Ortho Tips September 15, 2013

I want to talk about two things. Both items come from a bonding that I did on Friday morning. The first thing is I love to bond braces on teeth. The second thing is I think about sleep apnea problems with every case I see.

Did you see the newspaper today about the young girl who had stage four cancer because her radiologist missed a tumor behind her heart? I have a similar personal story with my wife. Her original dermatologist missed her cancer (non-Hodgkin’s lymphoma) by not interpreting full body itchiness with a swollen lymph gland as lymphoma. He treated her for a year and a half symptomatically without success. When she finally gave up and went to another dermatologist, she was into chemotherapy within 6 weeks.

My perspective on bringing sleep apnea into every diagnosis I make means, I don’t miss this kind of stuff.

Well, after bonding braces on an 11-year-old boy on Friday, his dad asked, “what do you think about my teeth?” I looked at him with a retruded maxilla, slightly over weight body type and an anterior crossbite and said, “Your case is not quite as simple as your son’s.”

I asked about snoring, nocturnal gasping and daytime tiredness and scored on two out of three questions. Then I asked about high blood pressure and scored again! I was on a role. Of course my health recommendation was an immediate sleep test with his physician. Orthodontic recommendations will be along the line of surgical advancement of the maxilla to increase upper pharyngeal airway, with upper and lower braces to correct the teeth. That diagnoses made me feel fantastic! I really felt that I was contributing to that family.

Now to the other feel good experience. I love putting braces on teeth. I’d like to let you into my head to understand why I’m so excited about personally putting braces on teeth.

Take the situation of planning the buccal contour of a crown for proper deflection of food during eating. If you get it right, everything is fine. If you get it wrong, the patient suffers with gingival grief! The result will be either recession or inflammation. The exercise only works if you have an understanding of the need for the proper shape of the crown.

Brace placement is the same. If I get it wrong, bad stuff happens. Because the of the curved shape of the buccal surface of the teeth, if the brace is too high or too low, the torque of the tooth will be off. (Torque is the axial inclination of the long axis of the tooth in the alveolar bone.) If I put it too far mesial or distal, the result is an improper rotation. Then I have to figure out how the contact points of each tooth should line up. Then I need to evaluate the gingival margin of each tooth since this changes if the tooth is intruded or extruded in error. Put all that together and multiply it by 28, which is the number of teeth that I often bond at the same time.

Now, include isolation from saliva and patient management during the procedure.

I think you can see why bonding braces is so challenging, exciting and fulfilling for me.

Just a quick note about sending me patients. Please send them! That’s why I write this blog. I want you to know that I need the patients and I want them. I’m experienced. I’m current and tech-savvy. Also, I’m excited about my work and I do a great job.

Your patients will enjoy coming to my practice.

Follow me on Twitter @waeseortho and on Facebook at waeseorthodontics@rogers.com.

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