So, it's been a little while...

My treatment has been flying by and it has been, for the most part, uneventful.

I have had a couple strange experiences with cold sensitivity that came out of nowhere and then disappeared on their own almost as quickly as they started.  A friend who is also an Invisalign patient recommended sensitive teeth toothpaste when I started and now I kind of understand why... I have some in my desk at work, but otherwise, I use regular tooth paste.

There was also a time that just recently ended (I hope, for good) that I did not like how my top teeth looked.  Additional space had to be created in my mouth especially in the upper arch.  Things get worse before they get better with this process and it's important to keep the result/goal in mind.  I've liked how my teeth look when I see them in the mirror as I'm brushing them over the past week or two.  It's a little hard for me to really see how straight they are getting because my brain can't get past the attachments.

Today was my first official appointment since I had IPR done and my attachments attached in July.   JULY!!! It took only a few minutes.  As I've seen - through Instagram, Facebook and the blogosphere - other patients with more frequent appointments, I wondered what in the world my orthodontist thought he was doing seeing me so infrequently.  But, Dr. P. clearly knows what he's doing.  There was even one tooth that was worrying me, to the point that I almost made an appointment, but then it moved into place and the 'extra' plastic that was making me nervous above it was no longer an issue.  I think because all the IPR was done at once that wonky tooth just needed it's time to come to march into it's new spot.

The best news from my appointment is that I can cut my wear back to 6 days per tray because everything is going well so far and I have the Acceledent device.

I have a dentist appointment next week and I'm hoping that they will be able to address some of the staining on/around my attachments.  I am a coffee drinker so staining happened on my natural teeth, too...  I guess I should say that I am a coffee gulper, because I've cut back to two cups a day with meals or snacks rather than enjoying it throughout the morning and early afternoon.

My next orthodontist appointment is February 19, 2015.  I should be on or near my final tray at that point.

Invisalign hygiene essentials

As soon as I made my down payment for treatment, I started searching for "accessories" for the system to ensure I was well prepared for all the brushing, etc. that would come with being an Invisalign patient.  It was pretty easy to order all these through Amazon.

A little over two months into Invisaign treatment, these are what I consider to be my essentials for maintaining good dental hygiene:

Retainer Brite cleansing tablets - One of the first steps in my morning routine is popping my aligners out and into their daily bath, with Retainer Brite cleansing tablets.  I do this in a plastic denture bath because I like the lid on the top to keep my cats out of it.  (The denture bath 'tubs' come as a two pack, so I use the spare when I travel.)  

Dental Appliance Cleansing Towelettes - These handy wipes are perfect for on-the-go!  I bought the 100 pack and still have a ton left at this point because I only use them when I can't get to a sink or, I've brushed my teeth at the sink but don't feel comfortable cleaning the aligners in front of random strangers in a public restroom after the weird looks I've received for brushing my teeth.  They are pretty big but you can fold them and/or use the corners to get into the grooves of the aligners.  

Colgate Wisp - I actually found these itty-bitty disposable tooth brushes at Target earlier this year when I was trying to get my teeth into shape before an overdue dental cleaning and exam.  I really try to rely on standard tooth brushes whenever I can, but these are good in a pinch.  For instance, during a day at Cedar Point when you're trying to travel light, they are perfect in a sandwich bag.  They're also good when the public bathroom seems sketchy or other folks in the public bathroom make you feel self-conscious about pulling out your plastic teeth.

Oral B Advantage (Glide) Floss Picks - My husband actually is the one that introduced me to the beauty of floss picks and, after trying a few brands over the years, these are my favorites!  They are super easy to use and I've mastered flossing without a mirror with them (maybe others have, as well, but this talent impresses my husband).  I floss with one after nearly every meal and, if I didn't floss after dinner and before my trays are in for the night, I make sure I use one before bed.  (I know the link is to a six pack of these - I usually get them at Target but they don't go bad and flossing is super important to dental health all the time, not just during orthodontic treatment. Stock up!)

Gum End-Tuft Toothbrush - The tufts on these toothbrushes are the perfect width for cleaning aligners.  I mean, a regular toothbrush works, too, but you can get these guys in there and really scrub, especially if your treatment includes attachments (and the corresponding bubbles for them on the aligners).  Whenever I'm home and especially before bed, I make sure to use one of these and some plain Crest toothbrush (not whitening or anything else special) to clean the aligners.  

I'm on tray 8! Time is flying! I deliberately stayed in tray 7 a day longer than usual. Days 1 and 2 have been pretty sore for me and I was tired of spending my weekends being uncomfortable. I figure that Mondays are already bad, so... 

Anyway, since I got the attachments on, I've noticed that not every tray feels the same way. Four (especially top) was a real pain in the shark to remove. I thought it was just because the attachments were new... Then tray 5 was easy to get out which led me to believe I had mastered removal. Then tray 6 was even more challenging than 4, so I realized it wasn't just the learning curve of post-attachment life with Invisalign. Tray 7 was more of the same.  The first few days, I almost cried because the frustration of trying to get them out was overwhelming. And now, on tray 8, it feels like tray 5- relatively simple to remove. Even better, there was the usual day one and two "pressure" or uncomfortable feelings. I suspect different ones are having different effects/impacts on my mouth. I do see a different, especially on top. The bottom front teeth ares still pretty crowded but in pictures, I can see how the teeth behind them are getting in line.

When I moved to this tray, I was a little concerned that my teeth weren't tracking correctly.  There were a few that seemed to show a bit more plastic in tray 7. Then, these trays (#8) fit fabulously. I've also noticed that the trays feel lose on the last couple days of wear and the new one almost seems to fit better.

Attachments and IPR

I need to start with a story about a friend who going through Invisalign, too.  The last time she came to visit me, she introduced me to a concept she tried at work during "Shark Week." Basically, you replace every curse word you feel like saying with "shark".  Thus, my appointment on July 18 is when shark got real with my Invisalign treatment.

My first three trays were set up by my orthodontist to have no attachments so I could get used to the aligners themselves before adding the craziness of attachments.

In order to accommodate some scheduling issues on the part of both Dr. P. and me and keep me from spending too long in tray 3,  the tech that met with me during my first appointment recommended I schedule for July 18. So, after wearing tray 3 for only 5 nights (with the AcceleDent), this happened:

Eighteen attachments!  Each blue blob above is a tooth colored "engager" or attachment to help move my teeth to where they need to go. 

The process of getting the attachments was actually fairly simple.  The tech first moved me back in the chair and then inserted a device to hold my mouth open.  Then she had to pull it out and have me remove my trays because they were so invisable, she didn't realize they were there at first.  Anyway, trays out and lip expander thingy back in... Then she used a suction thingy and had me bite down with it to hold it between my front teeth.  Next, she told me she was cleaning my teeth and proceeded to rub something along the outside surface of them. She suctioned a bit more and sprayed some water in, then some air, then did more cleaning type stuff on the outside surface. She advised me to keep my tongue behind my teeth.  As a result, I didn't taste or feel anything with my tongue. I mention this because I remember encountering some pretty nasty tastes when I got my traditional braces on.  Next she pulled the suction doohickey aside and inserted two trays - templates with the attachments - and shoved them really tight into my upper and lower arches.  Then she used a UV device on each tooth with an attachment to cure the adhesive.  She pulled the templates out and did just a little bit of scraping of the excessive adhesive.  Then I noticed something funny behind on of my teeth and she had to pick that out, which went fast, too. She sat me up and had me rinse.

The attachments felt weird when my tongue explored them. Really weird.  Four days later, they still feel strange and one on the lower front really bothers the inside of my lip when I have my trays out to eat. I figure it will keep me compliant. 

But wait, there's more!  Before the attachment procedure started, the tech brought me a one page handout on "slenderizing" or IPR. IPR stands for inter paroxysmal reduction, which is a fancy term for shaving down the sides/edges of teeth to make more room.  This is used as an alternative to extraction and/or surgery when there is crowding and issues with jaw size.  Each red line above represents a spot where part of my tooth was filed using IPR. The orthodontist came in and did all of the IPR called for since I will not see him again until I get to tray 20 or something. The number followed by mm represents the numbers of tenths of a millimeter of tooth removed. A millimeter is about the size of a period at the end of a sentence in 12 point font.  

I'm not gonna lie. The IPR was not fun but it wasn't nearly as terrible as I thought it would be. Dr. P. used manual files and called out for a single, then a double, then a single as he completed the prescribed work. I don't know if this referred to the tools being single and double-sided or single and double width.  In any event, it didn't take long and the most discomfort came from how he had to contort my face to get to some of the areas towards the back of my mouth.  I am usually really weird about filing (nails, etc.) but it wasn't too bad.  I think since I have had a few more unpleasant dental procedures under my belt - like fillings between teeth - this wasn't too bad in the grand scheme of things.

I was provided trays 4-36.  I noticed 37 and 38 don't have attachments. As long as I don't lose an attachment or experience any other complications, I don't go back until early November.

So far I haven't noticed any sensitivity or other issues from the IPR but I do really feel like my teeth moved a LOT with this tray.  It's also a real big pain in the shark to maneuver the upper aligner in particular to remove it to eat. 

Vacation + Invisalign = :-(

The subject says it all... I went on my annual vacation with my husband's family last week. The weather was wonderful and it was relaxing overall, but the Invisalign really out a damper on things. 

I couldn't enjoy beer on the beach and had to turn it down daily.  Daily!! I usually walk to the boardwalk each night for coffee and frozen custard but that was pretty much out of the question.  Two days I only ended up wearing the aligners for about 20 hours. The rest were closer to the optimal time of 22 hours. 

I suppose I could have broken the rules, but I really want to be compliant and hopefully be rewarded with completing my treatment on schedule.  Yes, it was a sacrifice but I told myself that next year, life will be back to normal and I can enjoy all the beer, coffee and frozen custard I want to with straight, beautiful teeth.

I thought I had mastered my temporary speech impediment after a week of tray one but when I moved onto tray two, I had a whole new set of problems! Other "s" words started causing me problems and I suddenly struggled with B's and P's. It has gotten better throughout this week. I am hoping tray three doesn't bring new issues. 

I have noticed a pattern with my first two trays:

- Day 1: tightness and pressure with the trays in

- Day 2: trays feel better, but teeth hurt while eating, especially biting

- Day 3: teeth still hurt a bit while eating, every so often the trays feel tight

- Day 4: trays are barely noticeable, still some tenderness while eating

- Days 5-7: all good

Things are still way better than I remember traditional braces. 

Seven days down!

It's been an interesting week, to say the least!  

I was able to wear my trays an average of 22 hours over the last week and used my AcceleDent consistently for 20 minutes each day.  The drooling has gotten better each day and I found it's easy to fit in while I'm doing chores around the house.  I'm waiting until I change trays before I got to bed tonight to do today's AcceleDent. 

I brushed my teeth at two bars (where we ate dinner), at a Cleveland Indians game and at the Cheesecake Factory.  Those were all pretty strange experiences.  And, I lost two pounds this week because I talked myself out of a lot of snacks!

The first few days were definitely the most uncomfortable.  At times, I didn't even notice the aligners.  There were also a few moments when I wanted to pull them out and be done.  Surprisingly, some of my greatest discomfort occurred when I had the aligners out on the second day.  None of the discomfort has even come close to the pain I experienced with traditional braces.  It's more like how things felt when I would go too long between wearing my Hawley retainers and decided to put them back in.  Over the last few days, they've gone to being barely noticeable.  I have worried a bit that I may forget I have them in at some point and drink a non-clear beverage.    

Since Thursday, they have been pretty easy to remove and put back in and, even though I don't see a difference yet, I already feel like flossing is easier on the left side of my mouth.  I struggle more getting the bottom ones out and, even with the Pultool, I worry about getting the bottom aligner out once there are attachments.  

My lisping has improved, but I still have issues with some words, especially those that have a combination of the letters that mess me up, like 'this' or 'choices' for instance.  

None of the coworkers I have seen around the state this week have commented on them.  I went to a cookout for July 4th and no one noticed them.  I also wore them Tuesday for a volleyball tournament and my team didn't notice until I blurted it out at dinner.  

Backing up... The scans

One of the big draws to both Invisalign and the orthodontist I selected was the availability of the Itero scanner, a technology whichever replaces the need for those awful dental impressions.  

I had to wait until after I had some fillings done on two teeth because the fillings changed the shape of my teeth a bit and capturing an exact image (or impression) is critical to Invisalign being successful.

The gal doing the scans told me we could take a break at anytime. The camera blows air and she warned me my mouth might get dry during the scanning process as a result.  The machine beeps as each tooth is read and calls out the position.  It was over in about 10 minutes and really was not the slightest bit uncomfortable, at least, as dental procedures go.  The other awesome thing was that I was able to see a rendering of the final results a few minutes later!

Well, today was my first day of Invisalign!

I was shocked when Dr. P's office called me last Tuesday to let me know my aligners were in.  That was less than 2 weeks from my scans on June 10!  I suspected the super fast speed had something to do with Dr. P's status as an Elite provider and he confirmed it today - he usually gets cases back in <3 weeks and has priority because of his provider status.

The first thing I did when they called me back was have another X-ray.  Apparently Dr. P. wanted to see something else about my bite to inform something later in treatment.  I wasn't paying much attention because I was so ready to the show on the road.  I got to pop the aligners in myself.  They went in pretty easily and I only had a little trouble talking.  It has gotten better as the day has worn on, but I'm still having trouble with the "s" sound, whether from an s, c or z and some "th" sounds.  So much better than I expected!  I sang along in the car on my drive home.  Seriously, "I Hope You Dance" is made for conquering a slight lisp.

I will get a lot of attachments (tooth-colored buttons that kept guide/direct/push the teeth) at the next appointment and have some IPR down the road, too, although I don't know when.

During my scans earlier in the month, the gal doing them talked to me about Acceledent.  She recommended that I consider it if I ended up with more than 30 trays.  I had heard of it but didn't think I would be able to swing another $1500 for my treatment.  I told her as much and she let me know that it's less than that and that Dr. P. believes in it so much, he was subsidizing the cost and patients could have it for only $310.  Well, I ended up with 38 trays so I decided to make that investment.  I will now be wearing my trays for 7 days at a time rather than 10.   This means I could be in retention next April!

I charged the Acceledent as soon as I got to the office after my appointment and did it while I was working during the afternoon, as I had the whole office to myself.  It was interesting...  It didn't hurt or anything but I feel like I was going to drool.

I started to feel some pressure in my top teeth during the drive to my office, but it's lessened since that first hour.  After I did the Acceledent, it felt even better.  I was really expecting to be more uncomfortable, like back in my late 20's when I was still sometimes wearing my retainer and the space between those times was  too long.  It feels nowhere near as awful as traditional braces did 25 years ago!

I only had my trays out for 50 minutes today to eat lunch and dinner and brush, floss and rinse my teeth.  I know I can't keep that up every day, but every hour of every day counts.  

Day 1:

Preparing for a consultation appointment

I first started researching Invisalign in September 2012 and put it out of my mind for a while and instead focused on paying off my car.  Still, I had plenty of time to think about it and prepared a list of questions in advance of my appointment. I would recommend anyone considering treatment do this before their consultation. Mine are grouped below and include answers and my musings.

1. With Itero (Invisalign's proprietary tooth scanning technology), is the treatment planning/development process really done completely without impressions? 

Another practice I explored that had Itero still used impressions and, since I was trying to avoid impressions, this was a priority for me.  I also learned that the impression process and material had improved a lot since my last experience in the mid-1990s so it doesn't sound nearly as terrifying. (Terrifying = drippy and gag and vomit inducing.) But, this office does use Itero for all Invisalign treatment. I won't have to have impressions unless I lose or break a retainer. They make the replacement retainers in-house in 24 hours. I'm looking into ordering an extra set at the end of treatment to delay the need for impressions, even if the technology and patient experience has improved.

Since my last post, I made an appointment for my scans. It's scheduled for June 12.

2. What percentage of patients need refinements? Is there an additional cost? What if something happens to my teeth during treatment?

I learned about 25% of patients need refinements or additional trays after the initial treatment is completed. These may be due to things the doctor and/or the patient want to address when the initial course of treatment is complete. Up to three sets of refinements are included in the treatment cost.

If something changes in my teeth (cavity, chipped tooth, etc.) a mid-course revision can be done. The coordinator that I was meeting with didn't think there was a charge for this but she wasn't entirely sure.  Fingers crossed I don't need to find out.

(This may vary by practice and Invisalign system.  That is, I am doing the full adult Invisalign but Invisalign Express and Invisalign Teen have different features and prices.

3. Are there recommended strategies for preventing decay?

I found some complaints on the web about people that ended up with cavities during/because of treatment.  Many people seem to think excellent oral hygiene habits (brushing and flossing after every meal/snack) are the key but others maintained that they did this and still had cavities. This practice prescribes an oral fluoride rinse to be done each day to prevent decay and strengthen teeth.  I'm not due for my next cleaning and exam until November which hopefully will be four months after I start Invisalign treatment, but I'm thinking about going every four months during treatment after that so if I do have issues with decay, they are caught and addressed early!

The daily hygiene routine that the coordinator described didn't seem that intense, but I am planning to brush my teeth after all food and floss daily for sure and maybe floss even more often.

4. Tell me about attachments and filing.

I was informed that I may need attachments (no idea how many) and might have IPR (interproximal reduction, or a slight reduction of my some of my teeth) done.  This was actually addressed/mentioned without me asking, but it was on my list of questions. As I've been researching Invisalign, I discovered many patients were not informed about this at the outset of treatment.  And, the Invisalign website really doesn't address this.  Both sound less than pleasant, but I understand the reasons for both.  IPR is used as an alternative to extraction when there is crowding. The orthodontist thought I might need this on a few teeth but also said its possible I won't.  I am hoping if I do need attachments, it won't be on a lot of teeth.

I was also warned about two other things I hadn't uncovered in my research. One is that some people have teeth that are fused to the jaw bone and don't move. This is rare - this orthodontist has only encountered it a few times - but can affect treatment/results when one tooth insists on remaining firmly entrenched.  The other is "dark triangles." These occur between teeth at the gum line when the teeth move but the gum doesn't "fall" because it's been caught there so long.  Teeth will be straight but patients may be disappointed in this less-than-perfect result.

The coordinator also noted that sometimes the orthodontist recommends a periodontal evaluation before treatment begins.  He checked my gums with a probe but didn't recommend this for me. (My pocket depths at my dentist appointment last month were all less than 3 which means my gums are in good shape overall with no signs of active periodontal disease.)

5. What is the retention advice? Which retainers are used?  Are they included in the cost of treatment? How much are extras?

The orthodontist told me I would wear retainers at night forever.  Initially, the wear would be daily but eventually, I could wear them just a few nights a week as long as there are not fit issues.  He uses plastic retainers, at least for Invisalign patients. These are similar to the Invisalign trays.  One pair is included in the cost of treatment.  They can make replacement retainers in their on-site lab within 24 hours, following impressions. The cost is $150 each, $300 pair.

6. Will my teeth be shaped at the end of treatment?

My teeth may be shaped at the end of treatment. This didn't happen at the end of my first course of orthodontic treatment and I still have mamalons on mine. I guess I'll cross this bridge when I come to it.

7. Are there ways to "catch up" on missed hours, like on Thanksgiving?

This practice recommends wear of the aligners a minimum of 20 hours per day.  The coordinator I met with said that they recognize there may be special occasions that prevent this from happening but not every day is a special day.  She made it clear the aligners won't fit and problems will occur if I slack in wearing them.  She also described how a typical day would work with eating, brushing, etc. and 20 hours per day seemed very doable.

8. Would traditional braces be a better option for me?

I added this question midway through my consultation appointment after learning impressions were better now and that I had some serious issues.  The orthodontist stated very strongly that he felt that Invisalign was the best option to address my problems becaus of the way the aligners act on the teeth.  His bachelors degree is in engineering and that's pretty cool to me because, to me at least, orthodontics is tooth engineering.

9. How often are appointments?

I was told appointments would be about every three months. This was even less infrequent than I expected.

10. What is the cost? What types of financing are available?

The cost for this treatment is just shy of $6000. I am fortunate that my dental insurance will cover $1500. I was presented two payment options: full with a 5% discount or $1000 down and a 20-month payment plan.  The monthly payments are a little less than my cheapest car payment (which was $199/month) and a little more than my monthly cell phone bill ($110).  This a reimbursable expense for most flexible spending accounts. While I didn't plan for this in 2014, I will for 2015.

The cost is $1000 more than what my dentist's office quoted me in late 2012, but I feel better paying for the expertise of an orthodontist.

Adult orthodontics - My Contemplation phase

I'm seriously contemplating Invisalign, so much so that I've created a blog about the journey that I haven't yet officially signed up for.

I had braces in junior high that pulled down my fangs and straightened my teeth. I followed the retention advice given at that time...which was not forever! My teeth have since shifted and it was primarily a cosmetic concern, coupled with frequent accidental cheek biting, that led me to explore orthodontic options for adults.

My last dental impression for a replacement retainer about 20 years ago was a miserable experience so the possibility that I could receive treatment without impressions was something I wanted to explore. Enter the Itero technology and me finding through Invisalign's website an Invisalign Elite provider in my area that offers this technology.

I had a very thorough evaluation on May 29 by Dr. Papandreas and his team. I discovered that my issues are much more significant than I expected:
1. Chief concern: alignment and crossbite
2. Prior orthodontics from outside this office
3. A separation of anterior teeth is interfering with proper dental function (this was my "cosmetic issue"
4. Crossbites: upper right second molar, upper right first molar, and upper left first molar
5. Narrowing of upper teeth/jaw and excess width of lower jaw relative to upper
6. Arch length deficiency: upper and lower crowding of teeth
7. Ranges of motion: Max open/right/left/protrusive: 49/12/14/1

Given this constellation of problems, Dr. P. feels that Invisalign is the best treatment for me and expects my treatment to last a minimum of 14 months(!)

As an aside, I left feeling that Dr. P. felt my orthodontic treatment nearly 25 years ago wasn't very effective since nothing was really done to address the issues with my jaw size.

I was presented with a very reasonable payment plan and discovered my dental insurance has a very generous orthodontic treatment benefit.  (That's right-I am a real consumer not receiving any benefits from Invisalign to share my thoughts on my experience.)

I need to get a couple of small cavities filled next week but after that, I think I'm going to get this show on the road!