For the most part, the appointment was pretty routine. Namine is comfortable with her doctor there, and has been for some time. Once the checkup was done, we moved quickly into unfamiliar and uncomfortable territory.
The dentist commended Namine on doing a good job with keeping her teeth clean. She brushes, flosses, and swishes (you know, mouthwash) pretty much all by herself now, and she’s pretty thorough. She has a hard time reaching those teeth in the back, so she does still need a little help.
I don’t believe I wrote about one of the omega loops coming out, but it did, all by itself. It was kind of alarming, to be honest. One night Namine was flossing, and POP! off came the loop.
If you don’t recall what the omega loops were, let me take you back in time a bit. When Namine was given a palatal lift prosthesis to help with her speech, it was attached by way of hooks, which were attached to metal rings. These metal rings, in turn, were attached to Namine’s teeth.
Namine has not needed the prosthetic for some time now; the pathologist at the hospital declared that her speech has improved because of it, but now it can benefit her no longer. But the omega loops, being glued to her teeth, remained.
Removing the other omega loop at the dental clinic proved to be much more difficult than the first. The loops were attached to teeth in the back of her mouth, so she had to open as wide as she could to make room for the dentist’s hands and tools.
After removing the omega loops, the dentist removed a loose tooth. But this was no ordinary loose tooth, and this leads nicely into what will happen over the next year or two.
Even though Namine’s mouth is growing along with the rest of her — something her plastic surgeon suggested may not happen after the mandibular distraction — it’s still small. It will always be small, and there is nothing any doctor or procedure can do about it.
Namine’s adult teeth are also coming in faster than anyone anticipated. These two events — her jaw being too small and her adult teeth coming in quickly — are converging to create a dilemma: there is not enough room in her mouth for her teeth.
The immediate problem was the loose tooth, which was being pushed out of the way of the adult replacement of a completely different tooth. So the dentist pulled it. Namine has had teeth pulled — she’s asked me to do it before, and she’s even done it herself — but this tooth was, in my opinion, not quite ready to go. It was loose enough to be painful, to say nothing of the new tooth hurting her as it was coming in, but it still resisted coming out. The dentist did get it out, but Namine was none too happy with her. (In all fairness, I wouldn’t have been, either.)
Obviously, the solution to Namine’s problem will not be as simple as pulling teeth. That possibility has been discussed, but the dentist did not feel that it was a viable solution. No, what she wanted to try — not immediately, but soon — was a palatal expander.
The purpose is to widen Namine’s jaw, in order to make room for all the adult teeth which will be coming in soon. (In the x-rays, they can already seen some displacement in existing teeth and ones about to come in.) Our concern, however, is for Namine’s palate. It’s already been repaired once, after all, and a scar can clearly be seen where a gaping hole used to be.
The dental clinic wants to go ahead with this in about a year. Under “normal” circumstances (whatever that means), they’d suggest having this done in two or more years, which would give her jaw some more time to grow. But it’s against how quickly Namine’s teeth are coming in, so the procedure will likely need to be done sooner rather than later.
The dental clinic wants to go ahead with the planning and execution of installing the palatal expander without consulting the cleft palate team. We, however, feel differently. The dental clinic say that they anticipate no problems with the procedure, but to that I say: famous last words.
We won’t allow them to proceed with this plan until we’ve met with the cleft palate team to discuss what they think on the whole matter. We’ve had to switch doctors a few times, what with the staff changes, but we’re fortunate in that Namine’s plastic surgeon is still at the hospital. He’s followed Namine closely, and we’re interested to hear his opinion.