Treatment 4 Begins Tomorrow!

Tomorrow my new journey begins. I will be getting clear braces for my top teeth and invisalign trays for my bottom teeth. I've never had braces before, so I'm kind of nervous. Everyone I've asked told me they are going to be painful and stuff is going to get stuck in them, a lot. I may have gone a little overboard getting prepared for that.

Stuff I bought in fear of having dirty braces

It's been a long time since I've had a reason to post. I had to clean up my blog like woah. So far I've redone the navigation, made updates to show my new treatment info, and posted my new 'before' to track my progress. Looking forward to sharing the dirty deets here.
SPOILER ALERT: I'm going to be in pain and will likely post about it.

Progress Weeks 17-18

Images After: Tray 9

Remaining Trays: 15

Lockjaw: Consistent. No pain
Headaches: None
Pain: Only sore first day of new tray

Wear: 16-20 hours a day
Brushing: Not as much as I should during the day at work
Flossing: Every night

Front View

Top View

Bottom View

Right View 

Left View

Progress Weeks 15-16

Below are pictures after tray 8, I'm currently on tray 10 so I'll also be posting pictures after tray 9 soon.
No changes to my tray-wearing experience. It's actually become pretty predictable, so I figured it would be good to just have a standard checklist that gets posted with each picture set to make posts easier and more consistent for me.

Images After: Tray 8
Remaining Trays: 16

Lockjaw: Consistent. No pain
Headaches: None
Pain: Only sore first day of new tray

Wear: 18-20 hours a day
Brushing: Not as much as I should during the day at work
Flossing: Every night

Front View

Top View

Bottom View

Left View

Right View

Progress Weeks 13-14

Tray seven is done, 17 to go! Below are pictures after tray 7. I was in a rush had just eaten. I didn't have time to brush so some of the pictures show just how super stained your teeth are after food and drink. Insane right? I've decided to try to add side shots to the set because this seems to be where things are doing the most movement right now.

The lockjaw and craziness of not really having a matched bite has become more "normal" for me. I think my teeth have gotten used to moving around all loosey goosey so I don't really have as much pain after a new trays. It's kinda of sore after I take of the trays for sure, but no major headaches or tension like I had when I first started Invisalign. Kind of hard to believe that I'll been wearing my trays for almost 4 months now. I'll be moving into tray 9 in just a few days. Kind of exciting to be coming up on the halfway mark (tray 12) before I know it! :)

Front View

Top View

Bottom View

Right View

Left View

Doing pretty good. I haven't been wearing my trays as much as I should - more like 18-20 hours rather than 20-22 but it hasn't been an issue. Things are moving around well, pain isn't constant in any way. I floss every night and have a brushing routine that isn't psycho. Things are good and it's more "routine" now. Not gonna lie though, I'm ready to have these things off. June 2013 can't come soon enough!

Progress Weeks 11-12

Here are my pictures after tray six, with 18 remaining trays.All attachments are still on, though I did get worried one day when I popped my tray on and something came loose. It was food. HA! Where did that come from? : O

Maybe I'm crazy but I feel like my teeth are looking MORE crooked on the bottom than before. I keep inspecting the trays, to make sure things are matching up and they are but who knows LOL. The lockjaw and popping is constant now, can be painful. When I was on tray 6 it was definitely the worst it'd been. I started taking the soma (muscle relaxer) which helped more than I thought it would. I'm behind on these post so I'm trying to get caught up.

Front View

Top View

Bottom View

Slacked on wearing my trays enough during tray 6. Hadn't been wearing my trays as much as I should - more like 16-20 hours instead of 20-22. OUCH. I still floss every night and the next tray went on without issue due to me being good about wearing it the few days before the switch! I blame snacking and delicious non-clear liquids. :)

Progress Weeks 9-10

Tray five is done, 19 to go! All attachments are still on and holding strong after my second tray with them on.

Below are pictures after tray 5. The headaches have been reduced a little, in favor of more teeth pain than anything. I do have jaw tension and my lockjaw has become pretty much constant. I filled the prescription for muscle relaxers when I started tray 7. I'm kind of behind on posting so I'll get these posted ASAP since it's almost time for post-tray 6 pictures!

Front View

Top View

Bottom View

Starting to slack. Haven't been wearing my trays as much as I should - more like 18-20 hours rather than 20-22. I'm still flossing every night though! Not wearing the trays as much as I should, I'm sure it having a direct affect on me having more constant lock jaw. I think its that combined with the fact that the movement is more aggressive now that the attachments are on. :(

Progress Weeks 7-8

Tray four is done. It was the first tray with attachments and I can say with pride that none of them have come off yet. Hopefully the glue holds for the rest of the treatment. :) Only 20 trays to go! Apparently people still can't see my trays. I like it.

Below are pictures after tray 4. No new developments; the headaches and tension are around consistently  for the first 4 days of the tray. The lockjaw chooses to be better/worse at random, but sticks around day in and day out. It's not affecting my health or life so I let it be. I did get a prescription for muscle relaxers just in case, but I haven't needed to fill it yet. We'll see.

Front View

Top View

Bottom View

Still on a roll. Consistent wear (hitting my 20-22 hours every day) and flossing every night. Routine is good - time consuming but definitely worth it.

Progress Weeks 5-6

Tray three is done, this week I got my attachments and new trays! Three down, 21 to go. Below are the pictures while I was wearing tray 3. I had to wear the tray a couple extra days due to the timing of my attachment appointment. Nothing new with tray 3, it was about the same as tray 2 from start to finish with headaches, tension, and jaw getting locked when I first started wearing it, but significant reduction after 3-5 days.

Front View

Top View

Bottom View

Still on a roll, no slip ups. I've consistently worn my trays for between 20-22 hours every day and have flossed every night. Getting into a good routine and being less psycho about brushing every time after I eat something small or drink something sugary during the day. Just making sure not to leave anything sitting for more than a few hours really.

Oh the Lockjaw!

Lockjaw you say? But isn't that something that happens if you've got tetanus. True enough, it does happen with tetanus, but it can also be associated with a bunch of other stuff. A more general term you might see used online is "trismus" or inability to normally open the mouth. What happens is you start to open your mouth and then BOOM, you realize it's locked and can only open so far. Thus the term lockjaw.

As the weeks have gone on, my jaw has been locked more and more frequently. It happens randomly, but usually is more common 1) right when I wake up in the morning or 2) when I've been laying on my side (putting pressure on my jaw).

It's not usually that painful. Just depends on how hard I have to work to force my mouth open.

When I do get my jaw unlocked there's a massive 'click' sound coming from the jaw itself. As far as I know, there really isn't any other thing you can do than just force your jaw open. After you get it open, just work it out over and over again. This gives you back the range of motion and releases the tension. My jaw clicks most of time now but how loud it is (audible only to me vs. audible to people near me) depends on how recently my last "lock incident" was. It kind of sucks and gets more painful over time, but luckily only one side of my jaw is locking.

I've been unsuccessful in getting the jaw unlocked more than a few times, without either removing the trays and massaging the muscles in my cheek. Once the jaw is unlocked, the trays go right back in. No harm, no foul. It doesn't seem to instigate more locking. I'm going to see what the dentist says about this the next time I go in. Not sure what they'll suggest or prescribe. Just haven't found a lot of useful information about this online when it comes to Invisalign-related lockjaw.


JAN 2013 UPDATE: I'm over halfway through my treatment. Something cool happened temporarily during the first couple days of my current tray.

If I had to rate my usual lockjaw tension from 1 to 10 - with 1 being not much tension, and 10 being so tense I can't get my jaw open without multiple attempts - I'm usually anywhere between 6 and 8. When I shoved my current trays on, the lockjaw loosened up for a couple days! It was around a 3 or 4 on days 1 and 2; the usual amount of tension (without pain) returned on day 3. Like I said, it was temporary, but what is cool is that it's a good indicator my bite is starting to get matched up again! Very cool. I can definitely see a lot of good progress since I started with Invisalign now in lots of places.

Progress Weeks 3-4

Tray two is done and I'm halfway though tray 3! Two down, 22 to go. Below are the pictures after tray two, posting them a little late, but equal intervals from the last progress post. I'm starting to see like one or two teeth moving, but other than that not any major differences. I can definitely feel a difference.

Tray two has been somewhat annoying with headaches and lockjaw. Based on my progress so far into tray 3, I'm expecting things to get more annoying/painful. It's not killer - maybe an average 4 on a pain scale of 1 to 10 when it hurts - but the headaches are inconvenient. Sometimes they try to rage on me when I'm tired or trying to work.

Front View

Top View

Bottom View

No painkillers for you! The dentist is being totally lame about giving me the pain medication I need. Taking 4 advil at a time (800 mg) does very little and any less does nothing. Not really keen on taking that much advil all the time. It's bad for your workout progress and for your tummy.

My previous dentist gave me vicodin and muscle relaxers for some jaw pain which helped tremendously. They want me to come in to talk to the dentist, because if I look him in the eyes and say the same thing, that will be more effective. I'm going in next week for my attachments so I figured I could suffer until then rather then go to the dentist 20 times each month. My dentist's office and I talk almost every week. They're always messing something administrative up, but damnit I like the dentists.

I've been a pretty good girl.
I've worn my trays for between 20-22 hours every day and have flossed almost every night. :) I've been a little more lax about drinking non-water things with the trays in. I keep my trays clean though so it hasn't been an issue. Yay progress.

Progress Weeks 1-2

Tray one is done! 1 down, 23 to go. Below are the pictures after tray one, I don't see much of a difference. Tray one gave me little to no pain. No one has noticed my trays so far. Very cool.

Front View

Top View

Bottom View 

Tray 2 is in! On Monday evening I put in tray two. It's been pretty painful for the last few days. I've had a headache going since Tuesday. Poppin' lots of advil which is helping some, not a ton. The top tray is giving me the most pain, but surprisingly comes off pretty easily. The bottom tray is less painful, but is nearly impossible to get off. Makes no sense!

Today is day 3 of my second tray set and it feels like my teeth are all over the place every time I put the trays back in. It seems to take at least 20-45 mins before I feel like my teeth are lined up inside the trays again. Definitely encourages me to keep them on for longer.

I've been a good girl!
I've worn my trays for between 20-22 hours every day. I've also been flossing almost every night. :)

My Treatment Overview

Since I started Invisalign I've had three sets of trays created. Below are the details of each, including alterations to the teeth completed to assist the treatment. In summary, my first treatment had almost a year of trays, attachments and teeth shaving. As I went through the plan the dentist changed the amount of teeth shaving based on my comments and the actual results. After my first treatment, I got my attachments removed. My second treatment was cut short because the trays were starting to fit sideways on top. I'm currently working through my third set of trays.

Treatment 1 - Start July 2012

Treatment length: 24 trays (48 weeks)
Attachments: Added to 11 specific front teeth after 6 weeks (or first 3 trays)
Teeth Alterations: Interproximal reduction (shaving of the tooth enamel to create space between the teeth)

• Teeth Shaving at 13-18 weeks of treatment (or after 7ish trays)
• 7 reductions on the top teeth of .5 millimeters
• 7 reductions on the bottom teeth of .2 millimeters

The video below shows the expected transition start-to finish and attachment locations (in red). The arrows point to where the teeth shaving (interproximal reduction) will occur.

Treatment 2 - Start July 2013

Treatment length: 15 trays (30 weeks)
Attachments: Removed! I wanted them off after my first treatment. My dentist worked the removal into my treatment plan for round 2. Basically it just takes longer
Teeth Alterations: None. The teeth shaving expected on the top teeth in Treatment 1 was changed after it seemed that the amount completed on the bottom was too much.

Terminated after 10 trays: My trays were starting to fit sideways. I thought it was just because I was slacking on wearing them, turns out the trays were fabricated in a wacky way due to the mold of my teeth.

Treatment 3 - Start August 2014

Treatment length: 17 trays (32 weeks)
Attachments: Nope
Teeth Alterations: None. 

These fit great.

First Appointments - What to Expect

If you're looking to get started with invisalign treatment I suggest you get the ball rolling. Depending on your current dental health and the availability of your dentist, it could be any number of months before your trays are ready. Expect to go in for multiple appointments. I've outlined the process below.

1. The Initial Consultation:  The person(s) in charge of your invisalign treatment will meet with you and look at your teeth. They'll tell you if you're a candidate and whether they think you'll need teeth removed or interproximal reduction (i.e. teeth shaving). You should also get an idea of the treatment length to expect.
2. Dental Exam: If you're confident that you're a candidate for invisalign, you should try to schedule the dental exam on the same day as your initial consultation. I was able to do this and saved myself a  trip. Expect a standard exam. If you have cavities, a broken tooth, gingivitus, etc. expect to come in again to correct these issues before your treatment can start.
3. Correcting Existing Issues:  You'll usually need to fix any existing problems with your teeth. How strict this rule is  depends on your dentist. I got away with just a thorough cleaning. Why correct problems? If you've got a cavity going, invisalign is only gonna make it worse. Think of the invisalign trays like incubators.  If you've got a broken tooth, not only will it be hard to predict how your teeth are going to move, but the tooth could break even more which will ruin the fit of the trays.
4.  Mold of Your Teeth: The dentist will take 2 molds, one for upper and one for lower. They will send these to Invisalign. Think of this as the initiaion of your treatment.  The molds will be turned into digital models that will be used to create your invisalign plan from start to finish.
5. Treatment Approval: After your molds are taken, it will take a few weeks before the treatment plan is ready. Usually this is a video that Invisalign sends to your dentist. I had the dentist email me a short version of the video so I could approve it. Technically, you can authorize the dentist to complete the approval, but this seems dumb. You want to be the one approving the final state of your teeth. I only got to see a short version of the video. To view the full video I would have had to go back to the dentist's office which seemed odd to me. Apparently Invisalign has licensing issues or something that prevents this. You would think since you paid for the treatment you'd have rights to YOUR custom plan, but not so much. Work with your dentist and try to get this emailed if you can't take off work to go in and approve.
6. Tray Fabrication: When you've approved your plan it can take 1-4 weeks for your trays to be fabricated. The dentist will call you when they're ready. You'll need to go in (again) to reeceive your trays and other goodies including cleaning instructions, holders, and chewies. Don't expect to get more than 6-8 weeks worth of trays (3 or 4 sets).

Before you receive your trays, you'll need to sign a waiver that says that a number of bad things could happen to your teeth. AWESOME. This disclaimer is really to protect the dentist from anything that goes wrong with your treatment. If you don't understand any of the terms, be sure to ask what they mean.

In total, I was able to get away with 3 visits to the dentist to get all of this stuff done. I did steps 1 & 2 on my first visit, 3 & 4 on my second visit, approved and asked questions all via phone/email, and then went into get my trays on the third visit. Expect to need to go in at least 3 times if you're lucky!

Progress - Before Invisalign

These are my before invisalign pictures. I take pictures after I've completed a tray - about every 2 weeks. Click here for a full list of my progress posts so far. My teeth tend to look more crooked in photos, so the images show an extreme version of any imperfections. My teeth aren't horribly mangled, but they're crooked in lots of little ways.  I can say with confidence that there's room for improvement. 

Notice twisting and crowding in front 6 teeth on top and bottom.

Crowding on top

Crowding on bottom

Right view

If you read my "About Me" you know that I'm looking to correct the crowding in my front upper and lower teeth. The crowding hasn't caused any major issues like pain or cavities yet. I do have minor plaque buildup on the bottom teeth when I go in for cleanings. Based on past dentists visits, the crowding is expected to increase over time, so I consider this both a preventative and cosmetic treatment. Can't wait to start seeing some progress!  :)

Is Invisalign Right for You?

Will it suit your life style?

Depending on current condition of your teeth, you might be worried that you aren't a candidate for invisalign, but what you should consider first is: Will it fit your lifestyle?

Did you know...

• You'll be wearing the trays around 22 hours a day.
• You can only drink water while the trays are in.
• You should brush your teeth every time you eat/drink non-water liquids before putting your trays back in. Technically you're also supposed to floss.
• You won't be inclined to pull the trays on and off a lot. It can be kind of a pain.
• You will be going in to the dentist every 6-8 weeks just like with other treatments.
• If your dentist doesn't see that you are making the progress you should be, they won't give you multiple trays at a time and you may have to go in more frequently.

If you're like most people, you don't floss every day and you don't tote around a toothbrush and toothpaste with you either. If you aren't someone who can commit to drinking water most of the time or can't commit to brushing pretty regularly, invisalign isn't for you. If you have to eat constantly or think you'd lose your trays as much as you lose your car keys, you're not a candidate. The trays are $50 a piece to replace and can take weeks to re-fabricate, making you treatment even longer.

Reality Check: No one is perfect.
The recommended rules can't be followed 100% of the time. If you can't get to the sink or forget your toothbrush, you can manage until you are reunited with your bristly buddy. But let's be honest. If you aren't willing to commit to the rules 95% of the time, you aren't going to get the results.

Don't waste your time and money if you don't think you can live up to the treatment expectations. Invisalign is a good option - don't get me wrong - but it requires you to be more diligent than braces, which are permanently attached.

If you're responsible, committed, and ready to start a 1-3 year journey then buckle up. For your hard work you'll be rewarded with the benefit of few of people noticing your corrective trays. :)

Will it suit your teeth?

It's the next logical question.You'll be surprised how many cases are treatable by invisalign. It can actually correct most types alignment issues. I've seen corrections on overbites, underbites, gaps, crowding, crossbites, and even some pretty serious cases of malocclusion (think of teeth that look like a mountain ridge.) For more info on malloclusiion check out the wikipedia page. Ultimately, your provider will decide if you are eligible. No two dentists are the same, so don't be scared to seek a second opinion if one dentist doesn't think you are a candidate.

For more details go to invisalign's official site a list of treatable cases, including images and additional details.

Cost - Is it expensive?

I'm sure the first question you have is, "Is it expensive?" The short answer is, not as expensive as you'd think. The cost of Invisalign has come down considerably since it came out. At many dental offices the cost is comparable with braces. You can find reasonable prices if you shop around. Skip the dentists who charge too much and want you to pay up front. I found a great dentists office with reasonable prices and more high tech equipment than I knew existed!

Cost

There are generally two types of invisalign treatment for adults - invisalign express and full invisalign. Below are some average prices and quick overviews.

• Invisalign Express is for adults needing very minor adjustments and whose expected treatment length is about 5 sets of trays. Expect to pay around $1500.

• Full Invisalign is for most adults who want corrections. This is what I got, and my treatment length is 24 sets of trays. My quoted price was around $3300, but I got a discount for pre-paying in full so I paid $3070.

Payment Options

I'd been postponing treatment because I thought hadn't saved up enough. To my surprise, the financing options were very flexible. My dentist offered an interest-free 20% down and the rest of 12 months, or an 15% interest plan over 24 or 48 months. If you're low on cash and are willing to pay interest, you can get away with paying less than $100 per month. Not bad.

Cost Breakdown

The dentist advised me that if I lose or break a tray each one costs $50. Please note, this is for per individual tray, top or bottom. The math works so you pay around $1000 for the appointments/design cost and the rest for trays. For 24 tray sets (24 x 2 x $50) = $2400.

What Insurance Covers

Any decent insurance plan will have some coverage for orthodontic treatment. Expect to pay up front to your dentist and file a claim with your insurance after you receive your trays. My insurance plan covered about half the cost of my treatment. Since it was a lifetime max amount, there are few options to spread the charges over different calendar years. If you're looking for additional coverage, most dentists will allow you to add a secondary insurance plan. Talk to your dentist about this, if your yearly dental cost is high, it might be a good option.

I'll be frank, there could be a couple months between your initial payment and when the trays are actually fabricated. This will delay your claim. Then expect insurance to take a while to fulfilling the claim. If you're looking to pay in full, best to save up and expect the cash back in a few months.

If you don't have insurance, you can still pay out of pocket with a payment plan. The options are that flexible.