Saturday, June 15, 2019

Orthodontia for Boomers!

I'm 69 years old. When I was a kid, my family was poor, and by poor, I mean no car, no indoor plumbing, bread-and-dark-Karo-syrup-for-dinner poor. So of course, no doctor visits unless you were dying, and nothing so luxurious as a dentist. My dad had almost no teeth, and my mother had false upper teeth, due a car accident in which she lost her upper teeth when she was young. 

When I was a kid, none of my six siblings owned a toothbrush. When I started school and became vaguely aware of dental hygiene and asked for one, I was told, "Go eat an apple; it does the same thing." 

When I was 8, we moved to town. For the first time, we had indoor plumbing, and I was enrolled at an elementary school where twice a year the teacher expected to see proof that each of her students had seen a dentist. We didn't have money for fillings (of course), so at my first dentist visit, two permanent molars which needed fillings were pulled from my mouth.

You get the picture. Eventually, I began taking good care of my teeth, but by the time I realized I needed to do this, there was a lot of damage to deal with. So for my entire adult life, although my gums are in great health, I've had a mouth full of fillings. In my 40s, I had all the silver amalgam fillings replaced with white composites, which have lasted well on my back teeth but not so well on my front teeth. Also in my 40s, I switched to a very expensive cosmetic dentist, who recommended a "smile makeover", but I couldn't afford the cost estimate of over $30,000, so I didn't do it. From time to time we did discuss the possibility of just putting veneers on my front teeth, but veneers are also incredibly expensive, specifically, I was advised that "to get a good result" I'd need a minimum of 6 veneers on top, at $1500 per tooth, "but 8 would be better".

20 years later, as a sexagenarian, I'm hardly in my cavity-prone years, but even without hard use, old composite fillings deteriorate, with the result that in the past 10 years I've had the composites on my upper central and lateral incisors redone close to a dozen times, each time losing a bit more tooth structure. Eventually, the very expensive, highly rated cosmetic dentist I'd been seeing retired, so I switched to a highly rated general dentist in my neighborhood.

The first time I went to see Dr. G, she looked in my mouth and said, "What's going on here?" "No dental care as a kid," I responded. "Yes," she said, "I can see that, but why on earth do you have all these composites on your front teeth? Hasn't anyone suggested crowns or veneers?" 

After reviewing my x-rays, she advised me that in her opinion, I had so little intact tooth structure that I'd be better off with crowns than veneers. Then she dropped the bomb, and asked, "Have you ever considered getting braces? Because look how your fillings and even your intact teeth are worn. If you don't correct your bite, you'll continue to have problems with any additional dental work." My teeth LOOK straight, that is, my central and lateral upper incisors are lined up as they ought to be, but after that, things get a little crazy. The permanent molars that my childhood dentist pulled so many years ago left gaps on opposite sides of the top and bottom of my mouth, so when my wisdom teeth came in (and I have all 4 of those), the gaps filled in, permanently changing the alignment, and not for the better. In the bottom of my mouth, my teeth have been moving sideways ever since, with the result that my lower teeth have not been remotely aligned with my upper teeth for years. In my upper teeth, one pre-molar is totally turned sideways and in addition to the cosmetic aspects of this, my entire adult life I've had an open bite on the left side of my mouth: my top and bottom teeth on that side don't meet by close to half an inch. I haven't had the headaches that plague some people when their bite is off like this, but for years I've periodically bitten the inside of my mouth due to this malocclusion, and more recently, as my teeth have continued to shift, I've worn down the enamel on my upper teeth, to the point that the bottom of my left lateral incisor is now crescent shaped. So rather than be put off at the suggestion of braces, the thought that all of this could potentially be corrected, even at my advanced age, THRILLED me.

Dr. G recommended Invisalign, a system of clear, plastic aligners that you wear 22 hours a day: you take them out and clean them while you eat, but the rest of the time, including when you sleep, you're wearing them. They're then changed each week until your bite is corrected. I could have gotten Invisalign through Dr. G, but after doing some research on the internet, I decided I wanted an orthodontist, and specifically, someone who had Invisalign's Top Provider rating and who could plan my treatment after scanning my mouth digitally with Invisalign's iTero 3 D Scanner.

Three of my four children had braces, but the thought of spending thousands of dollars out of pocket on straightening my own teeth at age 69 seemed incredibly self-indulgent to me. Also, when I'd mentioned that I was considering this option to 2 of my kids, although I know they love me, their reaction was "Really Mom, at your age?" But I kept thinking about the fact that if I didn't do it, I would just be setting myself up for more problems with whatever future work I had done on my teeth. I'd learned there was no charge (and no obligation) for the initial consultation with the orthodontist, so one Tuesday in May I called the office of the local orthodontist whom I'd decided I'd want to do the work, and 2 days later I was in his office for my free evaluation. "I guess I'd probably be your oldest patient", I said nervously, but he just smiled and said his current oldest patient is in his late 80s. He said he was intrigued by my open bite, which would be something of a challenge to correct. Nevertheless, there was no pressure to sign up for the treatment. One of his assistants provided detailed information on the interest-free payment plan, which required $500 down and then monthly payments of a little over $300 a month (no interest) for the next 15 months. That was doable financially, so I handed over my credit card and signed on, after which my mouth was scanned and a follow up appointment was made for one month later, at which time my first sets of aligners would be ready for me.

At the follow up appointment, I was excited but also nervous about putting in the aligners. I was worried they would hurt, but (so far at least) they don't hurt at all. I was nervous about being able to put them in and remove them, but that's easy to do. I was worried I wouldn't like the way they feel in my mouth, but they feel fine. My treatment plan is for 26 aligners, to be worn for 1 week each, or 6 months of treatment. The orthodontist explained that because of my open bite, it's possible that at the end of 26 weeks, I may need additional treatment to close that bite, but there are several options if that happens, and of course it may not happen at all.

So I picked up 13 of the 26 aligners and 2 orthodontic retainer boxes and made a follow up appointment for September, when I'll be halfway through treatment, and headed home. So far, so good!

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