Early September 2015

It seems a bit crazy that I'm writing the first entry of a diary about getting braces. Life is weird sometimes.

For the sake of proper documentation – after all, I'm a grad student (!) – a bit of context: I started grad school here three weeks ago on a scholarship; I finished my undergrad in psychology last spring. I'm 22, from a boring middle-class family from a boring middle-sized city. I'm in a graduate dorm/residence at this university in a bigger, more interesting city, and the first two weeks have been about getting settled, meeting advisors, getting stuff for my room, learning about the city, etc.

This residence has three private rooms and a common area, and it was clear from about 5 seconds after getting here that Janice, one of my two dorm-mates, would be one of my best friends. Super energetic, excited about everything, and just a good vibe from the very start, and so we've hung out together endlessly.

About a week after getting here (and meeting her), she came bouncing into the common area, which she likes to call "the den" (because it sounds like a thing dudes would call it, and she loves the irony). "How do you like your smile?" she asked. I was like, what? "I mean, do you like it? Are you happy with your teeth?"

I'd worn some kind of drool-inducing, awkward appliance for two years when I was about ten years old. Then I finished, and my dentist was happy with my bite. My teeth are still healthy, cavity-free and I don't think about them much. I told her this. "Me too," she said. "Well, my dentist in junior high said I had the best natural bite that he'd ever seen. He used to show other patients photos, because it's pretty unusual. But my wisdom teeth came in a few years ago, and look at this:"

She opened and pointed at her lower front teeth. One of them overlapped the other, just slightly. On her upper jaw, one of her upper canines looked a bit vampire-esque.

"I don't love this. And please don't hate me, Annika. But. Your teeth are fine, but they could look AMAZING. I can be an objective critic, and that's my assessment."

At this point I think I ran my tongue over my teeth.

"Anyway," she said, "I was at the student center and I saw a poster that said that the faculty of dentistry does orthodontic treatment for students at reduced rates, and so I dropped in." She said this very casually, like she'd stopped to find out about a recycling program. "Because we're grad students, and because we're both TAs on an undergraduate course, the reduced rate is pretty great."

"What's pretty great?" I asked.

"Free!" she said.

I thought about it for a second, and then I said: "I'd need to think about this a bit longer. This is honestly the first time I've thought about it at all. And we're 22 years old. Do you want to be walking around with braces at this age, especially when your teeth are fine?"

"Short-term pain for long-term gain," she replied. "And way easier if we both do it."

"I'll think about it, I said."

So then I went to a meeting with an advisor about my courses, and literally for the next five days Janice kept pestering me about it in her enthusiastic way. More than once I spent a bit of time staring at my teeth in the mirror and agreeing with her assessment – my smile was nice, but it could be AMAZING. So I decided it couldn't hurt to find out more.

Janice made us an appointment exactly one week ago, and this morning we went to the dental faculty building and into an office/reception area that was pretty much indistinguishable from a dentist's office. I think they try to make it seem similar so it's more like the real thing for patients and for the students. Janice had explained enough to them ahead of time so we went in together and sat in a room with a treatment person, Suzie, who was full-time professional staff rather than a student. On the shelf behind her were various models showing braces on teeth. Suzie's teeth were literally perfect.

She explained the program: free treatment for faculty members, which we indeed somehow qualified for as TAs, and we'd be treated by upper-year orthodontics students, who either had moved straight from graduating from dentistry or had returned from dental practice to add this speciality. It was run like a large clinic, so we wouldn't have a single orthodontist, but each would have access to the treatment plan and they would review progress together with faculty members. Treatment time would be the same as anywhere, but chair time might be longer because they would document stuff in more detail, take more impressions and photos throughout, and occasionally discuss the case for classroom rounds, blah blah blah. Any questions?

"So, I'm not a teenager, obviously," I said. "I'm assuming you've got options like Invisalign?"

"We don't work with Invisalign because it's a proprietary system and most of the work is done remotely at their facilities," Suzie said. "Because this is about training and experience, the one condition here is that your treatment will be standard orthodontics, where the students can work with and see the physics and mechanics of your teeth and bite, to understand first-hand how the process works."

It was pretty clear Suzie had answered these questions before.

"What about clear braces?" I asked.

"These are available, but they would require an additional out-of-pocket payment. Basically anything that isn't strictly necessary for your treatment would cost extra. So if you wanted the college logo on your retainer, you'd have to pay for it."

We asked a few more questions. If we dropped out of the graduate program we could continue with the treatment but we'd need to pay the (still-reduced) fees from then on. We ran out of questions and Suzie started wrapping things up. If we wanted, she said, she could book us in for an exam to move things forward. It didn't mean committing.

"Sure," Janice said. "Let's do it."

Early October 2015

OK, this was a bit of a weird day. I'm pretty sure I'm not friends with Janice any more.

So we got up early, ate together, brushed and flossed and all that, and then headed over to the dental building.

For the past 10 days we'd sort of not talked about this day. I mean, how much can you talk about getting braces, in the end? One day, Janice asked what it was like when I got my terrible appliance when I was 10, and I told her what I remembered – it was an awful day, I was super nervous about getting some kind of "appliance" and then it was worse than I had imagined. It basically filled my whole mouth, and my dentist, who I liked before and after that, was pretty clinical about it when he fitted it. I couldn't talk at all, at first, and the idea of wearing it ALL THE TIME seemed impossible when I was sitting in the chair with it in my mouth for the first time. I can remember blushing uncontrollably when I finally walked out into the reception area, and then my mom and the dentist having a super loud conversation about it right there at the desk in front of the whole reception area. The first few days at school were the worst, but I actually did wear it all the time, except for eating, for a little over two years. Actually, there were three different versions of that appliance, if I remember correctly, but I'd just go in for an appointment and leave with the new one when that happened.

When I was telling Janice that story I remembered that then I got a retainer to wear at night and I wore that pretty religiously until I was about 14.

So we got to the office and then they came to get us. I was like "should we hug?" and Janice was like "let's high five", so we high-fived before getting braces.

"Good luck!" we said at the same time.

Then we went off to separate rooms. Dr. Amy was there, the same faculty old guy, and a different student who introduced himself as Dr. Lorenzo. Dr. Amy was happy to see me, which was weird since I'd really only spent an hour with her poking around in my mouth. She wasn't wearing her mask and I saw for the first time that she wore braces.

"I didn't actually know you had braces," I said as I sat in the chair.

"Oh yeah, you didn't see them last time. I'm 9 months in to this treatment."

"THIS treatment?"

"This is my second time. I wasn't as obsessed with moving teeth when I was a teenager and I wasn't very good about retainers ... and they're free here, of course."

"Of course."

"So Annika," Dr. Lorenzo said, looking straight at me, "as promised we've studied your models and X-rays and developed your treatment plan based upon that information and the consultation last month."

His chairside manner was very professional, I noticed immediately. I guessed that he had worked as a dentist before coming back to school for orthodontics.

"Great," I said, hesitantly.

"As discussed, we'll be able to unwind the slight crowding of all your teeth without too much trouble. As for your observation about the width of your smile, some minor palatal expansion is still possible even in your adult jaws, and we should be able to widen your arch for a very satisfactory result."

(I have to say here that I remember mentioning wider smiles but I was really just trying to answer their question and babbling a bit.)

"During the expansion phase there is an increased risk of unwanted molar movement, which we'll address with extra-oral anchorage. Overall, it's a fairly simple case, and my classmate Dr. Jack's estimate of 12 to 18 months of treatment still seems accurate with good cooperation."

Dr. Lorenzo looked at me and waited to see if I had a reaction. I'd read a bit about braces in advance of this appointment and one term alarmed me.

"I'm glad the estimate still holds up," I said. "Can you explain what extra-oral anchorage is?"

Dr. Amy answered: "Standard headgear in your case, Annika." She walked over to the counter and said "Here, we actually have everything ready to go over here," and then held up a metal facebow and a blue strap, folded neatly in half and still inside a plastic package.

"Um," I said. I have a problem where I'm at a loss for words at the worst times. This was one of them.

After a pause where they were maybe waiting for me to say more, Amy said: "I'm sure you've cleaned your teeth thoroughly, but we're going to want to give them an extra cleaning now and then we'll get started. Are you ready?"

She lowered the chair and deftly pulled out my spacers, and then got a lip-spreader thing which I vaguely remembered from years ago and carefully fitted it into my mouth. She added a plastic device that held my tongue back, and then connected a suction hose. Then she and Dr. Lorenzo brushed, flossed, swabbed, rinsed, and did a whole bunch of other stuff to my teeth.

"We're going to start by fitting your expanders and your molar bands," Dr. Lorenzo said, standing back. He went to the counter and held up two metal devices, each with four bands attached. "The upper one is activated by turning a screw. The lower one uses a spring action to push the palate wider. Both are precision fit to the models of your teeth, but the spacers will have moved things slightly so we'll probably have to make a few adjustments. We'll test how they fit, then take the lip-spreader out, test them a bit more and then cement them in."

Dr. Lorenzo tried the lower one, which didn't fit easily, I think, as it took him about 15 minutes of making adjustments and consulting with the faculty guy. Then Dr. Amy went to work on the upper one, which took less time. Once they were satisfied with the fit, they took them out and put them on the counter. Then they each test-fitted two molar bands on my very back upper and lower teeth, he working on the left side and then she the right. They took the bands out, and packed my cheeks with cotton rolls, and then removed the lip spreader. Dr. Amy now put the lower expander into my mouth and had me bite on a wooden stick held over each band in turn, which she said would help seat it completely onto the teeth. The faculty guy pulled on gloves and examined the fit and approved it. Amy removed the expander again, dried it and my teeth with some kind of air tool, then added cement to the bands and reinserted it. I bit down on the stick four times again, she and the faculty guy had another look, and then she shone a UV light tool on everything to cure the cement.

Dr. Lorenzo repeated that process with the upper expander, and then they went through a similar pattern with the back molar bands. Finally, they replaced the lip-spreader and replaced the cotton rolls.

I will say that at this point I was pretty shellshocked. Was this really happening?

"This next stage is much easier, Annika," Dr. Amy said. "Expanders can be a bit gruelling to install, but we made it. You're doing great."

Then they began putting brackets on my other teeth. I could sort of see my teeth and the brackets reflected in the eye protection they wore as they leaned over me, and I watched as they positioned each bracket on a tooth, got faculty guy's approval of the location, and then flashed it with that UV light. That part took less than an hour, versus the 90 minutes or so of fitting the expanders.

Dr. Amy then got the facebow she'd showed me earlier from the counter and she and Dr. Lorenzo both worked on it inside my mouth for a few minutes before returning it to the counter. Then they took out the cotton rolls and the lip-spreader and raised the chair. They gave me a cup of water to rinse with. My mouth felt so weird! I couldn't decide whether the brackets on my teeth felt weirder, or the metal devices on my upper and lower palates. Dr. Amy handed me a tube of lip moisturizer and I smeared a bunch onto my lips.

Holding up two curved wires, Dr. Lorenzo said: "Annika, these are your very first archwires!" I chose a light-blue color for the ligatures they used to secure the wire into the notch on each bracket, and they methodically put the archwires into position.

"How do they feel?" Dr. Amy asked.

"I'm not sure if I can answer that yet," I replied. My tongue kept probing the complicated device in the roof of my mouth.

"Well, this is your final step today," Dr. Amy said, once again picking up the facebow, "and then you're free. Do you have a hair elastic?"

I pulled the elastic from around my wrist and gathered my hair into a ponytail. Then I opened my mouth - because what else was I going to do? – and Dr. Amy slid the facebow into place. This time I could feel it reach the desired position, somehow through my teeth. It had been more confusing when they were fitting it earlier, but now I could tell that the two arms had some kind of intended resting place.

At this point Janice walked in and her eyes got very big. My lips had just closed around the facebow for the very first time.

"Holy ..." she said.

 

What a surprise going in for braces and walking out with upper and lower expanders and headgear! Awesome! Looking forward to the next post.

very good so far, I walked out of my orthodontist office my first day with a headgear too

I added this story to The Archive. Keep up the good work. I am enjoying this story.

Wow, what a great start. I love it!

Fantastic story.
Cannot wait for more

Love the story, please update!

Great story so far!

excellent story, thanks for the update! Looking forward to reading more

Loving the story so far! Looking forward to the next update!

Very nice Story!

I have added the latest chapter to The Archive.

Great story, and as above, I wonder if it will continiue.  I keep checking back

Hope it gets continued soon!

Will be a shame if this isn't finished...

Late October 2015

OK. I just couldn't write any more a few weeks ago. I was so mad at Janice.

So when she had her individual consultation, she asked more questions about getting clear braces. And it turned out the extra cost was just $400. So she went for it. She said she assumed I would have too, since I had asked the question in the first place during the consultation. But I don't really get why she wouldn't have said anything to me about that.

We're friends again, but I'm pretty annoyed.

Anyway, I've spent the last couple of weeks getting used to everything. I spent most of that first day just staring at my teeth. Janice and I went back to the residence and sat in the den and traded stories about our experience. She asked a lot more questions beforehand, so she knew exactly what was going to happen. She got clear braces on her top and bottom front teeth and metal on the back ones, and that's pretty much it. She has none of the molar bands I have, but they said she might need some when she wears elastics later. Her treatment is supposed to take 12 to 14 months. So of course she's going to be finished with her braces in a year and I'm still going to be wearing braces and headgear.

Yeah, that. I couldn't bring myself to put on the headgear or even take it out of its case until I had to go to bed the first night. Even now, it just seems insane: I wear headgear. Like, really intense headgear. Ten hours a day is actually a lot. In September we'd usually stay up and talk in the den until midnight or later, unless we stayed out later at a bar, and then I'd get up at 8 for 9 am seminars a few days a week or earlier to go to the gym. So that's like 7 hours of sleep, sometimes 6.

For the first week I just went to my room early, put on the – my – headgear and read. Well, the routine is more like: spend ages brushing my teeth and using floss threaders to get all the food out, wash my face, etc., and then put on my headgear. Fit in the facebow, then the high-pull strap, then the neckstrap. I can see the outer part of the facebow if I look down, and I can see the plastic pieces from the two straps where they cross over, and I can feel it on my head, like, the whole time I wear it if I think about it.

But after a week that was getting pretty boring. So now if we're hanging out in the rooms at night, I just wear it. People come in all the time and it's endlessly embarrassing, but it's only a few people, and it's either that or I don't make 10 hours. But then, if we go out for drinks or something, I don't wear it, so then it's scramble to get a few more hours in the next day if I'm back working at my desk. Basically, somehow, pretty much all of my scheduling and thinking revolves around wearing my headgear enough every day.

I've turned the expander every third day. It's super painful for the next 12 hours or so, so I've started doing that at night. I guess one cool thing is that I can feel my teeth moving and I think I can already see a difference. But I'm literally the biggest braceface in the whole college, by a lot.

After the first week I had another check-in appointment. They looked at the expanders but they seemed most concerned about the headgear. Dr. Lorenzo talked again about unwanted molar movement related to the expansion process. He said the forces seemed about right, and he and Dr. Amy were almost delighted when I talked about my devotion to nailing the ten hours. "We're taught to expect poor compliance for headgear wear," Dr. Amy said to me. Dr. Amy was wearing elastics this time, which were kind of crazy and I asked her about them: three in total: one on each side from upper canine to lower second molar (or something?), and one in "box configuration" at the front of her mouth. She said I've got elastics in my future but it was way too early to say if they'd be like hers.

Overall, they said, everything looked OK, but they planned to take a closer look at the "precision of the extra-oral anchorage" at my next full appointment, which is two weeks from now.

Mid-December 2015

Not a great day.

Today was my second adjustment appointment since getting braces. And Janice's too, of course.

At the first adjustment, a month ago, they gave me new archwires, which are thicker and stronger (I guess each time you just get a slightly stronger wire, which, duh, obviously) and checked the expanders. Then they spent a lot of time on the headgear again, measuring the forces, taking the straps on and off. They took new X-rays and impressions, and they asked to see me again for a check-in two weeks after.

Janice, of course, was told her teeth are moving really well, and it's possible her entire treatment will come in under a year.

At the check-in appointment they had the new X-rays and the impressions and they again did a lot of looking at the headgear and those molars. Honestly, I really don't care if my molars move a bit. Who even sees them? But the faculty guy then talked to me – which seems to only be when they want to make sure I know this is very professional – and said it's about the bite relationship and that it's actually super important, even more than the aesthetic stuff that orthodontics provides.

"So at your next appointment we may reconfigure your extra-oral appliance in order to make sure we're on track," Dr. Amy told me.

So that was two weeks ago.

Today, first of all, Janice got elastics. Selfishly, I'm kind of happy about this as it makes her braces slightly more obvious, although they're sort of hidden further to the back of her mouth. And I also get the sense that elastics are a later stage thing, so somehow her progress is going crazily fast.

So I go in and they do the usual stuff first: remove the ligatures and the archwires, do a bunch of cleaning and poking around, adjusted something on both expanders, and then put in new archwires and new ligatures. I sat up to rinse.

"Oh yeah, you need my headgear now," I said, and picked up my handbag. I handed Dr. Amy the case with the facebow and the case with the straps.

"We told you about a reconfiguration last time," Amy said, putting them down on the counter. "So you're actually done with this facebow. We're going to try a similar one."

She went to another counter and came back with another facebow. It looked similar, but with the outer bow looping on either side just before the joining point with the inner bow. The ends of the outer bow had blue plastic stoppers on them.

"This is called a cushion-loop facebow," she said. "The wire loops around here, which helps to absorb some of the applied force. It lets us control the pressure more precisely."

"The problem we've been having with your headgear is that we haven't been able to control the direction of the force and the degree of the force as much as we'd like," Dr. Lorenzo said. "So this will help."

"OK," I said.

Then they lowered the chair, brought out a lip-spreader again and put it in. They both worked on the new facebow, adjusting it with what looked like pliers. After about ten minutes they showed it to faculty guy, who pulled on gloves and took it out and reinserted it a few times before telling them it was good. They took the lip-spreader out, raised the chair, and Dr. Amy gave me some lip-balm again.

Then they put the facebow back in.

"So we're also going to replace the straps you've been wearing with something that gives us more control," Dr. Amy said. She brought a clear plastic packet over and pulled out a small mass of blue straps. "This is called an Interlandi headgear. It's a single strap and it's easier to adjust the force exactly as we need it."

Dr. Amy arranged this thing over my head. It had a bunch of straps on top of my head that converged into a plastic piece at either temple. That plastic piece extended in front of my ears and then under them, back to near the corner of my jaw, where they were attached to a padded neckstrap. It felt like my combination headgear but much more elaborate. Dr. Amy and Dr. Lorenzo took a bunch of measurements and adjusted the straps, then removed everything, did something at the counter, and then put it back on. I could feel that it now fit more snugly.

"This appliance uses elastics to provide the force we need," Dr. Lorenzo said, holding up a small plastic bag of rubber bands. He and Dr. Amy then spent 10 more minutes connecting different sized (I assume?) elastics between the ends of the facebow and something on the plastic pieces in front of my ears. They used some measuring tool and wrote down various numbers, and then faculty guy again looked at everything and approved.

Dr. Amy handed me a mirror. I was used to seeing myself wearing headgear at this point. This was, in some ways, pretty much the same, but bulkier in every respect.

"There are two connecting pegs in the correct holes on each side of the headgear," Dr. Amy said. "You'll need to put everything on and then these elastics" – she handed me a baggie full of red elastics – "go from the top pegs to the facebow" – she connected two as I watched – "and these elastics" – she handed me another baggie of blue elastics – "go from the bottom pegs. When in doubt, B for blue, B for bottom."

I stared at myself in the mirror.

"Give it a try, Annika," Dr. Amy said.

I disconnected all the elastics and pulled the straps off my head. Then I reached into my mouth and slid out the facebow. Then I put it back in, pulled the straps over my head and neck, fiddled with the elastics and was wearing headgear again.

"Easy enough, right?" Dr. Lorenzo said. I nodded, reluctantly. "Ideally you should change these elastics every four hours, but if you sleep through it, it's not a huge deal."

"Annika, the other change we want to make is with wear time," Dr. Amy said. "We'd like you to wear this appliance 12 hours a day, preferably consecutive hours. Do you think that's possible?"

"I'll do my best," I said, for some reason. Why didn't I resist these things when they were happening? "Are we still on track for time?"

Dr. Amy and Dr. Lorenzo looked at each other. "It's still possible, but we've adjusted the expanders for now so that their progress is more moderate while we're resolving this anchorage challenge. So this might add a bit of time to the total treatment. It's still hard to say."

They asked me to make an appointment for a week later and for the day after I got back from Christmas break so they could check the headgear.

I got new cases for the new facebow and straps, a bunch of bags of red and blue elastics, and my old headgear ("if you want a souvenir," Dr. Amy said). I took everything off, thanked the orthodontists, and went out to meet Janice. I made two more appointments, plus one for later in January for my actual adjustment. Janice made a single adjustment appointment, same day as me.

So now I'm writing this at 10 pm the same day as that appointment, sitting at my desk in my room, wearing this thing called an Interlandi headgear, metal braces and two expanders. I've had the headgear on since 8 pm, and I will wear it till 8 am. There are four thick elastics that I can see out of the corner of my eye, two on each side.

I'm just not quite ready to hang out in the den with this. I can hear Janice out there joking with some friends about her elastics, her tiny little elastics. Oh well. Only twelve more months. Or more.

Keep going. Great story so far

nice addition to the story !

Great story cant wait to read more.

Cool story. Am enjoying it very much. Cannot wait for more.

Great story!

I love the story, it is really realistic and could heppen.

Great story!!

Probably not alone in here in hoping that this story gets continued.  Maybe a little "writer's block" or a loss of inspiration?  Anyway, hope that this will serve as a little encouragement.  It would be a shame to let this one go unfinished.

I agree with everyone else who had said they would love more of this.
It’s a great story and an interesting idea. Would love to see how it all plays out