When we took Namine in to this appointment, we were unsure if it would be the start of procedures or another planning visit. (Our uncertainty in itself should indicate the level of communication we’ve come to expect from the orthodontics department.) As it turned out, this was in fact another planning visit.
In addition to discussion on the work Namine needs done — which I’ll get to in a bit — there was the possibility of needing new impressions . In case you don’t know, or have blocked it out from your own traumatic experience, “taking impressions” means putting a putty of some sort in your mouth, letting it firm up (all the while you must breathe through your nose), then removing it and washing out your mouth.
Namine has had to have dental impressions taken a few times. It was necessary for the palatal lift prosthesis, and it is necessary prior to this new dental work. She had it done at her last visit, but the first thing the dental assistant said to Namine was “I’ll have to see if I can find your impressions. If not, we’ll take new ones, okay?” Namine did not return her smile.
A short while later, the dental assistant returned with the good news that she was in fact able to find Namine’s impressions. Jessica and I exchanged a look: why might they have lost them to begin with?
Shortly after that, the orthodontist came in to take a look at Namine’s teeth and discuss the work she would need to have done. Due to her having Pierre Robin Sequence, there is not room enough in Namine’s jaw for all her teeth. There was a time when it was thought that she would need a jaw expansion, but now they believe that the removal of four teeth and having braces will be sufficient.
In both her upper and lower jaws, Namine’s teeth are impacted; this means the teeth are too crowded, so something must be done to alleviate some room.
In her lower jaw, she has two baby teeth which have no corresponding adult teeth. They will not come out on their own, so they must be removed. The orthodontist believes this will be sufficient to make room.
In her upper jaw, Namine has two teeth, one on either side, which are blocking her canine teeth. The canines are of greater importance, so the other teeth — I forget their names — must be removed.
After the extractions, Namine will require braces for several years to straighten out her teeth.
Up to this point, there is nothing here that we did not know. It has taken Namine some time to fully internalize the upcoming procedures, but she’s since come to terms with it. There was still the issue of actually making the appointment — or appointments, since extracting four teeth and getting braces is a lot to do. The orthodontist told us we couldn’t make any appointments ourselves, however. When it came time, his office would call us, and it wouldn’t happen until sometime around March of next year. “At least four months from now,” he said.
Jessica and I were shocked. We had thought this most recent appointment was simply the last stop, that the procedure(s) would happen before the end of the year. From an insurance perspective, in fact, we hoped it would happen before the new year. Not doing so would likely result in having to start the paperwork process all over again.
The orthodontist brushed aside our concerns. “Insurance shouldn’t be a problem.” (Yeah, I’ve heard that one before. And I have a bridge to sell you, too.) But what he said next really struck me: “There are thousands of children who need dental work that will never get it. Namine is fortunate that she is seen here, and you should be thankful that we can treat her.”
Now hold up a damn minute. Waving Namine’s need in my face — as if I didn’t already know it — and telling me I ought to just be grateful that she can have anything done at all? I bit my lip. I mean that literally, I bit down hard to keep myself from saying something I’d regret. There was still one other issue to discuss with the orthodontist.
Whenever Namine has a dental procedure done, from fixing a cavity to even something as simple as a cleaning, she has to take an antibiotic. The reason for this is her heart: she has a severe heart defect, and anything that could get into her bloodstream (like germs in her mouth during a cleaning) could potentially cause damage to her surgically modified heart. So with some pretty major procedures coming up, dental needs Namine’s cardiologist to give his okay.
We closed out the appointment by Namine getting new X-rays. This she didn’t mind, being an old pro. Namine wasn’t quite tall enough sitting in her wheelchair, so I helped her transfer to a different chair. After the tech confirmed that the scans were good, we were free to go.
Unfortunately, due to abundant miscommunications, there is still no concrete plan for Namine’s dental work. The next steps are to get dental and cardiology talking to each other, which (as usual) will only happen through the Complex Care, formerly known as Special Needs, department’s involvement.