Namine’s dentist was pleased — as was Namine herself — to find that she (Namine, not her dentist) had no cavities. They always ask us how much we let Namine do herself, in terms of self-care, and they’re always a little surprised when we say that she does it all herself. We’ll check her teeth when she’s done brushing and all that, sure, but she’s in charge of her own hygiene.

Namine has another loose tooth, but there’s nothing to worry about there. It’s just another baby tooth being replaced by an adult one.

There is a larger concern with Namine needing dental work: to be specific, a jaw expansion and braces. The dental team had originally thought that would happen mid-2017 sometime, but now it’s looking like it won’t need to happen until August at the earliest.

Namine was born with a condition called Pierre Robin Sequence, which resulted in a few things. She had a regressed jaw, which partially blocked her airway; she was tongue-tied; and she had a U-shaped cleft palate. All of these things together made it necessary for Namine to get a tracheostomy breathing tube and a feeding tube (called a g-tube) in her stomach.

As Namine grew, her jaw grew with her, but not enough to eliminate the need for the tracheostomy. For that, she required two surgeries. First, she had the palate repair, which closed the U-shaped cleft in the roof of her mouth. Then she had what was called the mandibular distraction. The distractors were a set of metal expanders with pins drilled into the bone of her jaw. The bone was deliberately broken; the body’s attempt to heal the break, combined with the pins slowly moving the jaw out, resulted in the lower jaw growing longer.

Some children with PRS require multiple distraction procedures over the course of their childhood; some even as often as every six months. It’s recognized that sometimes, after breaking a bone during childhood, that bone will cease growing. Namine has been fortunate that that has not been the case; she only required the one distraction, and her jaw has grown nicely with her.

Now, however, she faces a new problem: not in her jaw’s length, but in its width. Namine’s adult teeth are coming in, and there is not enough room in her jaw, which will result in her teeth getting impacted — being too close together, they will rub against each other, deteriorating the enamel and damaging the teeth.

The solution, then, is two-fold. Namine will have a procedure done called a jaw expansion; unlike the distraction, however, this one will not require anything invasive. A piece of hardware is fastened by the teeth, which will widen the upper and lower jaws, little by little each day. (The expanders won’t be attached to anything but the teeth, but they will rest on the roof and floor of her mouth, so they will take some getting used to.) The end result will be a wider jaw.

At the same time as the expansion, Namine will also get braces. This will help keep her teeth in line within her expanded jaw.

There is, however, a caveat. Because Namine’s jaw will be widened, there is a distinct possibility — more likely than not, we are told — that she will need another jaw distraction. We won’t know for certain until step one, the expansion, is done.

Even though Namine will need quite a bit of dental work in the future, that time has not yet come. Her teeth are well cared for and cavity free, which is no small thing considering that her teeth are starting to impact a little. (Brushing and flossing will go a long way to helping protect the enamel.) Namine still has several months before she needs to start the jaw expansion procedure.