Braced and Challenged - Learning to Eat and Speak with the TPA

December 12,  2014

Learning to Eat and Speak with the TPA

Because of the location of the Trans-Palatal Arch (TPA) eating and speaking clearly is very difficult. The TPA is a metal bar with a unique shape (U-shape in the middle) that extends across the top of my palate attached to metal bands on adjunct upper molars. The TPA seats approximately 2-3mm below my palate (see picture below).

Learning to Eat with the TPA 

Eating with the TPA is most challenging but does improve with time and creativity.  When the TPA was first rendered I felt confident that I could handle the challenge but fearful and anxious.   On the first day eating was next to impossible. Chewing was difficult because of all the new hardware in my mouth along with the fear of getting food caught above the TPA.  Having all the strange brackets, bands, and TPA in my mouth made me feel uncertain of how to chew and move food past the TPA.  I learned quickly that chewing "solid" food and getting it past the TPA was going to take much practice along with a careful selection of the type and consistency of food.  Because the TPA hangs just below the palate it impedes the smooth movement of food by the tongue most often causing food particles to become struck between the TPA and the palate (frustrating to say the least). The limited movement of the tongue presents a real challenge when food gets stuck above the TPA.   Given my tenacious spirit, I sought other options - Smoothie King quickly became the predominant contributor to my meal plan along with scrambled eggs, steamed vegetables like cauliflower that can be mashed, mashed sweet potatoes, oatmeal, and rice.

Learning to Talk with the TPA  

As a professor, researcher, public speaker, and educational leader speaking clearly is essential for communicating my message.  My ability to articulate supports my professional credibility. The interruption of my tongue placement on the top of my mouth influences my ability to transfer aerodynamic energy into acoustic energy so that I can produce appropriate sound waves.

The placement and movement of your tongue in your mouth determines how sounds are formed. Some letters and/or their sounds require your tongue to be positioned so that it touches or brushes the roof of your mouth. Letter names such as T, L, and R require your tongue to interact with the roof of the mouth. Yet letter names that are formed by the tongue position between the upper back teeth like B, D, G, H, and J often require the interaction with the roof of your mouth.  The placement of your tongue to the roof of your mouth determines the quality of sound produced.  Words with the letters M, N, and G can be impacted as well.  Furthermore, the quality of your pre-consonantal nasal sounds can be compromised if areas of your mouth are too sore, painful, or movement of your tongue is hampered (as with the placement of the TPA).

With my determined spirit firmly rooted, I decided to begin practicing my speech playing around with the movement of my tongue.  Standing in front of my bathroom mirror watching the movement of my mouth while pronouncing words with the letters influenced by the position of the TPA, I quickly learned new ways to move my tongue so I could speak more clearly. While the sounds are not as clear as they should be, they are much improved.  I learned quickly that if I slow my speech down and not work so hard to pronounce the words, my speech was less impeded. Practice makes perfect - right?   I'm confident that I will learn to negotiate the TPA overtime.



A little break from the TPA - On December 16, 2014 - Dr. Sherman (or his assistant Chelsea) will remove the TPA for a brief time so that I can enjoy my trip to Hawaii.  I'm so excited about Tom and I celebrating our anniversary in Hawaii!  I will also be presenting at the Hawaii International Educational Conference January 4-8, 2015.

Intermission - Children are a blessing!

Intermission 

Children are a blessing!  There is no greater gift an adult child can give to a parent then to be supportive and encouraging of their dreams and goals.  As the years go by I find my children and I are changing places - they have become "my cheerleaders" often giving back what I gave to them along with so much more.

In recent days as I've struggled to learn to eat and talk with my new braces and the Trans-palatal Arch (TPA) I've received incredible support from my family - especially my girls.  My oldest daughter, Crystal Michelle a former dental assistant in the United States Air Force and an expert in alternative methods of handling health, stress, and emotional issues. When I called her to talk about my struggles with the TPA she quickly offered solutions, support, and a calming voice.  Cassandra, my middle daughter is an ER nurse and had braces recently as an adult  She offered encouragement by reminding me that this time of struggle would pass soon and offered some easy to prepare food options.  And my youngest daughter, Erin Rae, an ICU nurse offers a wealth of encouragement and reminds me that I have overcome greater struggles (she balances my panic moments) - her famous words "you got this ma" always reminds me that I can do this.  I'm the most blessed mother in the world with beautiful, intelligent daughters who are wonderful mothers to my grandchildren and servants to their community and others.

Cassandra, Me, and Crystal (left to right)

Me and Erin (left to right)

*impromptu photos -quickest ones to locate on my computer.                                        

The TPA and The Tongue-Tie Experience

December 9, 2014

The TPA and The Tongue-Tie Experience -2 Days Checked off on the Journey

I've made some stark revelations during the first 24 hours of having my braces and the TPA put on my teeth but the most significant one relates back to the wise words of the Bible.  In the book of James 3:8 the scripture says "But the tongue can no man tame, it is an unruly evil:.  While the initial writing of this scripture focuses on the spoken word, I can honestly say "the tongue is an unruly evil" in more ways than just saying things it should not.  Let me further explain.  

The Trans-Palatal Arch is a metal bar that fits across the palate. The metal bar is attached with metal bands around two upper molar teeth. The picture below shows an example of  how the metal bar looks inside  the top of my mouth.

The TPA does not hurt by simply being in place.  The problem begins when my evil tongue cannot be controlled. Our tongues are curious and they seek out all strange visitors in our mouth.  From the moment I left Dr. Sherman's office my tongue begin investigating the TPA and even though I have tried very hard to control my tongue it continues to find its way back to the TPA.  

I've learned more about my tongue movement in the past 24 hours then I ever knew.  My tongue hangs out most of the time at the top of my mouth where it is suppose to rest comfortably.  With every swallow my tongue pushes forcefully against the TPA as if it thinks it can remove the TPA from its position. Regardless of my attempts to psychologically decrease the force or the movement my tongue near and around the TPA it continues to do what it was designed to do - explore and move things from my mouth.   Tongues are dominate, Type A creatures with a mind of their own.  The constant swallowing and force of my tongue against the TPA has begun to cause pain to my tongue. Even with the pain, my tongue continues to visit the TPA with determination!

My daughter Crystal Michelle has learned about the many problems babies who are born tongue-tied experience because of the anatomical limitations.  Sadly, babies who are tongue-tied struggle to nurse properly and are often mislabeled as colicky or fussy.  During the past week I've been able to fully relate to how babies who are tongue-tied feel.  My tongue is somewhat "tied" because of the limited ability to move as it should move.  Swallowing is difficult and moving food past the TPA is especially a struggle.  But unlike a tongue-tied baby I can think through the issues and seek options to avoid the limitations of my "tongue-tied" movement.

Given the limited movement and the overwhelming determination of my tongue to "feel" the metal bar, I'm confident that I will adjust and eventually re-train my tongue to leave the TPA alone.  Oddly, I've learned that when I sing my tongue doesn't want to hang out at the roof of my mouth as well as when I walk on the treadmill my tongue is distracted.  So I guess for the next 18 months I can sing my favorite songs loudly and keep walking when I need to give my tongue a break from beating itself up on the TPA.  

Braced! Today was B-Day

December 8, 2014

Braced! Today was B-Day!  Only 547 days left to go....

Today the journey to correcting my bite officially began. My appointment at Dr. Sherman's office was at 8:35am this morning. I arrived on-time (which that in itself is a great accomplishment).  The braces didn't take long to put on because Dr. Sherman's office uses an Indirect Bonding procedure (I explained this process in a previous post).  Chelsea his assistant prepared my teeth for the braces and placed all but the top back brackets on my teeth.  Dr. Sherman checked in from time to time to make sure things were going smoothly. And when it was time he came in to seat the brackets that also have a Trans-Palatal Arch (TPA) attached to them.  Within a little over an hour the process of putting on my braces and initial wires was complete.  My next official appointment with Dr. Sherman in 8 weeks on February 2, 2014.  But I will visit with Chelsea next week for her to double check all the hardware.

During the installation of my braces I was a little nervous but not too bad.  However, afterwards when I began to try to talk with the TPA in the roof of my mouth I began to panic.  The braces themselves aren't too bad but the TPA is very frightening.  It would probably help to give a visual of what a TPA looks like and the role it plays on this journey. The YouTube video below demonstrates the placement and one part of the function for my treatment.

While correcting my overbite is one part of my treatment plan, the second and most important correction that needs to be made it to move my upper molars back into my gum line.

The TPA is difficult to get use to because of the effect it has on the movement of my tongue and food.  My speech is somewhat slurred and eating today has really been a challenge. But as I am with most things, I'm determined to make this process as positive and productive as possible.  I'm sure I will figure out how to speak clearly and what foods will work during this journey.  As for now, I'm celebrating the conclusion of DAY 1... only 547 days left to go!

Special thanks to Chelsea for her kind and gentle touch! 

Once just wasn't enough - Going for Round Two!

Once Just Wasn't Enough - Going for Round Two

Tomorrow is the day I get my 2nd set of braces - 42 years after having my first set.  My first set of braces were put on at the beginning of my 5th grade school year. It seems in my life once-is-never-enough and I tend to do things in threes.  In this case, I'm praying that my second set of braces will be the last.  But if by chance this alignment and movement of my teeth only lasts for another 42 years - at which time I will be 94 years old then I will happily sign right up!

Impressions and New Spacers

December 2, 2014

Preparing for Braces:  Impressions and New Spacers

Today's appointment was quick and painless.  Dr. Sherman's assistant removed my first spacers so that she could fit my 2nd & 15th molars (next to the last molars on top left and right) with brackets for the impressions. Orthodontic impressions were made by using a tray that fits over my teeth. The tray was filled with plaster type substance that had the consistency of thick cake batter.  The plaster hardened quickly and was somewhat easy to remove from my teeth and mouth.  The plaster model of my teeth will be used by Dr. Sherman and his lab technicians to prepare Indirect Bonding trays with the braces that will go on my teeth all at once.  Once the molds were finished, new spacers were placed into between the teeth in front and in back of the 2nd and 15th molars.  Next Monday, December 8, 2014 at 8:35am the braces go on and the 18 month journey begins.  

An explanation that is provided on Dr. Sherman's website is copied below. 

Traditionally orthodontic brackets or “braces” were applied to the teeth one at time. Today there is a technique that allows for all of your braces to be placed at the same time. This technique is known as Indirect Bonding.

An extensive amount of time is required for Dr Sherman and Balhoff and our lab technician to prepare the Indirect Bonding trays. However, having all of your braces “ready to go” prior to your arrival translates into a shorter time “in the chair” for you.

“Indirect” describes the process of your braces initially applied one by one to a plaster model of your teeth rather than directly to your teeth. The braces are then easily transferred to your mouth as a complete set. The process of getting braces is dramatically shorter with Indirect Bonding. Because all of the measurements and positioning of the braces are done on a plaster model of your teeth rather than in your mouth, our Indirect Bonding process is much more comfortable and precise than traditional methods.   http://shermanbalhoff.com/treatment/

Meet Dr. Regan - The Oral Surgeon

November 24, 2014

Meet Dr. Regan - The Oral Surgeon 

Oh my goodness, my oral surgeon looks like Elvis Presley.  Dr. Regan has a very large oral surgery practice.  When I entered the office I was surprised by the size of the lobby and the number of receptionists at the desk, I bet there were 5-6 receptionist!  I was impressed because all the paperwork is done electronically - no papers to sign. Given the large size of the office and the number of receptionists I thought for sure that the wait would be long but it was not.  The assistant called me back within 10 minutes. She took a few x-rays and printed them right away on our way back to the room where I met with Dr. Regan.

When Dr. Regan walked in the door I was shocked. He looked exactly like Elvis. I suddenly believed Elvis was alive.  Dr. Regan was a very polite man and showed great interest in getting to know me and my treatment plan. He carefully reviewed the x-rays and did an examination of my mouth including my bite, teeth and jaws.   Within minutes he began to calm my fears explaining that the procedure and anchors he would be installing would help to resolve my biting issues thus stopping me from cracking more teeth.

Dr. Regan explained that he would be using MAP Attachments to help move my upper back teeth into my gum line.  MAP Attachments are small titanium attachments (plates) that are secured to the upper jaw.  They are different from the TADs commonly used with braces.  These anchors require an oral surgeon to make an L-shaped incision in the upper gum tissue and then to strategically place the MAP Attachment securing them to the upper jaw with several rods.  Once the MAP Attachment is secured a small "loop" at the end of the attachment is left outside of the gum line and the incision is stitched around the loop.  The healing process takes a few days.   A few weeks after the attachments are installed the orthodontist can attach tiny coils to the MAP Attachment to help manipulate the back molars into the gum line.

Why this type of treatment?  MAP Attachments are used as an alternative to having jaw surgery.  After age 50 dentists and oral surgeons try to avoid jaw surgery which is a great thing!

I left Dr. Regan's office feeling relieved and ready to move forward with the procedure when the time comes.  This procedure will not be done for several months.  First Dr. Sherman will put on the braces and get the teeth shifted into the position they need to be before moving them up into my gum line.