"We'll be about 30 more minutes and then Annika will be out," Dr. Amy said to Janice.
"OK," Janice said. "I'll see you outside!"
She smiled a big smile at me and I made an actual surprised sighing sound, because it definitely seemed like she was wearing clear braces.
Just as quickly as she'd come into the room, she left again.
"How does the facebow feel in your mouth, Annika?" Dr. Lorenzo asked. "Any discomfort?"
"It's actually smoother than the braces," I found myself saying. I noticed that I was lisping significantly. The two expanders were very unfamiliar to my tongue. As I finished speaking my lower lip caught on a lower bracket and I had to kind of purse my lips to get it over.
"Yes, that's definitely one advantage to it. It will protect your lips and the inside of your mouth from the brackets somewhat. You'll adjust to the brackets quickly, but in the early days the headgear will give you some relief."
Dr. Amy walked back over with the strap in its plastic package and pulled it out. It was a thick blue pad with two white strips, and looked pretty much exactly like what I'd seen on a couple of friends once or twice when I was a kid. She snapped each strip over the ends of the facebow and just like that I was wearing a neckstrap and could feel even weirder pressure on my back teeth.
Then she walked back to the counter and returned with another plastic package and pulled out another blue strap, this one obviously for over my head and also like something I'd seen on a few less fortunate friends years ago.
"So the configuration you're going to wear is what we call combination headgear," Dr. Amy said. "We're looking for anchorage, not movement, so we want to hold your molars exactly where they are. The neckstrap alone is called cervical headgear, and it has a force mostly straight back, but also very slightly downwards. We just want to take care to hold those molars in place during the expansion phase, so we're using this second strap to introduce a force that cancels out the slight downward pull."
"Yes," Dr. Lorenzo jumped in. "The forces exerted here won't be very great, so your headgear shouldn't cause too much discomfort on the teeth. The upper strap in particular will be adding only a very, very slight amount of force."
Dr. Amy pulled my ponytail through the strap and then attached the white parts to the ends of the facebow, on top of those already connecting the neckstrap. Then they got some kind of measuring device and kept hooking and unhooking the various straps and writing down measurements on a notepad. Dr. Amy did some calculations and then showed them to the faculty guy, who looked at them for several long seconds and then nodded and said "good". My mind kept going back to Janice smiling ... maybe with clear braces? What had happened here?
They returned and adjusted the straps again and then with a marker made some kind of mark on the plastic strips.
"OK, we're finished," Dr. Lorenzo said. "Now we'll show you how to take care of all of this."
Amy reappeared with a large square hand mirror and held it up. And there was me, wearing a complicated headgear, staring back. The two white strips of plastic crossed over each other on either side. They were both attached at the fourth or fifth hole from the end of the strip.
"First, the straps," Dr. Amy said. "We've marked the correct hole on each side of each strap. It's important that you wear it in exactly this configuration. We don't want it too tight – there's nothing that will happen faster, but it could shift your molars in a way we don't want. We're going to monitor this quite closely to make sure we've got it right. So you also should not cut off the excess plastic here, as we may decide we need to loosen the pull."
She unhooked the straps. "There's a small bit of stitching here and here," she said, holding them up. "These always go on the right side. That way you'll never get them upside down. Now if you'll open."
I opened my mouth. Metal braces, with the fat bar of the facebow connected into a receptacle on my back molar. Metal rings around pretty much all of my teeth except the front ones. I lifted my tongue and could see an elaborate device behind my lower teeth. I leaned my head back and saw the even more elaborate expander in the roof of my mouth.
Dr. Amy squeezed the facebow with her hand and slid it out of the tubes. "These half-loops," she said, pointing to bends in the inner bow, "always point up. Open wider," she said, and picked up a metal tool. "You fit the facebow by giving it a little squeeze and guiding it into these tubes on your back teeth. You can use your fingers to feel for the tubes and then it's pretty easy to slide the facebow into place."
She handed me the – my – facebow. "Give it a try."
I sat there for about 10 seconds, pondering the situation I was somehow in. Then I adjusted my grip to hold the ends and, using the mirror she was still holding up, found the tubes with my index fingers. I squeezed the bow and it slid in just as she said it would.
"OK, now take it out and try again." I did this three more times. After the last one, with it still in my mouth, Amy handed me the straps.
"Cervical strap first, then the head strap."
I found the little black marks above the prescribed holes and strapped on my headgear, watching myself do it in the mirror. Dr. Amy had me do this two more times and then had me take everything off and put it back on again.
"Great!" Dr. Amy said, seeming genuinely thrilled. "You're a master."
Dr. Lorenzo now stepped in. "Annika, your upper expander is activated by turning it with a kind of key. You'll do this yourself. It's very easy."
Dr. Amy handed me the mirror and Dr. Lorenzo showed me a small metal wire that looked like a bent paperclip, attached to a strap of nylon or something. In the mirror I watched him point with the key to the expander. "Now, here in the center of the expander, is a small hole. You just insert this key and rotate it towards the back of your mouth. Always put the strap around your wrist first, and that way you won't swallow the key."
"Huh," I sort of said, his hand still in my mouth.
"It happens," he said. "Now you can do the first turn. Just one quarter turn. You'll feel a bit of additional pressure on your teeth."
I took the key from him, pulled the strap over my wrist, and managed to insert it into the hole using the mirror. Then I pushed it back, and, indeed, I could instantly feel a slight buildup of force inside my mouth.
"That's it," Dr. Lorenzo said. "Turn the key exactly like that every third day. We'll give you a spare one in case you lose that one."
"You can take your headgear off now, Annika," Dr. Amy said. "So: You should try to wear it at least 10 hours a day. More than that is better."
I immediately began unstrapping it. Ten hours! A day!
"Suzie will come and see you now and talk to you about caring for your teeth and your appliances, and take care of you from here. Any other questions?"
"How long will I wear the expander and headgear?" I asked, still lisping even without a facebow.
Dr. Lorenzo and Dr. Amy looked at each other, and then Dr. Amy nodded at him.
"The expander should take about eight months," Dr. Lorenzo said. "But we'll check progress often and if we find it can be sped up, we will. It might also take slightly longer. We'd like to see you in a week to see how it is progressing and to verify that the headgear is holding things steady."
"And the headgear? Same time?"
"Given the movements and timings, we'll most likely want you to wear the headgear for the duration of the treatment," Dr. Lorenzo said. "But we'll re-evaluate once the expansion is completed."
They looked at me expectantly, I guess in case I had more questions.
"OK. Thank you," I said, although I wasn't sure if I meant it.
"You did great, Annika," Dr. Amy said. And they left the room while Suzie entered, as though choreographed. Flashing her immaculate teeth the whole time, Suzie talked to me about brushing, showed me how to use some weird threader things to floss, gave me a spare expander key, some wax, threader things, a toothbrush, a hard plastic case that my facebow could be kept in, a case that looked sort of like a pencil case for the straps, and a chart to record wear time, which she said I probably wouldn't use.
"Same time next week to check on everything?" she asked.
"Sure," I said.
I put everything into my handbag. Then I headed out to the reception area, with 12 teeth banded, every other tooth sporting a metal bracket, expanders fixed into my jaws and the components of headgear in the handbag.
And there was Janice, smiling enthusiastically at me with what were definitely clear braces.
"What an ordeal!" she said.
