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Category: Dental care, preparing for ortho

1 week with a Palatal Expander AND broken!

1 week with a Palatal Expander AND broken!

palatal expander

June 2016 palatal expander1

Yup, you read that right, the palatal expander lasted for one whole week!  We even went on vacation with our water pik in tow and wouldn’t you just have guessed that the night before our follow up appointment with the ortho, my 8 y.o. walks into my room and says, “mom, something’s not right with my expander.”  I get up to look and can clearly see one side of the expander just hanging down and not at all attached!  I’m like, “what the $%#!?”

So, I tell him to push it back up and see if he can keep it there for the night until we get to the ortho in the morning.  It’s still very much attached on the other side and pulling it downward actually hurt the teeth it was still attached to.

Next morning we are headed to the ortho and needless to say she is not ecstatic with Gavin’s expander having lasted a mere week!  Neither.  Am.  I.  We haven’t even paid for the first one and now we need to tack on a second one that has to be made.  This 5 min. follow up appt. turned into an hour ordeal of new impressions, fittings for brackets and spacers being put back in. Grrrrr….

Of course it would be my son unable to keep his tongue and fingers off of the metal contraption in his mouth,the incessant wiggling and prodding around that caused a stress fracture on the one bracket, thus breaking it apart completely.  My son IS  however, the glass is half full kind of kid, so he impishly remarks to me and his ortho that at least he can eat whatever he wants for a full week, right?  He’s lucky there was a room full of witnesses.  No, seriously.

That is our update for week freaking 1.  Yes week one and only one.  Will let you all know how we progress, should we progress….Anyone else go through a palatal expander like this?

http://www.bracesbythesea.com/

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Check up and eventual bone graft surgery

Check up and eventual bone graft surgery

Well, thcleft palate teame time has come for Gavin to have his annual Cleft Palate Center team check up and to see where we are at in progressing towards his eventual bone graft surgery.  It was a loooong day for all of us.  We made the trek to Santa Monica and it only took over an hour to get there with all of the a.m. 405 traffic. Sigh.

Gavin was seen by his nurse, surgeon, dentist, orthodontist, pediatrician, speech pathologist and social worker.  He was being his usual self and giving each of them just a bit of a hard time.  All in all the visits with each were good and not at all surprising, but I have to say that after seeing his team orthodontist I was unprepared for her recommendations.  I mean, I knew things were happening with him with regards to his upper teeth and that we have been working towards the moment when he would need to begin the next leg of his journey towards his alveolar bone graft surgery, but I was caught off guard.

He has one front tooth that he lost and the permanent tooth had erupted and has been coming in slowly. The problem being that instead of the tooth coming in facing forward, the tooth is turned completely sideways and coming down in that way.  He has two other teeth that are erupted in the roof of his mouth behind the fabulously turned tooth and another one that has erupted in his upper gum area in front of the other teeth!  So much happening up there for my little guy.

The ortho wants to see him in her office and wanted us to visit his dentist to get additional x-rays to see what else is going on up there and suggested that we begin his orthodontic treatment with a palatal expander.  This will open up his upper jaw providing more room for his teeth to have a place to come in at and relieve some of the pressure he is experiencing with all of those teeth just sitting up in the roof of his mouth with literally nowhere to go.

It’s so hard as a mom to see that your little one is just dealing with the pain and is even used to it at this point.  All of the things he has to go through just to get him to be able to be where he should be is difficult on all of us.

The only part about his visit today that I wish would have gone differently is our visit with his surgeon. His surgeon, although nice and obviously well educated, is just not his previous surgeon.  She really was family.  We lost her a few years back and she simply cannot be replaced.  RIP Dr. Janet Salomonson. During our consult,the surgeon agreed that it was time to begin orthodontic treatment in preparation for Gavin’s alveolar bone graft surgery.  Gavin was in the room with us obviously, and his surgeon explained the two different procedures to choose from.

We could opt for the conventional surgical procedure where bone is drilled out of one or both of his hips and inserted into the gum line filling his alveolar gaps.  The other is to go with an injection of bone material into his gaps, thus, eliminating the need to go into his hip bone.  The one surgery would mean he would be on crutches and unable to walk for 4 weeks during recovery.

Later that day we went to dinner and just before our meal arrived Gavin looked up at me with tears in his eyes.  He said, “mom, I don’t want anyone to drill my hips and bones.  What if I feel it?”  I was surprised at this and just grabbed him and hugged him. We both sat in that booth crying and hugging each other.  I told him that he would be on the sleepy medicine and would not feel the pain.  That was not very comforting to an 8 year old who only heard his doctor say “drill” and “bone.”  I did not realize that even though he had not said anything at the time that he had heard everything discussed.  For hours he had been agonizing over it.

We talked a lot at dinner and assured him that he is a part of the decision on what is best for his care and treatment.  He is adamantly against the bone drilling and wants to go with the alternative surgical treatment.  He is nervous about the orthodontist and what is going to happen there, but as with everything on this cleft journey of ours, we deal with it as it comes.

I encourage doctors to be mindful around children when discussing medical or surgical procedures that are going to be performed on them.  Yes, you are speaking to the parents but I think it is equally important to be addressing the child and understanding what it is and how it is you should be addressing the forthcoming procedure to allay their fears.

We are fortunate to have a team around us and a quick phone call to his team nurse and social worker helping me to relay to him what it is that is happening to him and why, saved us both from a great deal of anxiety.  Reach out, get the help you need, ask questions and figure out how to talk with your child about these very real fears about upcoming procedures.

I now know that when talking with the doctor in front of him that he needs to be included in the conversation and I will be responsible for making sure that he is addressed and hopefully incite to the doctor that what is being discussed needs to be understood by a child.

I am in awe of the bravery and positive attitude my son has and continues to teach me while on his journey. His social worker asked him many questions about how he felt at school with cleft strongfriends and peers about his craniofacial difference and I could not help but smile the entire time at him as he answered her.  He told her that there was nothing wrong with his lip or his face for that matter and that no one ever asks him about it.  He plays with all ages of kids, does karate, soccer and doesn’t know why she would think anyone would think there is something different about him.  I LOVE that about Gavin.  I often wonder how much bigger his ego would be had he not been born with a BCLP because perhaps this “difference” he was born with was supposed to teach him some humility in this lifetime.  Guess we’ll have to try something else to teach him that…

 

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Dental Appt Update

Dental Appt Update

Our little guy had his 6 month dental check up with our favorite dentist, Dr. Frank Enriquez!  He got to put the purple tablet in his mouth that dauntingly showed where it is that he needs to be brushing better…shudder

As his mom, I know the purple tablet is “judging” me and letting everyone in the dental office know that we are not enforcing the flossing like we should be and we are not being as diligent about making him brush as long as he should.  Thus, I cringe a little when the purple tablet outs me.  I vow to be better about instituting more brushing time with that little timer they give me in his take home goody bag.  I know full well this may last for a few days after our visit and that inevitably we will get back into our routine, i.e. screaming around the house before bedtime and rushing through the brushing.  🙁  I am trying to be better – I promise.

The upside to this appointment was that he did not have any cavities so maybe our lack of attention to brushing/flossing is not such a bad thing? I mean, if he doesn’t have any cavities then maybe we are doing enough? Right…I know better but no cavities=good job in my book! 🙂

Our dentist really took his time explaining to us that we have about a year and half before we are going to need the alveolar bone graft.  Gavin has one upper tooth that is loose and his permanent front tooth is coming in above and in front of the loose tooth (which is not uncommon in cleft kiddos). The good point being that when this permanent tooth drops it will be out in front and he will no longer have the under bite he currently has (which is also common in cleft kiddos).  He has an extra tooth coming in through the gums above the baby teeth and  they are happy about this because in their words “where there are teeth there is bone.” For our cleft kids this is extremely important. Some cleft kiddos are not born with all of their permanent teeth and have to look forward to bridges or dental implants depending on their health insurance and family’s financial status.  Our little guy had a 360 degree x -ray taken of his upper and lower jaw revealing that he was born with all of his permanent teeth and a few extra. They have no explanation for this but continue to tell us this is better for him because after his bone graft, he will be able to begin orthodontic treatment and start working on moving teeth around or extracting teeth should that be necessary.

We also found out that with his permanent teeth dropping down in front and thus, eventually eliminating the under bite, that his speech will be markedly improved and we may even (cross our fingers) get to take a break from speech therapy and focus solely on reading therapy instead. It’s going to be awhile but the thought of not having to get him to private therapy each week and work with the school speech therapist AND attend IEP meetings is a bit of a dream for mom (ME!).

For now, we will continue to work on keeping the teeth he does have in tip top shape and continue to monitor his progress while working towards that inevitable bone graft surgery. 🙂

 

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Probiotics for Cleft Affected Children

Probiotics for Cleft Affected Children

Probiotics have been incorporated into my family’s daily regimen and defense of our immune systems.  I first became seriously interested in probiotics after my cleft affected son suffered from chronic ear infections and was on antibiotics more than he was off of them in the first few years of his life.  His pediatrician brought to our attention that our son might begin experiencing GI (gastrointestinal) issues due to his gut flora being wiped out time and time again.

Again, I found myself researching and gathering information on probiotics, different strains, the best ones that would help to recolonize my son’s gut, etc.  Through my research I found that using many different products and inserting a variety of probiotic strains, as well as enzymes was going to be the best approach for us in rebuilding his gut flora and immune system.

Imagine my surprise when I came across information relating to the dental health of cleft affected children through the use of probiotics!  Below is an excerpt from a study The Cleft Palate – Craniofacial Journal published. You can read the full article at (http://cpcjournal.org/doi/full/10.1597/12-243).

🙂 🙂 🙂

The Cleft Palate–Craniofacial Journal—Poor oral hygiene and higher incidence of tooth decay are often prevalent in people with cleft lip and palate. Food supplements containing probiotic bacteria can help reduce the incidence and severity of dental caries.

The Cleft Palate–Craniofacial Journal presents a study of 30 adolescents with cleft lip and palate analyzing the effects of probiotics on oral health. Fifteen subjects in the intervention group drank a probiotic milk powder containing Lactobacillus paracasei SD1 for 4 weeks while 15 subjects in the control group were given milk without a probiotic. Levels of salivary mutans streptococci and lactobacilli were measured at the start of the study and once a week for 4 weeks after use of the probiotic concluded.

For adolescents with cleft lip and palate, orthodontic treatment is usually necessary because of irregularities in tooth size, malalignment of teeth, or skeletal abnormalities. However, fixed and removable orthodontic appliances that help correct problems facilitate the colonization of bacteria such as mutans streptococci. This increases the negative impact of orthodontics for caries-susceptible patients.

Live microbial food supplements can help to stimulate natural immunity to infection and balance microflora. Use of the probiotic bacteria Lactobacillus can positively affect the oral cavity. Lactobacillus paracasei SD1 has been shown to have strong inhibitory effects against Streptococcus mutans, making it a good choice as an oral probiotic.

In the study, counts of mutans streptococci, which promote tooth decay, were significantly reduced among those patients who used the probiotic. Likewise, the good bacteria, lactobacilli, showed significant increases among the intervention group. In addition, Lactobacillus paracasei SD1 were still detected up to 4 weeks after active usage of the probiotic.

The Lactobacillus paracasei SD1 milk powder appeared to successfully colonize the oral cavity among this group of orthodontically treated cleft lip and palate patients. It was found to be safe and effective for oral use. Further long-term study of its beneficial effects should be undertaken.

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About The Cleft Palate–Craniofacial Journal

The Cleft Palate–Craniofacial Journal is an international, interdisciplinary journal reporting on clinical and research activities in cleft lip/palate and other craniofacial anomalies, together with research in related laboratory sciences. It is the official publication of the American Cleft Palate–Craniofacial Association (ACPA). For more information, visit http://www.acpa-cpf.org/.

🙂 🙂 🙂

If you are thinking of incorporating probiotics into your daily regimen for your cleft affected child you have two things to consider now when weighing this option and deciding for yourself if its good for your family.  Probiotics help to build an immune system from overuse of antibiotics due to chronic ear infections and can help to prevent tooth decay and impact the oral cavity by having a high incidence of good bacteria versus bad.

We were only looking into probiotics to recolonize his gut and found along the way that there is an even greater impact potential on his health with their use.  I encourage you to continue your research, talk to your pediatrician and make a truly informed decision when deciding whether or not to incorporate probiotics into your family’s regimen for health.

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Early Dentistry

Early Dentistry

As you may already know, having a cleft affected child means you need to be diligent when it comes to their dental care.  It is not uncommon for cleft affected children to be born without some of their permanent teeth so taking care of the teeth they do have is of the utmost importance.  I cannot tell you how many times I have heard the phrase “where there are teeth, there is bone.”  So keeping the teeth your cleft kiddo has, is without a doubt, an important factor in progressing towards the inevitable bone graft surgery.

Finding a dentist that has experience working with cleft affected children is also  important as that dentist needs to work with the bigger picture rather than just handle what is going on at that moment. You will hear “where there are teeth, there is bone.” Knowing this means that keeping those teeth intact is IMPORTANT.

When you have your Cleft Palate Team visits one of the team members will most likely be a dentist or an orthodontist.  They will explain to you their “dental age” and what the plan will be for their bone graft surgery should that be a surgery your child is going to need.

We live in the  South Bay and were lucky enough to be referred to Frank Enriquez, DDS of South Bay Pediatric Dentistry.  They are geared completely towards the kids and my son LOVED it there!  They were playing games with him, had him watch a video about brushing, and then he had a lesson in brushing.  Dr. Frank and his staff had a 360 degree X-ray of our son’s jaw done (which he thought was so cool) and we were able to see his permanent teeth sitting below his other teeth.  It gave us a great deal of relief to be able to see all of that and know what to expect.

Remember that early intervention, brushing, and having not only a good dentist but a great one that cares about your kid as if they were his is rare. When you find that “one” keep him!  Ours came highly recommended by the staff at the Cleft Palate Center of Providence St. John’s Hospital, Santa Monica (he used to be on the Cleft Palate Team) and his experience with cleft affected children is outstanding.  If you are in the area and can get to their office – make an appointment!

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