A Correction, Some Added Info, and Current Status

I got word a couple weeks ago that DNA does not stand for Do Not Adjust. I have investigated this by having a chance to glance at Dr Singh's and Dr. Krumholtz's  book "Epigenetic Orthodontics In Adults" and have confirmed that DNA is supposed to mean "Daytime-Nighttime Appliance". I have added an appropriate correction to earlier posts. I apologize for any confusion. I was reporting the information I got at the time. For whatever reason, that information was not correct.

I would like to add that in my brief look at Epigenetic Orthodontics In Adults I got the impression that a number of different kinds of appliances might be utilized in patients receiving E.O. treatment. While the DNA appliance might be commonly used, it is not necessarily used in every case. Or, a patient may have a DNA appliance and a different type of appliance as well. For instance one for the uppers, another for the lowers. Had I understood this at the outset I might have titled the blog differently, but I don't think it's an important enough distinction to justify changing the name of the blog now.

My current status is that both my upper and lower appliances are still "in the shop", which is to say, the lab. You may recall from previous posts that my upper was sent off for modifications, then I lost my lower and a so new one is being made. I hope to get them back soon. The dentist made a clear retainer for me for my uppers, so that should prevent any regression while I wait for the upper appliance. However, none was made for my lowers. I can detect a little regression there. Hopefully it won't be too significant, but obviously it will extend the treatment longer than it would have been had I not lost the appliance.

Don't Do As I Did, Do As I Say

 I will pay a high price for losing my lower DNA appliance, just as the dentist warned. It's going to cost me $750. Hopefully my mistake will a lesson to readers.

The trick is, how to prevent such a mistake? After all, one cannot very well effectively command ones self to never make an error- to never forget anything.

I think the answer is to have a system. (Review my previous blog entry on how I made the mistake if you need to.) How does one remember to never forget? My idea is this: Never go anywhere with your DNA appliance if you do not also have the carrying case with you. That's all there is to the system. Label that carrying case with your name and contact number.  If you ever need to take your appliance out, you will have your case with you and you will put it in that. It's less likely you will leave that behind, but if you do happen to leave it behind, it is obvious to others it is an orthodontic appliance, and you have your contact number on it. I think it's very unlikely to get thrown out. I would think the habit of always having your carrying case (or a spare carrying case) should greatly reduce the incidence of accidental losses like mine.

Setback- my own fault

The dentist warned me early on to be careful not to lose or damage my DNA appliances because they are "very expensive" to replace. To me, when a dentist calls something "very expensive",  that's very scary.

I ran into an unexpected social situation yesterday. I was running an errand and had not planned to linger anywhere. I was wearing my lower appliance. In the midst of my errand I was offered some very nice hospitality which included snacks. I took out my appliance in order to eat something. I wrapped it in a napkin. (It then looked like something that needed to be thrown out when clearing the table.) I forgot about it. After leaving, I realized my error and called the host but the place was closed for the day. I got there first thing this morning to dumpster dive, but it was garbage day and the garbage man had already come and gone.

I called the dentist office to report it. Spoke to office personnel, but the doctors were already gone for the weekend. Office personnel had no idea what the replacement is going to cost. They said it hadn't happened there before. I have an appointment for next Thursday. Until then I'm left wondering about about a dentist's definition of "very expensive". It was a stretch for me to do this DNA treatment to begin with.

Of course, this will set me back some weeks on the progress of my lower teeth as well.

Update and Some New information

So here we are seven months since the first appliance arrived, and two months since the last update, when the lower appliance arrived.

Progress so far: I've got a nice straight set of uppers, but I am told we are not near finished with them. We still need to widen the arch "x"millimeters, until the the width of the arch is at least as wide as the width of the (relaxed) tongue (the dentist measures these things).  So, I am not close to being done with the wearing and lateral adjusting of the upper appliance. However it is very nice to have the upper teeth straight already. It provides a real psychological boost. I agreed to do DNA orthodontics for health/quality of life in old age reasons, but I can't deny it is very nice to lose the self-consciousness about the messy rows of teeth.

I have also been told that once we are done moving the uppers, I will still need to keep using the appliance overnight as a retainer, permanently. The gaps in the appliance will be filled in, so I expect it to be a bit less awkward feeling. Will my speech (while wearing the appliance) improve also? I hope so.

In the meantime, the dentist wants me to temporarily halt adjusting the upper appliance, and give the lower appliance some time to help my lower teeth to 'catch up'. That is how things stand as of this writing.

You can see some visible gap in my lower appliance now, even with the low res of the photo. My bottoms are still pretty crowded and snarly, but I can definitely detect slow changes occurring. Since this appliance has little effect on my speech, I am able to wear it quite a few more hours per day than the upper appliance. As such, the dentist has just advised me to adjust it more often now. I am comfortable now adjusting it twice a week. This will hopefully speed things along.

However, once my bottom teeth have reached a certain point, the current lower appliance will be sent off for modification to add the ability to adjust it in the forward (anterior) axis, like the upper appliance. But this is unique to my mouth- the reader (or another DNA patient) will experience their own unique course of treatment.

Another piece of information I just learned which ties into a question a reader asked me previously: Sometime later, it is likely I am going to receive Invisalign appliances to wear. The DNA appliance will take me to a certain point, but then we will need to fine tune things a bit with Invisalign. This has something to do with "rotation". But I am also told it is included in the price of the DNA treatment. Which is good, because the expense is already quite a significant burden on my budget.

There are a few other details I have learned about what the dentist would like to do to my teeth, but they are unique to my situation and would not be relevant to readers, so I will decline to bore you with those details. I'll just say, my teeth have a lot of wear and tear on them.

Surprise: The unexpected arrival of the lower appliance

If there are confusing and contradictory things in this blog, it is only because they are confusing and contradictory in life, and I am just reporting my experiences.

Yes, I previously wrote the device had not been ordered yet and that they wanted to see further progress in my uppers first. That's what I was told by the dentist who worked on me that day.

Today, both to my surprise and to the dentist's surprise, a technician in the office presented my new appliance. I have no idea whether the appliance was ordered earlier and took a long time to arrive, or was ordered later and for what reason, or what.

I can't explain why there is all the miscommunication. What I can say is it is a practice with at least two dentists and about a dozen other employees, and I am attended to by different personnel on different visits. In addition, Dr. Singh's opinions are in the mix there somewhere. I don't know their process. The dentist who has attended me the past few sessions is not the dentist with her name on the sign and not the dentist who worked on me at the beginning of my treatment. For whatever reasons, no matter how clear or explicit I have tried to be in asking how my case is proceeding, things have been miscommunicated to me and by extension to you the reader.

However, I don't see where any harm has been done other than the confusion itself- which has no negative effect on me other than in the writing of this blog. My treatment is continuing in an apparently successful way. As many patients have probably encountered with many medical professionals, the accuracy of my understanding of what they are doing is not always high on the doctor's priority list. I don't want to dwell on this, I just want to let the reader know what has happened. I have tried very hard to be accurate in my reporting, but as they say, "garbage in/garbage out". I do not have control over the quality of what I am told.

So, anyway- the lower appliance has arrived, after all. I got it today. It is comfortable. It does not significantly affect my speech. If I don't grin widely, people don't see it. I can wear it while working. So I don't see why I shouldn't be able to wear it a good 16 hours a day. Of course it has to come out when eating, like the top appliance.

I am continuing with the top appliance. So at night I'll be wearing both. 

I'll report more, after I've been living with it a while.

Compare and contrast, then talk among yourselves

For those wanting a closer look at the teeth themselves, here is a new picture. Compare this to the The Fugly Truth posting from December 24, 2010.

                                                                  

Hurry up and wait

I think the enlargement of the gaps in the appliance as well as the improvement in the alignment of my upper teeth are quite noticeable

It has been a while since the last entry, but there is a reason for that- something changed in the plan and I didn't have the information yet what that change meant and how to best report it.

Previously I reported that the dentist thought it was time to start on the lower teeth. She took new mouth impressions in order to make the appliance. She also asked me to stop expanding the lateral adjustment upper appliance for the time being. However it turns out the new appliance has not yet been ordered, and I have since been asked to go back to expanding the appliance in both axes.

What I have since learned is that the dentist consulted with Dr. Singh about my case, and he determined it was not yet time to start on the lowers. The uppers still needed more improvement. So I am back to the normal routine of adjusting my appliance and the doc is looking at my mouth once a week, checking progress.

I look forward to getting work started in earnest on the lower teeth, hopefully soon.

New mouth impressions, adjusting the Do Not Adjust appliance

10/20/11 I have just made a correction to my January 30, 2011 blog entry. The appliance is NOT called "Do Not Adjust". It is supposed to be called "Daytime-Nighttime Appliance™"

Monday they took a new set of upper & lower impressions plus a new impression of the bite registration so that the lab can make an appliance for my lower teeth. The new appliance ought to be ready in about 10 days.

The dentist spent some time bending the springs at the front of the appliance, as well as the wire that arches across in front of all the teeth. She also removed one spring- the one that relates to my farthest-forward canine tooth- because we don't want it to come any farther forward. In addition the arch wire now touches that tooth, to prevent it from moving farther forward. All that was done to assist getting my front teeth in line.

I am still to expand the anterior portion of the appliance on schedule, while leaving the lateral adjustment alone. The gap for the anterior plate is now visibly wider than the gap for the lateral plates.

 You can also see where one of the springs has been removed. There is a whitish area there now because in order to remove the spring, the dentist removed some of the acrylic it was anchored into. Then she mixed some new acrylic to re-fill the gap she created. Her repair acrylic was white.

Clarifications, Progress, and a New Phase

Clarifications: As it turns out, I indeed had a wrong impression in the previous blog entry (April 18 2011). We are not permanently finished expanding the appliance laterally. It is only a temporary halting. Her explanation of pleasant surprise was genuine, however. She said I have made unusually fast progress. The temporary halting of lateral expansion has been ordered so that we can allow other growth areas to 'catch up' with the lateral growth that has occurred.

Something else that can use some clarification: I had mentioned the 2mm lateral expansion that has occurred at the C5 position such that there is now a (self measured) 34mm gap between those molars (see December 19, 2010 and April 18, 2011 posts). However I learned today that in my case, since I had my premolars removed as a child, C5 as shown in the diagram is not necessarily my proper measuring position. Again, I say in my case. Others should not extrapolate what is correct for them in this regard. In the future, I will not report any self-measuring, and I will just rely on the doctor to measure and judge the growth.

Progress: While we have not increased the width of the appliance for a few weeks, we have continued to advance the fore (anterior) portion of the appliance once a week (today being one of those days), thus moving my front teeth ever so slightly more in line. Today the doctor took photos of my bite (revealing quite a mismatch between my uppers and lowers, since my uppers have moved so much by now). She is sending the photos to Dr. Singh, and has ordered that next week, we are going to take new impressions of the uppers and lowers. All of which leads us to......

A New Phase: It is no longer a matter of guessing. I will be getting a lower appliance. I don't know a thing about it yet, so I'm not going to speculate. But the overview is, as I understand it, that we must get the lower teeth to 'catch up' with the position of the uppers, just as we are currently getting the upper front teeth to catch up with the lateral expansion. There may be more lateral expansion of the uppers later, but we need to work on the lowers first, so that the bite does not become wildly mismatched in the process.

A Surprise (with a correction)

(Important- Note the correction I added four paragraphs down)

Let me preface this by explaining that there are two dentists at the dental practice I attend. Only one has her name on the shingle, but when I come in for an appointment I may get one or the other.  Both are knowledgeable about the DNA Appliance, and both have been involved in my case since the beginning.

Today I went in for a routine appointment. I expected to be checked for irritations, and to have the appliance adjusted (abraded/polished) accordingly. I didn't expect anything more than that.

The dentist who saw me  was one I had not seen the past couple of appointments. She asked to examine my bite (sans appliance) and exclaimed surprise. Her surprise was that I am "there" (her word). I don't mean she was surprised I was physically present. I mean my upper arch has expanded adequately (see previous blog entry) and we do not need to adjust the appliance width any farther. Apparently, the 2 mm gained that I mentioned in the previous post is about right for my mouth. She was surprised it happened as quickly as it did.

However the front teeth are still not where we want them to be. (See photo in April 9, 2011 blog entry)

(NOTE: I am adding a correction here 4/25/11. A sharp-eyed and seemingly knowledgeable reader has informed me that Dr. Singh recommends a 38mm gap at C5 (for Caucasians), whereas I measured myself at 34mm in the previous blog post. It now occurs to me there is a very good chance I simply misinterpreted my dentist's comment that I am "there". The same sharp-eyed reader comments it may just be time to advance the anterior (front) section of the appliance while temporarily halting advancing the width so the front can 'catch up'. Perhaps that is all that was meant when she said I was 'there'. I will try to get more clarity next visit. Meanwhile, keep in mind this blog entry may have been based on a faulty assumption on my part.)

She adjusted the appliance in the relevant axis 1/4 turn more (leaving the width alone), and made adjustments to the springs and wire arch in the front using pliers. In previous appointments these had been left alone. She stated that we now need to "activate" the front teeth to move into position.

My job will be to continue to adjust only the front triangular section once a week, while leaving the width as it is with the 2mm gap.  

She also made mention of a lower appliance to come later. Previously, it seemed a possibility, but by no means a certainty, that I would need a lower appliance.  Now I get the impression it's a lot more likely I will need it.

But all in all, I feel like a milestone has been achieved. And judging from the dentist's reaction, in a surprisingly short period of time.

Well, SOMETHING is happening

In my December 19, 2010 post I reported that the gap between the molars at the C5 position was recorded by my dentist as 32mm.

I just made a homemade probe to measure that gap now. It is 34mm.

I also measure the midline gap in my appliance as it is now. 2mm.

Nothing ambiguous there.

Progress at Nine Weeks

First of all, let me mention that if you are new to this blog, or are just skimming, there were a couple questions relating to the expense and comfort of the treatment that can be found in the "Comments" section of the previous blog entry. I will suggest reading them there rather than my repeating my replies here.

I have by now been back to see the dentist for brief appointments several times, sometimes at one week intervals, other times two week intervals. No problems have occurred, but she likes to check and recheck the appliance for comfortable and proper fit. She had slightly ground or polished areas of the appliance several times now, trying to perfect the fit and bite alignment according to her goals. Other than that things have gone uneventfully.

When the appliance was first given to me, it was two weeks before she made the next mechanical adjustment to start spreading the appliance. Later this was stepped up to weekly intervals. Then she allowed me to make the adjustments myself, after tutoring me what to do. How often the adjustments are made depends to an extent on how many hours a day one wears the appliance. I strive for a minimum of 12 hours a day, and usually end up achieving 14 hours or even a little more. The more I can wear it, the earlier the treatment can end.

As you can see by comparing to the picture in the previous blog entry, the appliance has clearly expanded, an indication of the bone growth that is occurring.


I don't have a proper way to gauge the gaps in the appliance, but it looks to me like they have increased in the 1-2 mm range. You can clearly see through the gaps now, whereas you could not when the appliance was new.

As to changes in my teeth, I believe I am seeing subtle changes. I do feel the overall arch of the uppers has widened a bit, as gauged by the way my tongue fits between the teeth. I also believe that my front teeth are coming forward- but just slightly. Almost impossible to see in a photo. I feel like my face is filling out just a bit. One might guess I have gained weight, though I haven't.  But again, it is very subtle, and difficult to see in a photo, especially with the poor photo quality of this webcam. But I will post the photos for readers to view and compare with the previous entries.

As to the lower teeth, I see no change at all as of yet- however this is supposed to be normal.

Changes in the relative alignment of the upper teeth are still quite subtle at this point. Can you see a difference compared to the "Fugly Truth" pictures?

I tried to make this photo as similar as possible to my blog profile photo which was taken November 2010. I think my face has slightly more filled out appearance now, though again, it is quite subtle. I wonder if it is detectable to readers?

The DNA Appliance Has Just Arrived

It has well and truly begun. I received the appliance January 27, 2011 and have by now worn it three nights.

DNA Appliance in this instance stands for "Do Not Adjust" Appliance (*See correction below). There is some contradiction in terms here because you do in fact adjust the appliance periodically. I'm going to assume however they are using the term adjustment in the sense of orthodontic adjustments- like when people have traditional braces and go in for their monthly "adjustments" where the pressure on the teeth gets tightened. That is what they called it when I was a kid. And with the DNA Appliance you are not subject to that kind of adjustment.

Obviously "DNA Appliance" is also a catchy name for marketing purposes and serves to reinforce that it is coming from the field of Epigenetics. 

* 10/20/11 Correction: Apparently the information I received early this year about the name of the appliance is incorrect. It is NOT called "Do Not Adjust". DNA actually stands for "Daytime-Nighttime Appliance™"

 In the photo above note the Y-shaped divisions in the appliance. Note the metal device in the center. Periodically a small tool will be inserted into the metal device and the appliance will spread slightly at the lines of division. This will slightly spread the palate at the bony sutures (see previous blog post "What Is Epigenetic Orthodontics?"), and new bone will grow into the gap that was created, gradually reshaping the mouth.

In this second view we see what might be assumed to be a retaining wire across the front, such as found in traditional orthodontic retainers. But that is not the case. There is actually a substantial gap between my two front teeth and that wire. I believe the wire defines the position my teeth will be in by the time therapy is finished. Note also the ziggurat-like wires in the front. These are springy and touch the backs of the front teeth. However the pressure against the tooth is extremely slight and is hardly noticed.

I was instructed by the doctor that it is optimal to wear the appliance 16 hours a day. It is not necessary to wear it during working hours but should be worn otherwise. If I can achieve this optimal schedule, I should be finished with the therapy in a matter of months. If I cannot, it will extend the therapy perhaps to a year or more. I was also told that due to the timing of our natural biorhythms the bone cells we are trying to grow will not be active during work hours even if the appliance were to be in, so there is no reason to try and push it beyond the 16 hours/day.  In other words the cells will grow during the resting and sleeping periods, but not during times of high activity.

The appliance must be removed for eating, however.

Cleaning is to be done by rinsing and a denture-type soak. The DNA Appliance is not to be brushed.

More to follow in the next blog post.