has spoken to Dr Green about the genioplasty. She said my front teeth are still not responding correctly and she added me a new headgear that attaches to the sides of my upper braces and a thicker zigzag wire that goes over top of my top braces.
Dr. Angie: You're not going to be able to close your lips fully around the new headgear. And it will be hard to close your lips over the thicker wire at first. You need to try and with practice it will get better. I am going to adjust your lower tongue crib as I see your tongue is still getting around. We're going to reactivate your twin blocks in a few months. Sometime next year you'll go back to Dr. Green to see about the genioplasty. It's all coming together well. There is a lot of improvement and you're doing great.
