Chapter Nine.
Dr. Brad gave Tara a reassuring smile and said “Miss Reynolds, are we ok to continue? We can do this another time if this is all too much at once. But, the sooner we start the sooner you can get relief.”
Tara pursed her lips and said “please go on. And again, I am so sorry for my outburst.”
Dr. Brad said “please don’t apologize. You did nothing wrong. And thank you for trusting us here. We do want to help you. We have a couple of options. The first is surgical.”
It took about five minutes for him to explain the benefits of SARPE surgery, braces, and a lefort surgery combined with a bilateral joint replacement. She was shocked to hear that if she chose this route she would be wired shut for 4-6 months, on a complete liquid diet, and then be on a very restricted soft food diet for another 6-8 months. The whole process sounded horrible. It got even worse when Janice went over the financial numbers. The total cost of the treatment would be approximately $60,000, and even with her insurance she would be looking at around $20,000 out of pocket.
Dr. Brad could see in Tara’s face she didn’t like the idea. Once Janice was done, he looked at Tara and said “we have another option. A much better option. And the one I would recommend.” He glanced at Mandy who went over to the counter. She returned with her arms full of assorted orthodontic appliances. After she had placed them on the table Janice stood from her seat beside Tara and Mandy took her place.
Dr. Brad said “I know you had a chance to meet and speak with Mrs. Willingham. I am not sure if she explained much about her treatment plan with you or not, but your’s would be very similar. I want to start you out in splint therapy for 12 to 18 months. This will stabilize and decompress your joints. Splint therapy will not fix the root issues, but it will get you out of pain and get to were we can treat the real problem. We will do this with expansion. We will widen your upper palate by eight to ten millimeters. And with aggressive protraction we will be able to get four to five millimeters of forward growth. Once we have achieved the necessary expansion, we will use braces to align everything. The process of expansion will take 6-12 months followed by 18 or so months of braces. The treatment will be all about function. We will fix your jaw and your bite. And since form follows function, you will have a beautiful, wide, straight smile. I provide complimentary whitening to all patients when they complete treatment. As a thank you of sorts. And my hygienist Lisa is VERY good at it. I think Janice’s smile is a good example of that. And speaking of Janice’s smile, she can tell you the financials.”
Janice gave Tara a big smile and said “so, the cost of splint therapy would be $1500, the custom marpe treatment would be $4500, and braces would be $5500. But, if you do all three Dr. Brad will knock $1,500 off. Essentially you will get splint therapy for free. Total cost will be $10,000. But, I have good news. I have already spoken with your insurance provider. And while your plan does not cover elective cosmetic procedures, they do cover sleep apnea treatment, which your case would fall into. Your out of pocket expense will only be $1,500. For $1,500, Dr. Brad will give you your life back. Honey, you are entirely too young to go through the rest of your life in pain.”
Tara sat there in silence looking at the table and the assortment of appliances. Dr. Brad asked “what do you think? Do you have any questions?”
With her eyes still studying the table, she said “I know I need to do. I should do it. But it just sounds like so much. And braces at my age? I just don’t know. Could we do invisalign?”
Dr. Brad responded “unfortunately, invisalign can not address all your needs. Braces will be necessary for at least a few months, though I could transition you to Invisalign to finish your case. It would add $5,000 to the cost of treatment. I have had several patients that planned on transitioning to invisalign. But not a single one has. Because every single one has realized having braces is a big nothing burger. Every single one has just elected to keep their brackets for the duration of their treatment. You met one of those people today. But, like Beverly, I can fit you with clear ceramic brackets and wires, and for the same price as metal. These modern ceramic Lightforce brackets are almost as discreet as invisalign and all the attachments that come with it.”
Tara asked “will I need that big appliance? The one you said your wife is getting?”
Dr. Brad said “let’s not worry about it now. That would be down the road. But you would be a candidate for it and it would shave at least a few months off your total treatment time. But, we could also get the same results from a series of different appliances, it just wouldn’t be as efficient.”
Tara didn’t understand why, but again she felt the same mix of fear and fascination as earlier. She asked “can I see it again?”
Dr. Brad took the appliance from Alex once again. He held it up, gazing at it like a proud papa, and said “it really is amazing if I do say so myself. I am quite proud of it.” Tara had looked at the other appliances on the table as Dr. Brad had explained her treatment. Mandy had held them up and demonstrated them as Dr. Brad had been talking. But this appliance was in another league.
Dr. Brad explained as he hinged the orthodontic model “you see here we have an expander top and bottom. The top expander is an eight screw custom marpe, or miniscrew assisted rapid palatal expander. The bottom is a standard hyrax expander. Both of these appliances by themselves are very common. But unlike standard expanders, to attach them I am utilizing bands for all but the front six teeth. This will provide much more strength and symmetry during expansion. So that is a little different. But what really makes this appliance stand out are those two Herbst arms you see connecting the two expanders. This will allow me to adjust Megan’s bite precisely. In addition, I have come up with a very ingenious feature.
Now, I would never discuss another patient’s case with another patient like I am doing now. Except my dear, sweet wife’s. Megan mouth breaths when she sleeps. Mouth breathing is horrible. I have been having her wear a chincup appliance at night. It is big, bulky and not the most comfortable thing in the world. But it is worth it. Megan does it cheerfully because wearing it, at least after the first few nights of adapting to it, leaves her feeling more rested and refreshed. But many patients will not wear a chin cup appliance. I have solved that issue with this.”
He held the appliance up close to Tara’s face and said “see how the bottom of each herbst telescope is a little thicker? This is to accommodate this tiny torx screw that is threaded into each arm.” He pivoted the appliance open and closed. “Now it is unlocked and the jaw is free to open and close.” He picked up a small screw driver, and with the model closed he made several turns on each screw. Then he demonstrated as he said “and voila, now it is locked close. A much less invasive solution to eliminate mouth breathing. The screws are very accessible for the patient, in this case Megan, so they will be able to lock the jaw closed at night and unlock it the next morning. This also has a myriad of other applications. Children that thumb suck? Solved. Post surgery patients that have always needed bulky, uncomfortable wiring in the past? Solved. Hey, it could even be the newest fad diet aid.” He laughed and said “just kidding on that last part. I am currently in the patent process for this, along with the Sleep Well mask like Alex is wearing. And Mandy should be wearing.” He gave a look over at Mandy, who silently stood and made her way out the door.
He continued “and also this invention.” He pointed at a rear molar band and said “you notice this hook? It is pretty standard for protraction cases. But this” as he pointed to a rounded piece of metal that ran along the outside of it “is not”. He took an elastic and placed it over the hook. He then took the same screwdriver from earlier and made a few turns on the torx screw that held the shield shaped piece of metal to the appliance. As he did, it tightened down covering the hook. There was a small slot in it from which the elastic protruded through. He continued “and now the elastic is locked in place. It can’t be removed without opening the shield. Or a spring can be used in place of an elastic on the rare occasion we need maximum force. This really is aimed at younger patients. But it can also be of use in adult cases too. I have had a few patients note that they sometimes take their masks off in their sleep without even realizing it. This will solve that.”
Tara looked on at the appliance. It was huge. Terrifying. And she really wanted to know what it would feel like in her mouth. Her focus was broken when she heard Mandy exclaim “look who I found!”
Tara looked up to see Mandy walking into the room. She was now sporting a facemask herself. Waddling along behind her was a very pregnant but very beautiful soft redhead with sculpted, model like features. Dr. Brad’s face lit up as he stood. He seemed to forget he was even holding the appliance in his hand. As he rushed over he said “hi baby, what a great surprise! What are you doing out and about? And where is William?” Before she could answer he gave her a peck on the lips.
She kissed him back and said “I need to run to the grocery store. And I thought I would just stop by to see if you needed anything. William is out front, Maggie is playing with him.” She glanced down at what he was holding and said “wow, what is that? It looks super complicated.”
Dr. Brad said “baby, this is your appliance. The one I have been telling you about. It just came in from the lab this week. I was just showing it to our new patient.” He gestured over towards the couch and said “Miss Reynolds, I would like to introduce you to my incredible wife Megan.”
Tara said “hi, it is a pleasure to meet you.”
Megan just stared at the appliance. She then shook her head and muttered “whatever.” She looked over at Tara and made her way over to the couch. She extended her hand and said “it is a pleasure to meet you. So, are you starting treatment with my hubby?”
Tara said “well, I don’t know, we were just talking about it.”
Megan smiled and said “you really should. I have never talked to anyone here who says that they regret it. We could be braces buddies. Or whatever that monstrosity is he is holding. I am going to be starting treatment soon obviously. Apparently that gargantuan hunk of metal he is holding is mine and will soon be in my mouth. But I know it will be so worth it in the long run.”
Dr. Brad had made his way over beside Megan. He put his arm around her shoulders and said “it will be so worth it. You are going to do so great with it honey.” He gave her a peck on the cheek.
He turned back to face Tara and asked “So, what do you think Miss Reynolds? Are you ready to be free of TMJ pain?”
Tara looked at Alex, who despite having her tongue crib back in her mouth and her mask strapped to her face, was smiling. She looked over at Mandy, who now was sporting a matching facemask, also smiling. She glanced at the appliance in Dr. Brad’s hand and then at Megan, who was smiling despite knowing she would soon be getting it installed in her mouth. Tara couldn’t believe she was doing this. But she looked at Dr. Brad and said “yes, I want to be free of TMJ pain. When do we start?”
Dr. Brad looked at her and said “right now.”
