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.

Move Over - Making Space

Move Over - Making Space

November 20, 2014 @ 9:05am

The process of making space for the brackets to be placed on the top row of teeth began.  Promptly at my appointment time I was greeted by a sweet assistant who took me back to the rear of the orthodontist office into a big beautiful semi-circle room that was surrounded with full view of the gorgeous landscape through windows that seemed to go on forever - from floor to ceiling.  The view was breathtaking and served as a great distraction from the "spacing" process.  

Within 5 minutes the spacers were put in and I was on my way.  I was amazed that there was no pain involved with having the spacers put in but was cautioned that within a few hours I might have some discomfort.  And if by chance one of the spacers came out I was to call and come back in to have it replaced.  

So with blue spacers in place, I'm making space in my life for braces.  

The Decision Process - To Brace or Not to Brace

The Decision Process - To Brace or Not to Brace

Filled with resistance and frustration I know I must decide whether to move forward with braces or to seek other options.  So I begin my decision making process by talking to my previous dentist. Dr. Moffett in Mandeville and Dr. Tatum in Hattiesburg. Both agreed that the best route to correcting the issue is braces.  The other options are:

1. continue on the present path of cracking and breaking teeth with the possibility of losing teeth (leaving gaps in the bite)
2. replacing the crowns and attempting to shape my teeth to realign my bite and chewing patterns
3. remove 8 of my back teeth (4 on top and 4 on bottom) replacing them with implants or some other type of denture
4. bracing and realigning my teeth

Once I really considered the expense and possibility of losing teeth permanently - It really didn't take long for me to see that the logical decision is to be proactive and brace my teeth.  Yet on the inside I'm not happy about living with braces for 18 months.  

When I was 9 years old, I had all my back baby molars pulled and as soon as my adult molars came in braces were put on my teeth for almost 3 years.  It was a long process and a difficult one.  I realize that the bracing process has advanced and changed tremendously in the past 40 years and I'm praying that this time around will be much easier.  

After making the decision to begin the process, I called Poppy at Dr. Sherman's office and we set the schedule to begin. 

November 20th - Put in spacers to make room for brackets on the top. the bracket will allow Dr. Sherman to install a stabilizing bar on top to balance the force of the MAPS Attachment which will be used to exert force to move my top back teeth into my gum line. 

December 2nd - Remove spacers to make impressions for the brace design and replace the spacers.

December 8th - Put on the braces and the upper stabilizing bar and begin moving teeth.

Within 6 months - have Dr. Regan, the oral surgeon put in the MAPS Attachments into the right and left side of my upper jaw bone.

Meet Dr. Sherman, The Orthodontist

Meet Dr. Sherman, The Orthodontist

Two days after my 52nd birthday I found myself sitting in the dental chair at Dr. Sherman's office. Dr. Sherman has a well-established orthodontist office on Bluebonnet in Baton Rouge, a main thoroughfare just 15 minutes from my house and not far off my travels to and from work.  The distance from my house or LSU where I work is a critical consideration for ALL my daily adventures given the enormous traffic issues in Baton Rouge.

Similar to Dr. LaCour's office, Dr. Sherman's office is friendly, organized, aesthetically pleasing, and most of all professional.  I was greeted by two very nice young ladies who work the front reception desk - both have beautiful teeth and cheerful smiles.  My appointment began promptly which I much appreciated given my tight schedule, yet the appointment took about 2 1/2 hours - but the assistants kept me very busy during that time taking a complete dental history, along with taking a full set of pictures and X-Rays.  My initial introduction to Dr. Sherman did not happen until after all the evaluation measures were collected and put together for "us" to review together.

Once all the facts, images, and information were ready for evaluation and discussion Dr. Sherman's assistant, Poppy invited me into a very nice room with a large monitor on the wall connected to a computer. Poppy and I visited for a few minutes until Dr. Sherman joined us.  Dr. Sherman is an attractive 60+ year old man with a gentle hand shake and a sincere presence. He began our meeting by asking questions about my dental history and the struggles I've been having with cracking teeth. Then Dr. Sherman asked Poppy to show the images (x-rays and pictures) on the monitor so that he and I could review them and discuss them. He looked at each image carefully and explained what he saw and asked me to compare it to how I feel when I bite or chew.  Once we discussed all the images Dr. Sherman began a physical examination.  He examined my face, jawline, movement of my jaws, lips, mouth, smile, teeth, and then my bite and chewing patterns.  

After about 20 minutes of completing a physical examination and reviewing my jaw bone structure in the x-rays he said.......

"Let's see, How old are you?"  ~ Dr. Sherman

"I just turned 52." ~ Me

"Hummm if you were under 50, I would recommend jaw surgery to properly align your jaws and bite.  But over 50 years old we will need to look at other options." ~ Dr. Sherman

In my head...."WHAT!!!!! NO WAY, I'M NOT HAVING JAW SURGERY!"

Then the discussion began. Dr. Sherman explained using the images for support and demonstrating his evaluation by moving my mouth - I'm only biting/chewing on 4 teeth. These four molars are a combination of crowns and my teeth.  My other teeth never touch and that is causing the four teeth to continue to crack and break along with chipping the sides of the surrounding teeth.  Reviewing my previous dental records and images (over the past 20 years) my teeth have shifted and a whole host of issues have resulted - including a dynamic minimally functioning bite.

Dr. Sherman explained, the best option for my age is to use braces to move my teeth into a better position. And to install MAPS Attachments to pull my upper back teeth back into the gum line so my front teeth will meet and work properly. The process will take about 18 months followed by 6 months of wearing a retainer.  

Assessment and Referral

Bracing for an Adventure

In the past 6 years I've cracked 5 teeth, had two root canals, and broke two very expensive crowns. To protect my teeth from further damage I wear a night splint to prevent clinching and grinding as I sleep each night. About a month ago, I chipped one of my most expensive crowns which lead me to   seek "real" answers and solutions to stop the damage and continued expense of repairs.  

The week before my 52nd birthday with the highest recommendation from my former dentist in Mandeville, I visited my new dentist, Dr. Chad LaCour in Baton Rouge.  Dr. LaCour's office is located within 20 minutes from my house which means everything in Baton Rouge because of the heavy traffic patterns.  From the moment I called to make the appointment with Dr. LaCour I knew I had made the right choice.  Dr. LaCour's office staff made me feel at home from the moment I walked in the door. I felt as if I had known them for a very long time.  The first visit was comprehensive including many X-Rays, pictures, impressions, a close evaluation, and a rich discussion about my fears and goals for my dental care.  At the end of the visit Dr. LaCour explained that he would need a little time to review my complete case and to collect information from my previous dentist and then he would like to meet with me to make a plan for my treatment - together. Dr. LaCour seeks a collaborative partnership with his patients and that all decisions for treatment would be agreed upon by both of us.  This was music to my ears.  With my Type A personality, I am unable to allow others to decide my treatment and care plan.  Yet, I welcome a collaborative partnership.  

After the initial visit was complete, I was scheduled to return the next week to meet with Dr. LaCour to discuss his analysis and recommendations for treatment.  We met in a conference type room where we could view images of my teeth and x-rays so that Dr. LaCour could provide a visual perspective of his analysis and better present his recommendations to resolve my dental issues. 

Dr. LaCour carefully described his assessment of my teeth and providing a complete analysis of the situation with recommendations.   

Dental/Bite Issues

1. My bite is limited to four molars.
2. Lower back teeth bite too far behind the upper back teeth
3. Lower jaw tends to be less developed than upper jaw
4. Open bite tendency
5. Moderate protrusion of upper front teeth
6. Front teeth do not touch when biting down
7. Functional shift of jaw to the left when chewing
8. Jaw bones issues as a result of intensity of hitting on only four molars

Recommendations

1. Referral to Orthodontist  

As I left Dr. LaCour's office I thought to myself - "Who gets braces on their teeth at age 52?"  Could that really happen to me?