Trusting dentists…and a review of my visit at Aqua Dental (Sweden)

Judging from the comments on my blog, I’m not the only one who doesn’t trust dentists 100%. More than once, I’ve been to several dentists for dental examinations just to see if they come to similar conclusions. I have never found that they do and when confronting them, I have even experienced that they refuse to provide me or another clinic with the patient notes. (Yes, I know that they are legally required to do so, but it’s not the first time I have found that the main purpose of regulations in this field seem to be to enhance public trust in the profession, not to actually protect individuals). The damage that dentists have done to my health, coupled with the painfully acquired knowledge of my complete powerlessness as a patient after that damage was done, have obviously made me much more suspicious towards dentists than what you’d expect from someone who is otherwise skeptical towards conspiracy theories of all kinds. Thus, when my dentist (the one I trust the most: one in Italy that I have been going to for years) found two cavities “due to the absence of flossing” that he could repair “for the price of one” just after hearing me mention that recent studies have found that although flossing has been recommended for decades, there aren’t actually reliable studies showing beneficial results…I wasn’t prepared to book in a visit to drill and fill before having a second opinion. I am actually one of those people who floss daily, as I have experienced such debilitating tooth ache that I am prepared to do anything to prevent caries even if it doesn’t have any proven effect, as long as it can’t do any harm. This made me curious to find out whether it was just a funny coincidence that this dentist found a cavity between the teeth of an avid flosser just after hearing her complain about the scientific evidence supporting its effect, or if it might have been the case that he saw an opportunity to book in a lucrative appointment. Of course I realize that in this case (just like for most conspiracy theories), I couldn’t disprove that I had become too paranoid or prove that the dentist was dishonest, but by seeking a second opinion, I could make myself more confident that no unnecessary drilling was done.

Thus, I was delighted when I was offered the opportunity – four months later – to try out a dental examination at a Swedish clinic (Aqua Dental) free of charge in return for an honest review. (Well, the annual contribution from the state was used up, but I will get the rest back). Note that no one at Aqua Dental knew of this blog when offering me this opportunity – they searched for interested people via Facebook and I applied. Although this post is also an honest review, it is not the one I had to complete for the refund. Also, the dentist did not know that I was one of the people trying out Aqua Dental for free, but she might of course have guessed.

The examination at Aqua Dental felt thorough and the dentist competent and reliable. She found no cavities large enough to require drilling. When I told her about the exam in Italy, she said that I have several small cavities but that it is better to leave them, as they progress slowly and may even heal by themselves. She said she’d tell me exactly where those small cavities were, but in the end, we both forgot. I really can’t blame her for forgetting, as I kept asking questions and also forgot about it myself. Clearly, she could have been able to earn more money by telling me that I needed to have those cavities filled – her examination was thorough enough to ensure that she could not possibly have missed them – but she didn’t. (The reason I’m mentioning that is that I once had a ridiculously quick (but full price) examination done during which no cavities were found, and shortly after, another dentist found several during a much less rushed exam). She also removed some tartar without charging any extra, as she said it was too little to require a visit to a dental hygienist. Followers of this blog have probably realized that I’m not an easy patient, that I ask a lot of questions and cannot stand dentists who think that their training means they don’t need to listen to their patients to understand each individual case. In that respect, too, this dentist was ideal – she patiently answered all my questions, provided plenty of information and clearly took everything I said into consideration when suggesting how to move forward. The examination was more expensive than most of the ones I have had previously (my dentist in Italy doesn’t even charge for it!), but if paying more for that means I can avoid unnecessary (and costly!) drilling, it is well worth it!

Although this is not directly related to the bigger problem of regaining a functional bite, I thought this would be a good place to write a review, as trust in dentists has been a recurring theme here for obvious reasons: it was a dentist who ruined my bite, causing enormous biomechanical problems that I have had to live with ever since. As patients without training in dentistry, we are extremely vulnerable and easy targets for dentists who are only interested in money – there is no easy way of distinguishing them from the ones who care about their patients’ health. Second opinions are expensive and don’t offer any guarantee. I know that some dentists argue that early treatment can prevent more serious damage and that others think it is better to wait and see, as small cavities can heal, but dentistry shouldn’t be entirely arbitrary. I will never know whether the Italian dentist sincerely thought that having those small cavities filled would have been better for me, or whether he just wanted to make sure that he got paid for his time (in Italy, dental exams are free, which I think is a bad idea if you want to avoid unnecessary treatment). Likewise, I will never know whether the Swedish dentist decided not to recommend treatment of my small cavities just to give me the news she knew I would have loved to hear, or whether she would have made the same judgment had she not been aware that some patients were there to judge her and send a review to her employer. All I can do is give both the benefit of a doubt, and conclude that I wish I could always get a second opinion without having to spend a fortune.

I’m curious to read about other people’s experiences, especially if you have gone to several dentists to get more opinions on the same diagnosis!

The latest visit…and some more about my experience with the Myobrace

After several years, I finally plucked up my courage to try yet another orthodontist. This one had been recommended to me both by my dentist and by some friends, and I had also followed his research for some time. In addition, he had actually taken the time to correspond with me via email despite his extremely busy schedule. Thus, I knew that he was an exceptionally experienced and knowledgeable orthodontist, genuinely interested in his work and in making contributions to the field. (I also knew that he was critical towards some “alternative” approaches, such as ALF).

I’ll start with the positive aspects of the visit: the visit felt thorough and the orthodontist gave a professional impression. No other orthodontist has checked my muscle strength and expressed such clear understanding of the effects of my bite problems on my energy levels. I also felt that he made a stronger effort to make a complete diagnosis, and then explain it to me along with the proposed treatment. At the end of the visit, I was given his notes for the visit, clearly stating both diagnosis and suggested treatment. A copy was also provided for my dentist. Although these are the kind of things we should expect from all orthodontists, I have always been disappointed before – and I have been to a large number of orthodontists in several different countries. (This was the second one I had been to in Italy and the first one was the very worst of them all!)

Now to what I felt was negative: I was told that I have a short mandible and that I would need surgery to have it lengthened. To me, this makes no sense: I did not have overbite before the wisdom tooth was extracted and my bite was ruined, but since that extraction made me lose all stability and contact between upper and lower teeth, I soon got used to forcing my mandible back to achieve at least some contact. Dentists then tried to adapt my bite to the new position by filing down my wisdom teeth on the other side, which only exacerbated my stability problem. This orthodontist actually wanted to file them down even more!

Interestingly, he was surprised that my TMD was not more severe considering the extreme severity of my overbite and malocclusion. Just like all previous orthodontists apart from the ones I saw soon after the extraction, he did not believe me when I said I had no problems before that extraction. (Those I saw soon after the extraction, on the other hand, were shocked by the incompetence of the dentist who performed the extraction, as they said the devastating consequences should have been obvious). I think there are two reasons why my TMD is not (yet) as bad as it “should” be: it takes time to develop, and I have made an effort to hold the mandible in the correct position even though it means no contact. The Myobrace certainly helps with that – after wearing it for a while, it doesn’t even require any effort. The orthodontist told me the Myobrace is useless because it is soft, but since that visit, I have tried to wear it 1-2 hours a day. When I don’t, my jaws start clicking and I get cervicogenic headaches.

To me, the natural position of my mandible is clear: it is where my mandible was before the dentist ruined my bite. Marie Tullberg, a Swedish oral myologist, also told me of a quick and easy method to check how the mandible should be positioned. (She has also invented a relaxation tool that offers relief to patients with tinnitus and/or TMD – see http://www.tandlakartidningen.se/material-och-metod/tinnitus-tandlakaren-kan-hjalpa/, in Swedish only). If you put the tip of your pinkies in your ears and then move your jaws as if chewing, you should not feel the TMJ pushing your pinkies!

As I’m afraid that this orthodontist will keep insisting that my mandible should be positioned where it currently is when I chew (he got rather annoyed when I said I felt it was a question of position and not length) and that my teeth should be filed down even further, it looks like I still haven’t found the right orthodontist for me.

As always, comments and suggestions are very welcome. The fact that I disagree to some extent with all orthodontists I have been to see does not mean that I think I know as much or more about orthodontics as they do, but that I know my problem better than them – from having suffered for 10 years due to the mistake of one dentist, and learning something from each specialist. It’s rather worrisome that they hardly agree with one another on anything, but it also means that I can keep telling myself that I will eventually find someone with an approach that makes sense to me.

Another step…?

As those who were hoping that this blog would describe a journey towards recovery have probably realized, I largely lost hope after the failure of my latest intense efforts to get treatment. That was in Ireland, about 3 years ago, and before that I had tried in other countries and with numerous orthodontists and other dental professionals. My malocclusion and all the problems that it gives me are still constantly on my mind, but with a small child to look after and so many failed and costly attempts to reverse the damage done by one dentist (and worsened by some of those I consulted for help), I didn’t have any energy left to keep trying.

The repercussions on the rest of my body keep getting worse, though. The bad posture that my neck and spine are forced into does of course make decent body alignment impossible, and the more I try to remedy those effects, the clearer it becomes that it cannot be done without addressing the root cause. It’s exhausting and there is no way it can improve by itself.

I think I have mentioned in replies and/or comments that I would like to see an orthodontist in Trento, Italy, who have been recommended to me. I do of course realize that in theory, I need an oral myologist rather than an orthodontist, but I have already tried a few and in Italy, they don’t even seem to exist! More than a year ago, I had some email correspondence with this orthodontist and I have been following his research for some time (although – as I hope is clear to all readers – I have never worked with or formally studied any kind of dentistry: my own education and research experience are in medical research not related to dentistry), but not actually been to see him. My malocclusion problems were too exhausting for me to deal with and I was too afraid of yet another costly failed attempt.

This morning, however, I finally plucked up my courage and phoned to book an appointment (and I did it in Italian, which is a feat in and by itself!). My appointment is in a couple of weeks and in preparation for it, I will of course read the advice and experiences shared here by those who have commented, and I also welcome any new advice! I’ll keep you updated on the outcome of the visit…

A little gem of a book – “Buteyko meets Dr Mew” by Patrick McKeown

While waiting for my appointment (I have to travel for 12 hours to get there and I arrived an hour early), I continued reading a book that I started last time I was there: “Buteyko meets Dr Mew”. A great little book that I would strongly recommend to anyone with malocclusion or asthma problems, and to anyone with small children! It has lots of breathing and swallowing exercises and also explains everything in a clear way. The references are also great. I now have my own copy, which I ordered from bookdepository.com. If you do read it (or if you’ve already read it), please leave a review on Goodreads to get the word out! I would of course also be grateful if you would comment on it here.

The book is packed with interesting and useful information. Here is an example:

-When the UK TV programme “Dispatches” investigated “whether the standard orthodontic treatment of extractions to make room for teeth actually damages a child’s face[…], 700 UK families were interviewed. More than half of the children undergoing treatment had teeth extracted. A comparison was made with treatment in California, where extractions take place in only 15% of cases. There many orthodontists apply expandable braces to gently widen the jaws to make room for the teeth. In addition, children are taught exercises, including correct swallowing and nasal breathing as part of their treatment”. (Am I the only one who suddenly wants to move to California?)

I also love this quote, as it offers some hope for the future (while sadly reflecting why science doesn’t progress faster than it does): “A scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.” Max Planck

Everything in the book resonated with me apart from some of the comments regarding nutrition, which didn’t seem very logical. One reason why crooked teeth are more common in Ireland now was said to be that oat porridge is no longer the standard breakfast. I certainly believe that the change of diet has a large impact, but I really don’t think it’s because of lack of mushy cereal! Besides, if oat porridge was capable of giving a child perfectly aligned teeth, I would never have needed any treatment. I had oat porridge for breakfast (and sometimes even for lunch) for 35 years…

 

Second visit (3 months with the Myobrace)

Last week, I returned to Ireland for my second visit to my orthodontist. I was worried that the Myobrace did me more harm than good, as it has been preventing me from sleeping at night, as well as given me a dry mouth and a bad headache every morning. I have never been a mouth breather at night and whenever my daughter let me sleep all night, I woke up refreshed and eager to go for a run. Since I started with the Myobrace, I get out of bed exhausted and in pain. I was hoping that it would at least have had the desired effects so I would be able to progress to the ALF appliance. Potentially positive effects I had noticed were that my teeth were somewhat more aligned, a small space had appeared between my lower front teeth and I now find it less tiring to keep my jaws aligned (pushing my lower jaw out against my overjet). One tooth had also tipped inwards, which I think was an undesired effect of the fact that I cannot center the Myobrace in my upper jaw. During the visit, I was told not to worry about whether the Myobrace is centered, as “the Myobrace is supposed to do the work, not [me]”. As teeth are easily moved back and forth, my orthodontist also didn’t think that the tipped tooth was anything to worry about. When I told him about my sleeplessness and dry mouth with the Myobrace, Dr McDermott said that this must mean that I breathe through my mouth “even when I wear the Myobrace”. This I find very hard to believe, both because it is practically impossible to breathe through one’s mouth while wearing a Myobrace and because I only ever breathe through my mouth at night if I have a really bad cold. I discussed this with his assistant today and she said that the dry mouth is likely to be due to clenching all night. That makes sense, as I certainly feel that I need to clench quite hard to make the Myobrace stay in. During this visit, Dr McDermott also brought my attention to my swallowing. I have always had problems swallowing and this actually led me not to drink anything for many years (!). My body clearly got used to it (which isn’t to say that it was healthy!) and I didn’t even eat particularly moist food during that period. I have ran many marathons without drinking a drop of water and although sunstroke and extensive racing in temperatures exceeding 45°C eventually led me to get my body used to water, I’m well aware that I still don’t swallow correctly or drink sufficiently. My incorrect swallowing technique probably plays a large part in my malocclusion. The bad news was that Dr McDermott doesn’t think I’m ready for the ALF appliance, seemingly because I’m not friends with the Myobrace. I certainly wasn’t feeling great on my way home after the appointment – it’s happened so many times to me that dentists, orthodontists and oral myologists have told me that the reason for my problems is that I do something that I know I don’t do, and now that I thought I had finally found an orthodontist who respects his patients and truly want to help, he doesn’t believe me when I say that I don’t breathe through my mouth at night. (Usually they tell me that I grind my teeth, and they insist on this even when I inform them that I never have headaches or TMJ pain – and some even don’t give in when they see that it is physically impossible to get my teeth to touch each other!) Will this treatment too fail because I’m not a typical patient with TMJ, headaches and nightly mouth breathing? I may well breathe too much through my mouth during the day, I definitely swallow incorrectly, I clearly had malocclusion even before it started giving me any problems (which was 8 years ago, when a dentist pulled out a wisdom teeth and I lost my ability to chew food), and I definitely think that gentle expansion using ALF seems right for me, but I guess I’m unusual in that my main problem is that the total contact area of my teeth is 1 mm and that I therefore cannot chew food properly. If anyone reading this has a problem similar to mine, please let me know, as I’ve never heard of anyone else like this and neither had any of all the professionals I’ve seen. Today I phoned the clinic to discuss these issues, as I’m really worried and unsure of whether it’s a good idea to further sacrifice my mental health (prolonged sleep deprivation isn’t the healthiest thing you can do to your brain!) if the Myobrace isn’t likely to have some positive effects very soon. I was first asked to phone back at a specific time and then to phone back next week. I’m clearly not an easy patient and I hope they won’t give up on me, but I think it’s important that my treatment is based on my case and not just the typical case. For this reason, I’d like to know what kind of progress is needed from using the Myobrace to enable me to progress to the ALF. I’ll post again if my next call yields any clarity, and I will then try to be more concise. (Could it be the lack of sleep that makes it so difficult for me to express myself briefly and concisely?) Comments are greatly appreciated. I would especilly like to hear about other people’s experiences with the Myobrace.

Case studies (on the correlation between adult malocclusion and certain habits in childhood)

One of the oral myologists that I have seen for my problems told me that the reason why malocclusion is so common is that we move around more than before and consequently also mix races more. This theory would support my mother’s explanation for my own malocclusion: that I got the maxilla from one parent and the mandible from the other. My mother was joking, though, whereas my oral myologist seriously believed that the mixing of races cause the misalignment of teeth. Scary!

Research, on the other hand, show a correlation between malocclusion and a lack of breastfeeding, overuse of pacifiers and thumb-sucking. As Dr Mike Mew and others argue, these habits don’t only pose a risk when the first teeth emerge, but they can also lead to poor oral habits (in terms of tongue position, for example) that then reinforce the malocclusion.

If you read this, you are probably familiar with Dr Mews’ studies on twins and siblings, but it is of course impossible for us readers to know whether he cherry picked from a large sample. I find his theory convincing, but couldn’t resist trying it out to see if I could find instances where it does not hold up. For this reason, I try to check this correlation in individual cases whenever I get the chance. This far, I haven’t found any case where one sibling has perfectly aligned teeth and the other malocclusion, and the one with the perfect occlusion wasn’t breastfed for longer OR used pacifiers/thumb-sucking less. Here are my case studies:

1. Friend with perfect occlusion, whose brother has severe malocclusion. None of them was breastfed. My friend never used a pacifier and never sucked her thumb. Her brother used a pacifier for several years.
2. Siblings (boy age 7 and girl age 15). The boy was breastfed for two years, the girl was never breastfed. Neither used pacifier and neither sucked their thumbs. The girl needed orthodontic treatment (although her malocclusion was not severe), whereas the boy has perfectly aligned and functional teeth.
3. (This is one that doesn’t say anything yet, but it will be interesting to follow its development): 1 year-old girl with only one tooth this far, but that tooth is very crooked. The baby was never breastfed, but uses pacifier. (The other three 1 year-olds that I see frequently have aligned teeth and are all breastfed. One uses pacifier). If this can be seen in a larger population, it would point to a biomechanical advantage of breastfeeding: just like strengthening the muscles in your foot develops the arch, the kind of sucking used when being breastfed could stimulate the development of the maxilla and mandible to accommodate the teeth.
4. (New cases added the 23 May 2015): Boy who was breastfed for 18 months, other sucking/chewing habits unknown (as is the extent of breastfeeding during those 18 months, which is a common flaw even in scientific studies only referring to “exclusive” or “partial” breastfeeding). Two of the teeth in his upper jaw are completely misplaced and I can’t see how extractions could be avoided: they are in the gums above the other teeth. The other teeth are aligned.
5. When the father of the child mentioned in “case” 4 told me about how long his son was breastfed, a mother of three also contributed with the breastfeeding history of her children: all three were breastfed for “approximately 6 months”. At least two of them required braces to align and widen their bite. I will have to ask her about the third child. (The other two had actually previously told me about their orthodontics).

I will add more cases when I find them, obviously irrespective of whether they support the theory or not. The best ones are clearly when there are significant differences between twins with similar habits, since anyone who does not believe in this theory would argue that it’s all about genetics.

My own belief is that genetics play a role, but that enough breastfeeding and no pacifier/thumbsucking can still give a child with the “wrong” genes aligned teeth. (Kind of like the unproven theory that genes for myopia may give you myopia if you spend too much time indoors, focussing on nearby objects rather than the horizon, but those genes may not express themselves if the bearer spends most of the time outdoors, not reading books or staring at screens). It’s clearly multifactorial, with some factors having a positive effect and others a negative effect, and perhaps there are also individual differences in susceptibility due to genetics, as well. It may be that some children need to be breastfed longer than others to develop a perfect bite. Perhaps such a child would even have a greater desire to be breastfed for longer…or perhaps such a child would get their teeth later than a child who needs less breastfeeding. Clearly, some children are easier to wean than others. I was, for example, harder to wean than my brothers (one of whom had mild malocclusion, and the other has never had any problems at all with his teeth or bite) and I would like to find out whether this is of any relevance. I hope someone will read my blog eventually and give me their views and personal experience in a comment.

In case it’s not clear above, I would like to add that I’m in no way pretending that these kind of case studies – no matter how numerous – would ever prove anything. I present them here as a basis for discussion and to show how difficult it is to determine which actually causes malocclusion. Scientific studies have been carried out and I hope to get time to discuss their findings and possible design flaws in a separate post.

Neurocranial Restructuring (NCR)

A few months ago, a Swedish blogger being treated by Geir Olsen in Norway kindly agreed to meet up with me for a discussion. I was interested in hearing more about his treatment, how he felt about it and what kind of problems he had had before. During our discussion, we also talked about our experiences with manual therapies. He had tried quite a few and found that NCR was the most useful one. When we met, he had had two treatment series of four sessions each.

I had read a bit about NCR before, but it seemed too “airy-fairy” and unscientific for me. There are of course testimonies on various websites, but hearing straight from someone with no financial interest in it that it really worked for him always bears a lot more weight. I became interested and decided to find out more.

Again, I didn’t find the information online particularly convincing, and all the articles I found about it in scientific journals only discussed the (only) two incidents where people have been hurt. My concerns were that no prior testing is done or requested to ensure that the patient’s bony structure can handle the force (although, admittedly, the fact that not more people have been injured indicates that the risk isn’t great) and that many sessions may be needed for a significant and long-lasting result. The treatment is very expensive, but some practitioners have done it to themselves or near relatives hundreds of times.

The blogger clearly felt that his two treatment series had had a beneficial effect, and he later arranged for a practitioner to come to Sweden to give more people the chance to try it out for themselves. This meant that I would also have the possibility to try it and the timing would in theory be perfect: the sessions will be at the end of this month (Nov. 2014) and I have just started my orthodontic treatment, but haven’t been fitted with fixed braces or ALF yet.

I discussed my concerns with Ian Hedley, the practitioner who’s coming to Sweden. When I continued having doubts (as I keep losing small pieces of tooth and worry that my facial bones may also be brittle), he suggested I’d write straight to Dr Dean Howell, the founder of NCR. He replied that his oldest patient was 96 years old and that he regularly work on his mother, who is 90 years old, and that none of his patients have ever suffered a broken bone with NCR treatment. The amount of pressure used is less than 25 pounds and the doctor who injured the 51-year-old woman was using excessive pressures and not in the manner that he was trained. Dr Howell assured me that with an aware therapist, there is no risk, as the pressure is discontinued when the bones’ joints open. He also explained that although NCR is an accumulative treatment, some long-term changes can be accomplished in the first series and that they “will not entirely leave the structure ever – even if the symptoms that annoy the patient do not cease”.

I still haven’t made up my mind. My man, who is normally not as “obsessed with science” as I am (i.e. he hasn’t spent most of his life studying science and working with scientific research, and he also has a much more developed and trustworthy intuition than I do!), is completely against it. He argues that the practitioner cannot know how much pressure he or she applies, as no manometer is used. The amount of pressure will depend on applied grip strength of the person. If there is an obstruction (such as a narrow passage through the nose, which was the problem the 51-year-old woman had and tried NCR to cure), it would be natural to apply more pressure to deflate the balloon. By the way, we have actually measured my man’s grip strength with a manometer. It was 160 kg. (I definitely wouldn’t want him to perform NCR on me!) Here is a photo of him (using his strength without putting anyone else in danger), because a blog post looks nicer with a photo, but I have no photos of NCR.

Two weeks with the Myobrace

Now I’ve had the Myobrace for two weeks and worn it for five nights, and at least one hour each day. I would like to wear it more during the day, but I also try to talk to my daughter as much as possible, as I’d like her to learn my language. She has her own language now and although I’m slowly learning it, life would be easier if she would start using those of her parents. (I would, for example, prefer it if she would tell me verbally when she’s had enough food, rather than spitting it out in my face).

Wearing the Myobrace during the day no longer hurts (yes, it used to hurt, not just give my “mild discomfort” as described on their webpage), but I still find it hard to wear it at night. I was told to sleep on my back, but that gives me restless-legs-from-hell and it’s also exhausting. Not only do I have to activate muscles to hold the Myobrace in place and my mandible/lower jaw forward, but I even have to fight gravity whilst doing so! Keeping the Myobrace in place while lying on my belly or side is not easy, but nowhere near as tiring. I still haven’t found a position that allows me to sleep and wear the Myobrace at the same time, though.

I think my problems with the Myobrace stem from the fact that my jaw and teeth are very assymmetrical. My lower left teeth have fallen inwards quite significantly since I lost my upper left wisdom tooth…and I also haven’t used my left side for chewing for the past 7 years. It’s probably due to this “lopsidedness” that I just can’t get the Myobrace centered or make it stay on. It always kind of hangs in some places and is tight in others, and my right lower teeth won’t stay in for long. If I center the Myobrace, the ridges between the slots in the Myobrace push against some teeth and I also have to clench my teeth quite hard to keep it in place. As soon as I relax a bit, teeth fall out (of the Myobrace!). Thus, I have decided to give up on trying to get it centered – at least that way my teeth stay in it for a while.

Speaking of teeth falling out, two very small pieces of tooth actually DID fall out in the first few days of wearing the Myobrace. I guess my teeth are so fragile that they couldn’t handle the  increased pressure. (And no, it’s certainly not the first time I lose small pieces of tooth).

Effects after only five nights of wearing the Myobrace: Maybe I’m just imagining it, but it feels like one tooth has already become more aligned. Keeping my mandible forward (i.e. in the “correct” position) has also become easier!

My first appointment with a functional orthodontist

After having tried numerous oral myologists, orthodontists and general dentists in Sweden and Italy, I realised that I had to look elsewhere for help. Swedish blogger Elin recommended Dr Hugh McDermott in Ireland and the more blogs and articles I read, the more convinced I became that if anyone could help me, he would be the one. I wrote him an email and was thrilled that he replied immediately and agreed to see me. A week ago, I went to Ireland for my appointment.

The visit was very different from all the previous visits I had had with dental professionals. Even though I had always made it clear that I felt my problem was my jaw having become too narrow after the fifth tooth was extracted and that I therefore still wouldn’t be able to chew properly even if my teeth were in contact, no-one had ever measured the width of my arch before! McDermott was also the first dentist to request a lateral skull x-ray:

(No need for any training in anatomy to tell that something’s very wrong here!) Other orthodontists and oral myologists had filed down my teeth and told me that I couldn’t get a functional bite back unless I had more teeth removed(!), but no-one had actually looked at the position of my jaw in my skull! And no-one had believed me when I said that extracting the wisdom tooth had made my jaw more narrow and lopsided – even though it is visibly clear which side lacks the tooth, even when my mouth is closed. Neither had anyone before believed me when I said that I felt that my arch was too narrow and that I wouldn’t have enough force to chew even if my teeth regained contact. I didn’t have to mention any of this to Dr McDermott. He measured…and found that my jaw was far too narrow and my arch much too high to enable proper occlusion. I was given a Myobrace (for teens, as my jaw is too narrow for the adult models) that I’m supposed to use at night and two hours every evening and if this has effect, I will commence treatment with ALF in a few months’ time. If that has the desired effect, the spaces where my teeth were will be reopened and I will be able to get four or five implants…and a well functioning jaw and skull!

Here is my “before” photo, taken when I got back home after my first appointment: