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Why is it so difficult?

2/26/2018

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Difficulties are in the seeing - or not seeing.  Perhaps we should say in the not recognizing what is trueabout life.  

Think about how frequently you tell yourself, or feel,  “I can’t”, vs. how often you think, “I can do this, even though it’s hard.”  

You can if you think you can.

And you must if you want change.

Remember that saying, “The definition of insanity is doing the same thing over and over, and expecting a different result.”  You can change what you are doing.

Let the connections to why you “can’t” go.  Let the too’s go - too old, too young, too poor, too uneducated, too inexperienced.  

You are perfectly imperfect, and perfectly capable of changing, one tiny step at a time.  

The difficulties will become smaller.  You will become bigger.  You can.  You will.

Start meditating every day.  Start saying three gratitudes every morning before you get out of bed.  Start eating more vegetables.  Start reading a few great pages every day.  Start talking to people who motivate you.  Start loving people like crazy.

Go out there and start.  Life is too good to wait.  It’s wonderful to start.  It’s wonderful to succeed.  

You can.

Love,

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Orthodontics: How You Start Finishing at the Beginning and Reduce the Stress at the End for You and Your Patient

2/22/2018

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© 2018 Dr Chris Baker



LEFT: Patient "Miss A" (see below for case explanation), displaying a right lateral openbite and forward tongue.  © 2018 Dr Chris Baker
PicturePatient "Miss A", with evidence of mouthbreathing and a forward tongue. © 2018 Dr Chris Baker
Funny how we call detailing the tooth alignment and the bite, “finishing”.  Funny because it all starts from diagnosis. Actually it starts at the initial examination. What we do at the beginning makes our finishing time longer or shorter.

  • Identifying the existing risks, discrepancies, malpositions, and adverse trajectories of erupting or unerupted teeth begins your finishing.
  • Making them part of your written treatment plan information for the parent/patient puts you all on the same page, reducing surprises and disappointments later.
  • When you work these out, discover, document, and add the concerns to the treatment plan, and review with the parents/patient BEFORE you start, you will feel better, they will feel better, and even though the challenges are there for all of you, there is a better chance of working together with the realities.
Think about the facts yielded by the patient’s medical history and status, dental history and status, and current findings, skeletal, dental, airway, function.  Your level of awareness and utilization of these facts will help you from level and aligning to finishing stages of treatment.

Here are three examples of finishing challenges that can become overwhelming, and how you can know of the facts, and handle the challenges better, from the start:

Facts and challenges like:

Patient Miss A may need lengthy and difficult anterior bite closure - how do you know?.

  • Signs and symptoms of airway and breathing limitations (bedwetting, ADD/ADHD, mouthbreathing, snoring, bruxism/grinding, enlarged tonsils, enlarged adenoids, dense turbinates and more).
  • Vertical or dolichofacial growth and muscle patterns
  • Forward and low tongue position, tongue habits, forward tongue swallow, difficulty with sibilant sounds and even generalized spacing between teeth
  • Short sub-lingual frenum, which makes the tongue stay low and forward
  • History of or current finger, thumb or pacifier habit
  • Deficient overbite
  • Protrusive incisors
Treatment during or throughout the ortho treatment, not just during what we call finishing may include:
    - ENT referral and treatments
    - Tongue exercises that you prescribe
    - Sublingual frenectomy
    - Habit treatment
    - Bite turbos, posterior biteplate, or other posterior intrusion therapies
    - UAW or other molar positioning and incisor extrusion where appropriate
    - TAD anchorage with posterior intrusion
    - Lower full coverage splint following ortho treatment

And look at the concern typed onto the treatment plan for this patient, just above the signature line for the parent/patient:

Concern –  Airway issues, habits and adverse tongue positions all contribute to adverse growth and continued adverse forces on teeth, with or without orthodontic treatment. Adam’s growth is vertical, which is made worse by mouth-breathing and low tongue position.

This may predispose him to an openbite. All treatment will be directed to improving these adversities, but longterm stability is lessened and risk of relapse is greater, depending on the success of the airway treatment, tongue position improvement and habit cessation.


OR

Vertical growth patterns are difficult to correct, and when corrected, often relapse, with a return of the open bite (space between upper and lower incisors, when the patient is biting on the posterior teeth.) 

Even in the best-case scenario, openbites may relapse.  Beginning treatment as soon as is feasible may help in longer-term stability.  Compliance with elastic wear, if indicated, is important.  All treatment is directed to improving the openbite pattern with as much stability as possible.


Annie’s tongue position is low and forward, and probably is contributing to the spacing of her teeth.  Tongue training may be helpful, including CM circle and ball on retainers, and wear of her retainers as directed, will be critical, because the teeth often exhibit connective tissue memory/relapse without excellent retainer wear, due to the tendency of the tongue to remain forward and low throughout life.

Patient  Mr. B may have later excessive mandibular growth, “outgrowing” your orthodontic treatment that attained a beautiful Class I, and the patient ends up Class III with open bite tendency.  How do you know?
  • The patient has more than 4 total clinical deviations from the norm toward Class III, between Porion Location, Ramus-Xi position, Cranial Deflection and Molar Position.
  • The patient presents with Angle Class I occlusion or Super Class I occlusion
  • The patient has a brachyfacial growth and muscle pattern.
  • The patient is skeletal Class III.

A patient and his mother presented for a recall orthodontic evaluation, and the mom said her dentist had asked her why we took the braces off, when he had 0 overbite and 0 overjet.  A review of his final photographs at orthodontic completion showed a Class I occlusion with 3 mm overbite and 3 mm overjet.  Indeed that was not the case any longer. 

​
His treatment plan had listed the concern of possible excessive mandibular growth.  He had a chin sling for nighttime wear prescribed for wear with his retainers, which had not been worn.  Don’t we dislike these concerns expressing themselves in reality? 

But - we don’t make the growth, and we are pleased to stress the concern at the diagnostic and retainer delivery stage.  The patient compliance may not work to advantage.  We hate that, of course.


Treatment during or throughout the original active phase, not just during what we call finishing may include:
    - Class III Correctors - Motion or D2 appliances
    - Chin Sling or Facemask wear
    - Posterior intrusion therapies
Communication of growth progress to the parent is critical, throughout treatment.  Keep them in the reality loop!

Patient Miss C may have difficulty attaining and maintaining adequate canine and/or posterior overbite.  How do you know?
  • Low and adverse tongue position
  • Narrow palate, result of low tongue and cheek muscles strong without tongue balance
  • possibly Class III tendency
Treatment during the active phase of orthodontics may include:
    - Tongue exercises
    - Blue Grass or other beads in palate
    - Castillo-Morales circle in palate
    - Crib on appliances
    - Expansion therapy

We could similarly lay out the signs of future TMJD, of lack of eruption of an ectopic tooth, adding 2-3 years to a treatment time, of the complete dependence on the patient’s compliance if the occlusion is to be corrected, and on and on…

So, before you even consider putting appliances into a patient’s mouth, consider the findings - all of them.  Do excellent diagnostics.  Get all the information - about medical, airway and breathing, dental, skeletal, growth and finally dental findings.  THEN put it together in a comprehensive treatment plan that you can share with the parent /patient, giving them the information they need to make good informed decisions about the treatment.

Then, pay the closest attention to your bracket placement. Bracket placement, though impossible to do perfectly, can make huge differences in finishing needs.

Keep everyone — parents, patient, your chart — in the loop. Be honest and open with the progress, OR LACK THEREOF. This will help you throughout the treatment. Your finishing will be more predictable, and could be a lot less surprising, a lot less difficult, and a lot less stressful for all.

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Patient "Mr B" (case discussion above), displaying zero overbite, zero overjet and excessive mandibular growth. © 2018 Dr Chris Baker
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Patient "Miss C" (see above for case discussion) displaying an adverse tongue position. © 2018 Dr Chris Baker

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What we want so desperately

2/19/2018

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1. We want to be able to trust people.  Put another way, we want people to make guarantees to us. — Instead, we can work on keeping our promises to ourselves

2. We want love and acceptance from others, so we feel valued and validated.  Instead,  practicing compassion / love for others makes us feel truly important - because then we are.  

3. We want to have the best of everything.  But - the happiest people don’t have the best of everything - they make the best of everything.  

4. We want to be happy.  But - we too often complain, judge others and wish it were different.  We call it “being realistic.” Instead,  just stop it and be happy.

Here’s a funny take on negativity from Bob Newhart.  Enjoy!
https://youtu.be/4BjKS1-vjPs


Claude and I send love,

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Are you trying 'just to survive'?   ...WOW is ever so much better!

2/16/2018

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​In the day to day push, pull,, challenges, service to many people, it’s easy to feel an overwhelming feeling of “just trying to survive.”

The day to day routines, the business drag, the difficult patient, unhappy staff members, worries over money - all are tough to survive.

What if your practice went from survival mode to WOW?

WOW! that patients come in and go out raving about being in your practice.  WOW that you have new patients referred by happy patients.  WOW that you and the team are having great fun in serving wonderful people.  WOW.  Just WOW.

How in the world do you get there??

A few steps to help:

First off, evaluate what you are trying to survive.  In dental practice it is often stressful practice days, worries about money, staff issues.    

Once you identify the difficulties, understand a mindset of peace and acceptance will help you get past and get to WOW!  Honestly, you may be battling yourself.  Worries are your own battle.  Your disappointments are another battle.  All the negative thoughts keep swirling around in your head, and multiply your worry thoughts.  It gets harder, not better.

“Life is too short to spend at war with yourself. The biggest disappointments in our lives are often the result of misplaced expectations. Letting go of needless expectations is your first step to happiness. Come from a mindset of peace and acceptance, and you can deal with almost anything and grow beyond it."     ~ marc and angel

What works for you?  Meditation?  Walking in the woods?  Anything that brings you peace is good.  There is a new product which changes your neural activity.  It's called Touchpoints.  Go to thetouchpointsolution.com. 

Touchpoints are tremendously helpful to a lot of people.  Touchpoints are used for autistic people, and it was discovered that they relieve stress by over 70% in people (both autistic and non-autistic) in as few as 30 seconds.  The neuroscience department at Harvard has looked at  how they create and change your neural pathways to, neutral to positive.  How about that when you are feeling stressed out  and negative??!!

Feel free to email me for more information - I am not affiliated in any way with the company; Claude and I just find them amazing - for stress, for sleep, for calm.  You’ve got to try various settings to get the one that works best for you.  Worth it!!

Secondly,  understand that life IS difficulties and problems.  They are part of this thing we call life, which is a school for our spirits to learn and grow.

Those who recognize problems as a human condition and don't measure happiness by an absence of problems are the most intelligent kind of humans we know; also, the most rare.     ~ Dr. Wayne Dyer

Now, you smart you,  you can start reminding yourself how smart you really, are.  Happiness, as Walt Whitman said, “not in another place but this place ...not for another hour, but this hour.”  This can be your purview.

I once heard someone say, when we think we are having no challenges at all, we might want to ask, “God, don’t you trust me?  I love this life.  Keep it coming!”

That’s life, as Frank Sinatra sang.  And it’s a good ‘un!

Oh yes, we’re going for WOW.  OK  how about,

Thirdly,

Focus on gratitude.

Think about your patients who love you - and there are those - YOU KNOW IT!.

Grateful that you and the team can have fun and find joy in serving wonderful people.

Grateful that you have a team.

One person can wow, but to wow continuously and consistently  - get the entire team onboard.

We take turns in the morning saying the word of the day.  Each team member gets a turn.  It’s usually a saying, or a word.

Some days since we’ve been working on WOW, the word has been - WOW!

1,2,3: Know what the stresses are - and change the thoughts to what the joy is!

Two, accept the crazy reality that life is challenge, will always be and is supposed to be.  See it as opportunity, fun, sure,  challenge, but there’s good.  Find it.  Find the peace in your life.

And three,  remember to find what you are grateful for.  Thank you for all that I HAVE had, all that i NOW have, and all that I SHALL have.  Thank you thank you.

WOW.  Just WOW.


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Why are all the songs about love?

2/13/2018

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My mother and I were listening to songs on the radio while she ironed clothes and I folded. I was 11 years old.  

I asked Mother, “Why are all the songs about love?”

Mother said, “Love is what makes our lives wonderful.”  

Our deepest needs hinge on being loved. 

All warm-blooded animals are born with an innate need to be touched and stroked affectionately. Human babies actually die from lack of touch.  Love is life.

In the nineteenth century, most institutionalized infants in the U.S. died of marasmus (severe malnutrition and wasting away, as if they knew no one loved them). 

Orphanages reported a majority of infants under the age of two had died due to failure to eat and thrive, related to the lack of touch and affection.

Affection and touch not only help babies thrive and live, but help develop lower levels of adult aggression and higher levels of adult happiness.

Love is what makes our lives wonderful.  

This week, see how many people you can tell, “I love you.”

Give hugs.  Share smiles. Share songs about love.

Celebrate Valentine’s Day -  a great celebration of love.

Love,

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Create the 'Wow Factor' in your dental practice

2/10/2018

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Creating "Wow" can be a big reason for your dental practice's success. Here's a video of a talk I gave this week during a meeting with staff and doctors at the Advanced American Dental Clinic in Abu Dhabi, UAE. 

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Finishing (How do I Get Out of This Pickle? Part II)

2/8/2018

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© 2018 Dr Chris Baker
The In-Treatment-Presenting Posterior Crossbite

Pickles can be sweet, tart, bitter, or sour.

“Dr.  Chris, when do I get my braces off?”

“Let’s look,” I say to the pretty teenage girl in the orthodontic chair.  She has worn her elastics well, kept her plaque under control, and wants to be finished with orthodontics.

Back to the beginning.  The way it works is, an awful lot of young patients today want braces.  Either their teeth and smile are not ‘Hollywood’ beautiful, OR all their friends have braces and they want them too.

No matter, the two questions asked by these young people are,
  1. “When can I get my braces?”, and
  2. “Do I get to pick colors?”​

Two Q’s with easy answers.  “As soon as you get your records done, give me a few days, your mom and I can conference - sit down and review what’s going on with your growth, bones and teeth, then as soon as it’s ok with your parents.”

And, “Yes.”

Not many months later, sometimes only 4 or 5, the Q is more difficult to answer:
“When do I get them off?”

I formulate the answer from two areas of information.  The first, I pick up the chart, and study the original treatment plan, with time estimate, goals, and steps of treatment planned, as well as look at the original or most recent pano.  The second, I give the assistant status notes.  She is charting the information, as to alignment and spacing, overbite, overjet, all teeth erupted and accounted for, canine relationship and molar relationship.

And this pretty, sweet teenage girl is waiting expectantly for my answer, hoping it is some version of  “Soon or very soon.”  (She can always hope, can’t she?)

On our treatment plan, the time estimate is on the same page as the parent’s signature.  That can help them, because the child or parent notices the signature and hopefully familiar page, when I say, “Our estimate was in February to May next year,” though the eager patient is disappointed, they handle the un-hoped-for answer better.

But - what if your estimated time is about now?  And what about if the patient is looking pretty darn good?  And what if, as you are calling off the status to the assistant, “alignment good, overbite 3, overjet 3, no spaces left, right molar and canine Class I, left molar” - UH OH!.    You notice a lingual cross bite of the left six year molars.

Your mind races. “Where did that come from?  She’s about done, she and her mother want the braces off, and we have a crossbite. In this case, perhaps the lower molar is kicked out buccally a bit….”  It’s a crossbite. Or, you have done Class II correction and distalized upper molars in reference to lowers, and the lower arch width is wider “back there”.   What to do??

What options are there?
Here are three for you:
  1. Cross elastics, from the lingual hook or cleat on the upper molar, to the buccal hook on the lower molar tube. Wear 24/7 and re-evaluate 2-3 weeks or more later.  This is a good option if the patient is compliant (she wants to get her braces off, so she just may be,) if tipping the molars a bit will be acceptable in alignment and occlusion, and IF the cross bite is basically just the molars.  It’s also when you have a labially positioned lower molar.
  2. NPE - Nitanium Palate Expander if the 4,5 or 7’s are also a bit edge to edge, cross bite or tendency, OR the upper 6 in cross bite needs a bit of rotation, the NPE can do that, along with some expansion, if you remove the arm of the expander.  Watch closely so that the rotation and expansion are not overdone.  See every 2-3 weeks.  (You are getting mostly tipping, as with all of these corrections, so if you truly need expansive movement, gotta think RPE.)
  3. If the crossbite entails several teeth in the quadrant, this is an option.  From our dear friend Dr. Larry White, turn a rectangular NiTi arch wire backward into the maxillary tubes.  The curve of the wire can expand (tip) the teeth - careful again - check in a month, then in another if needed.
Your patient is still waiting for your answer.  Do not rush your answer.  Get your information in order.  Evaluate everything and carefully.  Then, be brave (avoid approval-addiction).  Be straight-forward (tell it like it is).   Your patient and parent will cope.  They usually want it right.  (At least the parent usually does.)  Either way, you want it right -  so just say it.

Just sayin’.

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Images and text © 2018 Dr Chris Baker




Dr Chris Baker's book, "Your Child's Smile" (right) is an excellent guide for parents to help guide their children to optimal oral  health. 

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Shortcuts

2/5/2018

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"...when our focus stays constantly in the moment, our moments last longer and don't race away from us."  - Dr Chris Baker
On a road trip out west, we spent almost all of our drive time on two-lane roads - avoiding the interstate highways.

​We wanted to enjoy nature, find the little towns, breathe the fresh air, discover little ice cream stores and sleep already so refreshed that sleep was for dreaming as our bodies didn’t feel tired.  
​

No shortcuts.  Our son  Trey has been known to call that the“longcut.”  The Auto Club calls it the “scenic route,”  while the GPS says, “recalculating.”

Thinking of that beautiful three-week trip recently, it dawned on me that it is a great metaphor for life.  If we are living in the moment, with intention, being here now, we are on the scenic route.  

We enjoy beauty around us, connect with the people in the ‘little towns’ on our journey, breathe deeply, take time for an ice cream, and sleep so refreshed that sleep is full of beautiful dreams, a rest unlike any other.

We know when our focus stays constantly in the moment, our moments last longer and don’t race away from us.

Let’s take the scenic route!  

Let’s stay in the moment, savoring EACH one.

To ice cream!

Love,

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    Dr Chris Baker

    America's most-trusted teacher of orthodontic continuing education, Dr. Chris Baker has practiced and taught for more than 30 years, and is a current or former faculty member of three U.S. dental schools.  She is a pediatric dentist, author, blogger, dental practice consultant, and mentor.  Dr. Chris is also Past President and Senior Instructor of the American Orthodontic Society.  She is based in Texas, USA, but lectures around the world.

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