Metal Mouth Message Board

My "close enough" 9 year old daughter is being fitted with a palete spreader and Herbst appliance in about two weeks as part of six to eight year two phase plan. I've lodged my objections to this first part with both the orthodontist and her father, but it is being done anyway. We are divorced and share equal custody, two weeks alternating. Because I expressed my objections to the orthodontist, the office considers me "combative" and will not speak to me. Her father has never had dental work of this intensity. I don't feel he is putting nearly enough consideration into it. So I'm left with some questions perhaps another parent would be better at helping me out with anyway...

My daughter is a grazer eater. She eats small amounts of food all day long, very very slowly. When should I brush her teeth? Normal times of waking, after breakfast, lunch, dinner and before bed?

Yes, when should *I* brush her teeth. My daughter must be watched over to brush her teeth now. If I don't watch, she'll lie. Taking it as far as running the water, and wetting the brush, but not actually putting the brush in her mouth. I cannot imagine that once the pain of the appliances come into play she'll be in any way willing to brush them. I can do this when she wakes, after breakfast time, when she gets home from school, after dinner time and right before bed. I cannot do it when she's at school and I'm at work. I will if that's the only option, but driving to her is not endearing me to this AT ALL.

Will the humiliation eventually bring her to brush her own teeth so we don't have to drive to her? I sure hope so.

She's had four spacers for about two weeks in preparation for the appliances. She's been demanding special food because "my teeth hurt!" She doesn't know what follows is going to hurt more. A lot more. She thinks she's getting "jewelry for her teeth".

I had a sister who had the same two appliances 14 years ago, while I was still living at home. My sister's experience was extreme in the amount of trauma so my daughter can't talk to her. Neither my daughter's father nor the dr has yet mentioned, "Hey! This HURTS!" Dare I tell her? She's going to be rightfully upset with me, and everyone else if she isn't told, but after I tell her she may become SO combative (she gets it from me) that putting the appliances in will be nearly impossible.\

Thank you for any insight.

My daughter had an RPE several years ago to correct a crossbite. She wasn't too happy about it at first, but kids are resiliant and she came through with flying colors. My concern with your situation is that you don't seem to have a positive attitude about her treatment. If you approach the process with negative feelings, she will surely sense your attitude and may decide "If mom hates this, so should I".

Your post seems to indicate that your ex-husband is directing your daughter's treatment and you don't agree with him - to the point of alienating your daughter's ortho. You and your ex may not see eye to eye on much of anything; but, in my opinion, you need to put your personal conflicts aside and do what is best for your daughter. Have you gotten more than one ortho's opinion about treatment? Perhaps you would feel more comfortable with the treatment plan if another ortho (or two) agrees with your daughter's treatment.

I would try to be positive and explain to her that the work she's getting done now will make it much easier for her later. I would assume that without the RPE and Herbst treatment, she might be looking at jaw surgery later on and that's no picnic. Try to prepare her that her appliances might make her mouth sore (but having braces myself I can say that spacers are almost the worst part of treatment and she's already dealing with that). Try not to scare her with talk of "pain".

As far as brushing goes, it sounds like she already has some issues about good brushing habits so that's probably not going to get any better with appliances. I wouldn't worry too much about her brushing while she's at school. Try to get her to if you can, but if not just be sure she brushes 2 or 3 times a day at home.

I know it's hard to do anything to your kids that is going to hurt, but making the tough decisions for our children is what being a parent is all about. She may not be happy with you (and her father) for a while, but she won't stay mad forever. And when she's in high school and has a beautiful, healthy smile, she may even thank you!

Good luck.

Chris

Thank you for the "2-3 times" a day. I figured as often as I could get them brushed would be good enough, but I'm glad to know that if she eats and the food sits on her teeth for a few hours, it isn't immediate scarring. I live and work 25 miles from her school so I drive her there and back each morning and afternoon. A third trip wasn't making me very happy.

A second opinion would have helped, but that was not an option. My ex paid for this first phase in advance at the very first appointment. The deal was then all office visits are free and a 10% discount on this phase. I have opinions about that program, but it's his money. I am not legally obligated to pay because none of this is "medically necessary" per the orthodontist. Money plays only a very minor role in giving my daughter the best care possible. Being angry and trying to point fingers isn't part of caring for my daughter.

My sister had significant health reasons for needing these appliances. It was visually obvious. I was 17 when my sister started the first phase. It was horrific to witness. I'm not ashamed to admit, it affected me. It was really, really awful for my sister. The fact she found out once everything was done that she'd need jaw surgery anyway was just an insult to injury.

Although, if you're not warning me that it's milkshakes and mashed potatos the entire herbst time, and it doesn't take two people to turn the ratchet, perhaps some improvements have been made. I have no idea what it's like today, and that's why I posted here. The dr did tell me that if everyone experienced what my sister did, there is NO WAY they'd do it except in those extreme cases. And this one dr does it on 500+ kids/year.

My ex wants to do this so my daughter can have "a perfect face". I did not want to do it because I didn't consider the cost of what my sister went through being necessary on a child whose face wasn't all that bad to begin with. My daughter gets *many* compliments on her natural smile, portraits were selected for a local studio advertisement, she is in no way embarassed of the way she looks. But she's 9. Will she still have a cute face when she's 16?

Well, I came here looking for help in taking care of them. I thank you for that advice. I've been searching the web trying to find instructions and have been stunned at how little there is. SOmething like 75% of kids have had braces these days and no one talks about how to take care of them?? As I've continued to search, I've sometimes wonder if I'm not finding much because it's just not that big a deal anymore.

Please God, let it be as easy as it seems.

Reina, it seems like you are a little more comfortable about your daughter's treatment. I don't have any experience with the Herbst appliance, only the RPE.

The RPE got turned every night for only two weeks and then no more turns. My 7 year old took children's Tylenol the first couple of nights, but after that she didn't take any pain reliever. My only stress in turning the key was trying to get it in the key hole without poking the roof of her mouth. Sort of like threading a needle.

Her biggest complaint was she couldn't eat Doritos, popcorn or the gummy fruit snacks. Most other foods were fair game.

Be prepared, the RPE will probably cause a fairly large gap to appear between her front teeth. It doesn't look great, but that's exactly what it's supposed to do to make more room in her jaw for her permanent teeth.

You might want to post any questions you have about the RPE or Herbst appliance in the "Ask the Doc" forum of this BB. Drs. Rick and Randall are great about explaining procedures and/or providing reference sites.

Hope the info helps.

Chris

Hi Ladies ..... I'm sticking my nose in here.

I found this thread after googling "Herbst Appliance" because believe it or not, my 12-year-old daughter's orthodontist just installed her Herbst this morning.

Reina, one thing I can say for sure is that it's pretty difficult -- *at first*.
As Chris mentioned though, kids are so resilient .... if only I could still be that easily adaptable!

I can understand your concern about getting another opinion. In my case, there are 3 other girls and one boy in my daughter's class who are already in their braces. After our orthodontist explained the Herbst, I came home and called all of their mothers, just to see what they each had to go through (3 of these go to different orthodontists, btw). Amazingly, they all wore the Herbst for varying amounts of time, due to different reasons. It is obviously a wonderful contraption that can do incredible things to improve our kids' smiles.

As for my daughter, she has a slight overbite - of which I wasn't even aware .... like you, I thought her smile and face perfect -- and she will wear this until August 30, when they will install her braces.

This afternoon, she's not very happy. She feels as if she has a mouth full of metal, and is having problems speaking, chewing, and swallowing. I've given her ibuprofin and she said it's already helped. But all in all, I'm very optomistic ...... she is being very upbeat about all of this and is taking it stride. Her orthodontist - and I - reasured her that this discomfort is temporary.
I may "Ask the Doc", though, for some other ways to relieve her discomfort during these first days.

One thing I'm very lucky about -- she doesn't like chewing gum, or sticky candy. Woohoo! That's one battle I'm not going to have, thank goodness.

I agree that you really should go into this with the kind of attitude that you're behind her all the way ..... and that only good things will come from it. That's so hard sometimes ....... believe me, I've been there! *grin*

Hang in there, and best of luck .....

Thank you for your reply Shelly.

If practical, could you reply back and let me know how long it takes for your daughter to be able to eat? Any other significant "dang, wish Ida know THAT was going to happen!"

Much like you, I was googling information about the Herbst appliance and palete expander (I should really learn to spell that word, I'll be saying it a lot in the next few years) when I came across this board. Isn't it amazing that for so many children that have had it, there's so little talked about? I can find thousands of web-pages on caring for my new puppy, but very few on caring for my child undergoing medical treatment. The one I found is of the highest quality though. =) Still, I keep thinking I've missed "something".

Perhaps for totally foolish reasons, I'm more paranoid about the expander than I am the Herbst appliance. I've seen the photos of kids with the gaps in their teeth. I must say, I'm not at all thrilled by that. There's a two year gap (no pun intended) of "I-have-no-idea-what-treatment" between phase 1 and phase 2 for my daughter, as her perm teeth come in. For some reason, the perm teeth are really taking their time. She lost her baby teeth early/right on time, and has six gaps in her mouth. And the whole point of phase 1 is to introduce more space? It's difficult for a layman like me to recognize "space" is going to be a problem. I just don't get it.

Best wishes for a comfortable and steady recovery for your daughter Shelly!

Thank you so much, Reina! At this point, well wishes and words of encouragement help more than you know .......

I'm not very familiar at all with expanders .... as far as I know, my daughter isn't going to have to go through that phase. And I'm not sure why ... she has a very small mouth, and actually had to have 2 baby teeth extracted when she was younger just to make room for her permanent teeth.

I don't know, but this is possibly the reason your daughter's permanent teeth haven't made an appearance yet. Once they install the expander, they could come popping right through!

I'll for sure keep you updated on her progress in getting comfortable with the Herbst. Like you, I was surprised not to find a wealth of information about this. The tiny little pamphlet the dr gave me seemed so brief.

As for our first night ...... she slept soundly and is still snoozing away this morning. My hope is that after a good night of rest and completely relaxed jaws, she'll wake up feeling somewhat better.

She ate a little last night after I fixed her a soft baked potato. She just can't get the hang of swallowing yet ... maybe today will be better!

Reina, my daughter had her RPE for six months when she was 7/8. After six months, the ortho removed it and we're still waiting for Phase II (braces) of her treatment to begin. Remember, her key only got turned for two weeks. The rest of the six months was just time for her palate to generate tissue in the gap created by the expansion.

The ortho checks her every six months to be sure her crossbite hasn't relapsed and to see how many baby teeth she still has. She'll be 11 in August and still needs to lose 4 baby teeth as of last week. I'm not expecting her to be in full braces for another year - maybe two. Personally, I would rather wait until she's a little older and more responsible about all of the care involved with having braces.

Shelley posted on the Ask the Doc board about the Herbst appliance, so hopefully the Docs will provide some helpful info.

Chris

momof2grlz wrote:She'll be 11 in August and still needs to lose 4 baby teeth as of last week. I'm not expecting her to be in full braces for another year - maybe two. Personally, I would rather wait until she's a little older and more responsible about all of the care involved with having braces.

Chris

Chris, that's the reason my daughter is just now beginning her treatment, at the age of 12. She finally lost her last baby teeth during the past year. Like you, I'm also happier with the idea that she can now be more responsible about taking care of her appliance, and later, braces .... specifically, keeping it clean.

And ladies, good news!
Reina, when she woke up yesterday morning (first morning after they filled her mouth with the foreign object ), the improvement in the way she felt was incredible! The first thing she said to me was, "Mom, I can swallow now." YESSS!

I think that one of the things that made all the difference in the world was simply having those hours where her mouth and jaws were completely relaxed -- whether she knew or not. That first day, I believe that her natural instinct was to "fight" it -- in other words, her jaws were constantly trying to go back where they were before. And, of course, she was thinking about it non-stop.

She is talking better also. The only problem yesterday was a little soreness on each side of her tongue where the metal had rubbed. I'd bought some of the cream that they make for this, and when it would get too bad for her, I'd just dab a bit on each sensitive spot with a Qtip. Instant relief .... and she's rinsing her mouth often with warm salt water.

Things are already looking up already, so I think you and your daughter will come through this with flying colors!

Shelley

when she woke up yesterday morning (first morning after they filled her mouth with the foreign object ), the improvement in the way she felt was incredible!

That's great news, Shelley. Have a nice holiday with lots of ice cream, Jello, pudding . . .

Chris

Thanks! Happy holiday weekend to y'all, too .....
Jello and ice cream are definately on the menu, along with a few more of those soft baked potatoes!

My daughter had her Pendex palate expander (*) put in about an hour ago. For all the fretting and paranoia I went through for the past three weeks, it is
tremendously anti-climactic

I will give you an entire play by play (ok, maybe not entire)
A [daughter] goes in, hops in the chair. Starts babbling
Dental assitant puts the pendex in, daughter is still babbling.
Bite down on the molar bands, blah blah. Babble, babble.
Dr comes over, glue is put in, daugter babbles. Dr. tells her "A, you have to be quiet for five minutes while the glue sets." Daughter starts crying.
Assitant takes the glue equipment out, daughter is back to babbling.

She talked the entire way through the fitting (except for the gluing, five minutes of silence, the horror!) and is still talking now.

Sheesh, I had thought I'd need to take the week off work. Guess not. I'm embarassed at what a tremendously NOT big deal this has turned out to be. Embarassed, but very relieved.

(*) When I went in three weeks ago to discuss the treatment with the dr, I was certain the Herbst appliance was mentioned. The Herbst is no longer part of her treatment. I do not know if this course was scraped because of that conversation or some other reason.

Way to go, Reina. That's great news. Your daughter will do fine. Just try to gently coach her about good oral hygiene. Remember, she'll have good days and bad days, but try to encourage her and remind her she's working toward a super goal - a beautiful smile!

Chris