A story:
We're at the orthodontist's office, late in the afternoon, after school.
It's me, my dad, and my younger brother and sister. My brother is 9 and my sister is 12.
I'm 16, and I'm in the clear. I did my time here a few years ago, from when I was 10 until I was 13. I wore a bionator for about two years and then another couple of retainer things which I still wear a few nights a week. It sort of sucked, but I didn't really care when I was 10, and now my teeth are amazing.
The assistant comes out and says we can go in. My brother and sister came in last week to have impressions and photos and stuff, and now Dr. Patel is going to talk to my dad about the plans for them.
We all go in and sit in the office, and Dr. Patel brings up my little brother's images on his screen.
"Robbie's teeth are coming in pretty well," he says. "It seems like this won't require much interceptive treatment, just some straightforward alignment once he's a bit older.
"There are still a few teeth that haven't fully grown in, so I actually don't think we need to do much now but keep an eye on things. I'd like to have a look every six months or so for now."
My dad asks him why it's different than me.
"Quite simply, Ainslie's jaw and bite aren't the same as Robbie's, so it will be a different treatment for him," Dr. Patel says.
I'm distracted but I tune in again when he says my name. I run my tongue over my teeth, feeling their smooth, straight arc.
"Now, Emily actually has a similar jaw relationship to Ainslie," the orthodontist says. He brings up her pictures.
My sister squirms a bit. I remember this part. It's weird when they talk about you like you're not there.
"Given they have the same parents, this is simply an instance of some genetic elements being passed on in similar combinations, which is why Ainslie and Emily look quite alike – very similar lips, jaw angle, and teeth size."
My dad's a bit of a nerd, so he's fascinated by this.
Dr. Patel pushes back from his desk in his chair, wheels around to Emily and very deftly begins poking around in her mouth with his gloved fingers, getting her to bite and showing various things to my dad. He was always hands-on, but somehow it never felt obtrusive, just like he was doing his job.
"So Robbie got a different set of genetic info for his mouth, basically," my dad says.
Duh, Dad. Obviously.
"Yep," says Dr. Patel. "So for Emily, the first phase will be much like Ainslie's treatment. We'll use a bionator to bring the jaws into a better alignment and to restrict lower jaw growth slightly."
He snaps the gloves off and immediately puts on another disposable pair.
"A bionator? Is that what you had, Ainse?" my sister asks.
I nod my head. It's a bit of a bummer for her. She's two years older than I was. She sorts of blushes.
"Emily is a bit older than Ainslie was," Dr. Patel says, as though he just read my mind. "But her bone growth and overall development are still in a good place for an appliance like this, so we should get a very efficient result.
"I may add an extra-oral device that will attach to be worn at night in Emily's case, but we'll decide about that later. And once that phase is over I expect we'll need 12 to 18 months in braces."
"Sure," my dad says. "So what needs to happen now?"
"I need to do another, more detailed set of impressions to make the appliance, as well as a few more X-Rays, all of which we can do now," Dr. Patel says. "You can also deal with the paperwork with the treatment coordinator."
Oh God, we're going to be here forever. Why did I tag along? I poke my dad – I think I'll go to a store around the corner rather than sit around waiting for this.
"Hey Dad–" I say, just as Dr. Patel says, "and how are you, Ainslie?"
"Oh, I'm good!" I say. "I think I'm going to jet while you guys do this stuff. I've seen enough impressions in my life."
"Let's see that smile," Dr. Patel says, and I give him my best Hollywood grin.
"Looks great," he says, and then he wheels over from Emily and super quickly has his hands in my mouth, pulling my lips around and looking at my teeth.
"Bite down for me?" he says, and I roll my eyes and bite down.
"And open?"
I open. He does this a few more times and then slides back to his desk.
"Some of your best work," I say, grinning, as I stand up.
"Actually, it looks like there has been some overall jaw movement that was not forecast," Dr. Patel says, and types a few things on his keyboard. My case file comes up. "Your alignment on your lower arch is still excellent, but your bite isn't quite where it was and your upper arch has shifted in a few places."
My dad and Emily look at me. I'm a bit dumbfounded, to be honest.
"So what can we do?" my dad asks.
"Well, the answer is pretty clear to me," Dr. Patel says. "We can use braces to deal with the alignment issues, and we're likely in the last window of bone development where I can use headgear to encourage or restrict growth to restore the natural bite relationship without us needing to pull teeth or consider surgery."
Pull teeth? Surgery? Headgear? Five minutes ago I was going to the store.
"That's a pretty detailed diagnosis!" my dad says, taken aback.
"Well, yes, that's a good point," Dr. Patel says. "I'm quite familiar with Ainslie's case, of course, and what's happening here broadly is quite clear and well documented in similar cases. I didn't recognize Ainslie's case as a case of this nature, but now that is apparent. We will still need to take impressions and X-Rays to understand exactly how to proceed, but in general I'm confident about what is needed. You can see the positioning of the bite in these post-treatment photos here" – he points to the screen.
Then he wheels back around and has his gloves in my mouth again – "and you can see for yourself here how that has evolved."
My dad looks carefully and nods.
"Huh," he says. "So what's next?"
I'm definitely blushing right now. Robbie has Dad's phone and is playing some game. Emily is paying close attention to what's happening.
"As I said, we're in that last window of bone development, so it's literally a case of the sooner the better," Dr. Patel says. "It's quite lucky you were here today, Ainslie."
I try to smile. My mouth feels a bit dry.
"I would actually suggest that we start Ainslie on headgear wear today so we're sure to take advantage of this critical period," Dr. Patel continues. "We can fit the appliance now and also do her impressions and X-Rays so we can figure out the details of the rest of the treatment."
"OK," my dad says, decisively.
"Ellen," Dr. Patel calls, and an assistant comes in from outside. "Can you take Ainslie for impressions and the full-set of records, with X-Rays? Then please prepare her upper and lower rear molars for banding – there should be adequate space without spacers, but we can see. Upper molars with extra-oral guides."
Ellen smiles at me – she's wearing a retainer, I see. "Sure, come this way, Ainslie!"
I get up and follow.
"How's your day going?" she asks.
"It's a bit of a weird day," I say. I'm a bit stunned.
Ellen has me brush, floss, and rinse, and then she scans my mouth with some weird wand. The last time I had impressions it was with all this goop, but she shows me that the wand is creating a detailed 3D model of my mouth.
Then we walk into a room and do a bunch of X-Rays, and then photographs.
She takes me to another room with a normal chair, clips a bib around my neck, reclines the chair, gets some stuff out of a drawer, and starts cleaning my back molars and applying various substances – I don't know. Then she tries a series of different rings around my teeth until she has some she likes, and then I bite on a stick a bunch of times to put them in place, and then she pops them off again and walks out of the room.
Dr. Patel comes in a few minutes later, with Ellen.
"Ainslie, great to be working with you again," he jokes.
"Honestly, I'm not really sure what's happening here," I say. "This is all really fast."
"Yes, I'm sure it feels that way," Dr. Patel says. "But this is extremely lucky. If you'd come in six months from now, it might have been too late. Or later than that. More likely your bite would have gotten worse without any intervention, and you'd develop bigger problems when you're older."
Dr. Patel tries the four bands and shows something about one of them to Ellen, and then puts some goop in one, puts it on my upper tooth and has me bite the stick again. Then he shines a light on it, and then repeats that on the other side.
He gets out some other thing, puts it in my mouth, and then asks Ellen to go get a "number 4 facebow." In the meantime, he does the two bottom bands.
Ellen comes back in with the facebow, which is a metal headgear thing. Is this happening?
It is. Dr. Patel puts it in my mouth, takes it out, adjusts, puts it in, takes it out, adjusts, several times. Then he leaves it in. He has me open and close my mouth, purse my lips around it. He takes it out, adjusts it again, and puts it in again.
Ellen leaves again and comes back with some plastic-wrapped black thing, unwraps it, and it's a padded strap that Dr. Patel fits behind my neck and attaches to the arms of the facebow. I have headgear. I now have headgear.
"So Ainslie, based upon what we've observed about your growth, we're also fitting your sister with a similar appliance," Dr. Patel says. "I thought it might be necessary later, but your case demonstrates the need to take precautions earlier. I'm going to see to her, and Ellen will help you with putting your headgear on and caring for it."
He walks out, and Ellen brings out a mirror, which I hold up in front of my now-headgear-wearing face. She has me put two fingers from my other hand on the facebow at the middle of my lips, and then she unclips the strap ends from the facebow.
"Now, Ainslie, use your thumb and finger to hold the facebow inside your mouth and squeeze it slightly," she says. I do.
"Now pull it out?"
It comes out.
"Now try the reverse process."
I put it back in. She takes the mirror from me and hands me the strap.
"It's easy. Just behind your neck, and then the third hole on each side," she says.
I attach the strap.
"Great. Now you just need to brush those molar bands frequently, and floss in there as well," she says. "That will be harder once your braces go on, but for now you should take advantage. You can clean the facebow with a washcloth, and the strap can go in the laundry. Here's an extra strap."
She hands me another strap, and then a small stack of papers. "This is a time chart to track your wear," she says. "Dr. Patel has you down for 16 hours per day. For older patients we often see the wear go down a bit on weekdays because of school, and then they wear it all weekend to make up for it.
"Any questions?"
I don't have any. 16 hours!?
She takes off my bib and then we walk back out to the reception. My dad is standing at the counter. He seems nonplussed by the fact that I am now wearing headgear, but I can feel a bunch of other eyes lock on me. I blush.
"Ainslie, is the afternoon a week from today clear for you at school?" he asks.
"I think so?" I say. "What for?"
"This is for your braces fitting," the receptionist says. "I could also fit you in the next morning or ... maybe the morning after. It will take about three hours."
"I think that afternoon is fine," I say.
Then Dr. Patel comes out with Emily, who is wearing exactly the same headgear as me. She is blushing intensely and also glaring at me like this is my fault, which it sort of is.
"Dr. Patel, we have Ainslie down for a week today for her braces," the receptionist says. "That's the soonest availability."
"Great," Dr. Patel says. He turns to my father. "So we were fortunate to be able to fit their appliances quite efficiently today," he says. "I was considering using an extraoral force as a removable attachment to Emily's bionator, but Ainslie's growth made it clear that a stronger and earlier response will be meaningful. We'll fit Emily's other appliance next week – it can be worn at the same time as the headgear, but they will not be a combined appliance."
"Got it," my dad says.
"Emily is to wear her headgear 12 hours a day. Slightly less time is OK for the next few days as she gets used to it, but then 12 hours will be the minimum.
"Ainslie should wear hers 16 hours per day. Ainslie, I'd like to see at least 100 hours of wear by next week, please. We've started with a cervical force – a neckstrap, but the records we've taken today will determine whether we need to adjust the direction of the force, which we can do next week."
"How long will I wear this?" I ask, finally finding my voice.
"It's very early to say," Dr. Patel says. "If we can get 12 months of this growth window, or more, that would be a very great outcome. I feel that six is more likely, but as long as there's any development happening, we can and should use this appliance. Any other questions?"
We all look at each other. Nobody has questions.
"All right," Dr. Patel says. "We'll see you next week."
